Cognitive functioning in compulsive hoarding

Department of Psychiatry and Behavior Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe St., Baltimore, MD 21287, USA.
Journal of anxiety disorders (Impact Factor: 2.68). 08/2011; 25(8):1139-44. DOI: 10.1016/j.janxdis.2011.08.005
Source: PubMed


The aim of this study is to determine whether neurocognitive performance distinguishes individuals with compulsive hoarding (CH) from those with obsessive-compulsive disorder (OCD). Compared to control subjects, OCD patients and CHs scored significantly worse on the Serial Reaction Time Task suggesting disturbed implicit memory in both patient groups. On the Iowa Gambling Task, an overall learning progression difference over time was found between the CHs, OCD group, and control subjects, suggesting differences in decision-making between the groups. The groups did not differ in performance on the Stop Signal Reaction Time Task (motor inhibition). This study found evidence for impaired implicit memory in CHs, but also in OCD patients, albeit less severe. There was evidence that OCD patients learned more slowly on a decision-making task than CHs and control subjects. This latter finding provides some evidence to suggest that CH and OCD have, at least on this one measure, differing cognitive substrates.

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Available from: Rianne M Blom
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    • "A recent account points to shared neuropsychological and neurobiological impairments between HD and ADHD (Lynch, McGillivray, Molding, & Byrne, 2015). Neuropsychological findings in HD have been mixed, but several studies have linked HD to impairments in visuospatial memory (Blom et al., 2011; Hartl et al., 2004; Testa, Pantellis, & Fontenelle, 2011) and sustained attention (Grisham, Brown, Savage, Steketee, & Barlow, 2007; Tolin, Villavicencio , Umbach, & Kurtz, 2011; see Woody, Kellman-McFarlane, & Welsted, 2014 for a review). Similarly, adult ADHD is characterized by impairments in memory and sustained attention, among other "
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    ABSTRACT: Hoarding disorder (HD) is characterized by excessive saving and difficulty discarding possessions, which results in severe clutter and functional impairment. HD shows patterns of elevated comorbidity with the inattentive subtype of attention deficit-hyperactivity disorder (ADHD-I). ADHD-I symptoms are associated with more severe HD pathology (Tolin, Villavicencio, Umbach, & Kurtz, 2011), but the mechanisms underlying this association are unclear. The present study used serial mediation analyses in a sample of individuals with HD (n=32) and healthy controls (n=26) to test one potential pathway: ADHD-I symptoms lead to poor memory confidence, which leads to excessive saving of possessions to facilitate remembering, which in turn leads to clutter and corresponding functional impairment. The model provided a strong fit for the data, accounting for over 90% of the variance in functional impairment. Alternate models that did not include ADHD-I symptoms and poor memory confidence provided a weaker fit. These findings support and extend leading cognitive-behavioral conceptualizations of HD (e.g., Frost & Hartl, 1996) and point to inattention symptoms and memory confidence as potential targets for HD prevention and intervention research.
    Full-text · Article · Oct 2015 · Journal of Obsessive-Compulsive and Related Disorders
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    • "Worse performance in spatial planning using similar tasks has been previously reported in mixed groups of OCD patients (Veale et al., 1996; Purcell et al., 1998; Watkins et al., 2005) and in hoarders (Grisham et al., 2010). Similar inhibitory difficulties were reported in non-hoarding OCD (Chamberlain et al., 2006), although a recent study failed to find SSRT difficulties in a group of non-hoarding OCD and a group of hoarders where just over half had OCD (Blom et al., 2011). Current results lend converging validity for difficulties in these two domains across both OCD hoarders and those with hoarding disorder. "
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    ABSTRACT: Hoarding disorder is a new mental disorder in DSM-5. It is classified alongside OCD and other presumably related disorders in the Obsessive-Compulsive and Related Disorders chapter. We examined cognitive performance in two distinct groups comprising individuals with both OCD and severe hoarding, and individuals with hoarding disorder without comorbid OCD. Participants completed executive function tasks assessing inhibitory control, cognitive flexibility, spatial planning, probabilistic learning and reversal and decision making. Compared to a matched healthy control group, OCD hoarders showed significantly worse performance on measures of response inhibition, set shifting, spatial planning, probabilistic learning and reversal, with intact decision making. Despite having a strikingly different clinical presentation, individuals with only hoarding disorder did not differ significantly from OCD hoarders on any cognitive measure suggesting the two hoarding groups have a similar pattern of cognitive difficulties. Tests of cognitive flexibility were least similar across the groups, but differences were small and potentially reflected subtle variation in underlying brain pathology together with psychometric limitations. These results highlight both commonalities and potential differences between OCD and hoarding disorder, and together with other lines of evidence, support the inclusion of the new disorder within the new Obsessive-Compulsive and Related Disorders chapter in DSM-5.
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