Neuropsychological profiles of patients with obsessive-compulsive disorder: Early onset versus late onset
In this study, we assess the neuropsychological profiles of both early and late symptom-onset obsessive-compulsive disorder (OCD) patients. The early and late-onset OCD patients are compared to the control group with a series of neuropsychological measurements. The late-onset OCD patients exhibited impaired performance on the immediate and the delayed recall conditions of the Rey-Osterrieth Complex Figure Test (RCFT) and the letter and category fluency of the Controlled Oral Word Association Test (COWA), compared to the normal controls and the early-onset OCD patients. The controls and early-onset OCD patients did not differ on any of the neuropsychological measurements taken in this study. These results suggest that different neurophysiological mechanisms are in play in early and late-onset OCD patients, and age of onset can serve as a potential marker for the subtyping of OCD.
Available from: Tae Young Lee
- "However, findings of cognitive dysfunction in OCD have not been consistent across studies (Kuelz et al. 2004; Chamberlain et al. 2005). Discrepant findings may be attributable to confounding factors including sex (Savage et al. 2000; Deckersbach et al. 2004), duration of illness (Nakao et al. 2009), medication status (Nakao et al. 2009; Segalas et al. 2010), comorbidity (Aycicegi et al. 2003), age at onset of illness (Henin et al. 2001; Roth et al. 2005; Hwang et al. 2007), insight (Tumkaya et al. 2009), family history (Boone et al. 1991) and symptom-based subtype (Ceschi et al. 2003; Cha et al. 2008; Nedeljkovic et al. 2009). However, data on the impact of these confounding factors on cognitive functioning have been conflicting. "
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ABSTRACT: Substantial empirical evidence has indicated impairment in the cognitive functioning of patients with obsessive-compulsive disorder (OCD) despite inconsistencies. Although several confounding factors have been investigated to explain the conflicting results, the findings remain mixed. This study aimed to investigate cognitive dysfunction in patients with OCD using a meta-analytic approach. Method The PubMed database was searched between 1980 and October 2012, and reference lists of review papers were examined. A total of 221 studies were identified, of which 88 studies met inclusion criteria. Neuropsychological performance and demographic and clinical variables were extracted from each study.
Patients with OCD were significantly impaired in tasks that measured visuospatial memory, executive function, verbal memory and verbal fluency, whereas auditory attention was preserved in these individuals. The largest effect size was found in the ability to recall complex visual stimuli. Overall effect estimates were in the small to medium ranges for executive function, verbal memory and verbal fluency. The effects of potentially confounding factors including educational level, symptom severity, medication status and co-morbid disorders were not significant.
Patients with OCD appear to have wide-ranging cognitive deficits, although their impairment is not so large in general. The different test forms and methods of testing may have influenced the performance of patients with OCD, indicating the need to select carefully the test forms and methods of testing used in future research. The effects of various confounding variables on cognitive functioning need to be investigated further and to be controlled before a definite conclusion can be made.
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ABSTRACT: An experimental study has been performed under microgravity conditions to obtain the detailed information needed to understand the combustion phenomena of a fuel droplet which autoignites in supercritical gaseous environment. A fuel droplet suspended at the tip of a fine quartz fiber in the cold section of the high-pressure combustion chamber was transferred quickly to be subjected to a hot gas in an electric furnace. This resulted in the evaporation, autoignition, and combustion of the fuel droplet in a supercritical gaseous environment. A high-speed video camera was provided to observe the behavior of the fuel droplet and the droplet flame. In the present study, primary attention was focused on the ignition delay and the flame diameter at the initial stage of droplet burning. 1-Octadecanol and n-octadecane were selected as the test fuels. Mixtures of oxygen and carbon dioxide and of oxygen and nitrogen were used as the ambient gas. The ambient pressure was extended up to pressures around two times the critical pressure of the fuels tested. The ignition delay was found to have a minimum around the ambient pressure equal to the critical pressure of the fuel, and a maximum in the range from 1.5 to 2 times the critical pressure. Higher oxygen concentration of the ambient gas caused shorter ignition delay at ambient pressures equal to or above 1.5 times the critical pressure. Higher ambient pressure caused a smaller droplet flame at the onset of autoignition and higher flame growth rate and a larger flame diameter afterward. The flame diameter decreased with an increase in the oxygen concentration of the ambient gas.
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ABSTRACT: The past decade has seen an explosion in the number of medically refractory conditions and neuroanatomical structures targeted
for DBS treatment. While a review of the literature and meta-analyses indicate DBS for movement disorders to be safe from
a neurobehavioral standpoint it is also clear that a small subset of patients have experienced moderate or severe neurobehavioral
morbidity. If one combines the various cognitive and psychiatric morbidities reported across studies, approximately 10% of
patients with PD undergoing DBS have experienced one or another neurobehavioral adverse events. Furthermore, several small
studies have indicated that improvements in motor symptoms and quality of life (QOL) may not necessarily translate into social
readjustment. A greater role for ancillary health services, such as speech therapy, occupational and physical therapy, neuropsychology,
and psychotherapy needs to be contemplated. Health care providers should not rely on subjective impression or spontaneous
patient report to identify neurobehavioral and psychosocial issues. Recent consensus statements on patient selection, treatment,
and outcome evaluation should facilitate greater uniformity in outcome reporting and identification of neurobehavioral risk.
What has proved elusive is the identification of reliable predictors and risk factors for such neurobehavioral changes. Ethical
concerns and methodological limitations hinder the initiation of more sophisticated, controlled, blinded, comparative trials
with large numbers of subjects needed to isolate predictors of neurobehavioral and QOL outcomes. Similarly, it is difficult
to conclude at present that stimulation alone is associated with neurobehavioral morbidity, though in some cases, there are
replicable effects on mood and cognition when stimulation is turned on and off. In the case of PD, and likely many of the
disorders for which DBS is beginning to be investigated, outcomes may be related to an interaction of the surgical procedure
and stimulation as well as subsequent changes in medications, psychosocial factors and pre-operative vulnerability. Conclusions
that DBS is neuropsychologically safe in conditions such as dystonia, depression, obsessive compulsive diorder (OCD), Tourette
syndrome (TS), epilepsy, multiple sclerosis (MS) and others must be considered highly preliminary until adequate controlled
trials are completed. The emergence of cognitive and social neuroscience studies of DBS, particularly when accompanied by
functional neuroimaging, are encouraging signs that DBS may be used as a vehicle to better understand the cognitive and behavioral
roles of the basal ganglia.
Keywordsneuropsychology–cognition mood–quality of life–deep brain stimulation–Parkinson's disease–tremor–dystonia–epilepsy
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