Neural mechanisms underlying cognitive inflexibility in obsessive-compulsive disorder: a review

Area of Science:

• Neuroscience
• Cognitive Psychology
• Psychiatry

Background:

• Cognitive inflexibility is a key feature of obsessive-compulsive disorder (OCD).
• It presents as a reduced ability to adapt behavior when circumstances change.
• Distinct cognitive processes may underlie superficially similar deficits in OCD.

Purpose of the Study:

• To investigate the neural basis of cognitive inflexibility in OCD across diverse tasks.
• To determine the extent to which different tasks engage shared versus unique neural dysfunctions.
• To elucidate the network-level brain abnormalities associated with cognitive inflexibility in OCD.

Main Methods:

• Examined neural correlates of OCD-related cognitive inflexibility using eight tasks.
• Tasks assessed set-shifting, feedback adaptation, interference control, response inhibition, working memory updating, and value-based flexibility.
• Analyzed cross-task convergence of brain abnormalities to identify shared and peripheral neural structures.

Main Results:

• Functional abnormalities in OCD were linked to a shared set of core brain structures (ACC, caudate, OFC, PFC) and less shared peripheral structures (putamen, thalamus, parietal cortex).
• The cortico-striato-thalamo-cortical network was central, with contributions from salience and default mode networks.
• Peripheral areas showed less consistent involvement but still contributed to OCD deficits.

Conclusions:

• Cognitive inflexibility in OCD stems from failures in interaction between multiple neural networks, rather than dysfunction within a single system.
• Shared core brain structures are implicated across various cognitive flexibility tasks in OCD.
• Understanding these network interactions is crucial for addressing cognitive deficits in OCD.