Functional magnetic resonance imaging study of neuronal activation during cognitive tasks related to frontal lobe functions in patients with obsessive-compulsive disorder

Previous neurological studies and brain activation studies using functional magnetic resonance imaging (f-MRI) have suggested frontal lobe dysfunctions in patients with obsessive-compulsive disorder (OCD). However, no f-MRI study has used cognitive tasks reflecting fluency of ideas and memory related to frontal lobe functions. The purposes of this study are to assess the neuropsychological examinations and brain activities of OCD patients using f-MRI, as well as, to investigate the relationship between the severity of obsessive-compulsive symptoms and frontal lobe functions. The subjects were 22 right-handed persons consisting of 11 outpatients who had received a diagnosis of OCD based on diagnostic and statistical manual of mental disorders-fourth edition (DMS-IV) and age- and sex-matched 11 healthy controls. All subjects were examined using Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Wechsler Adult Intelligence Scale-3rd edition (WAIS-III), Wisconsin Card Sorting Test (WCST), Modified Stroop Test (MST), Verbal Fluency Test (VFT), Idea Fluency Test (IFT), and Rey-Auditory Verbal Learning Test (RAVLT). The brain activities were measured with f-MRI during three cognitive tasks; Task 1: idea generation (IFT), Task 2: word generation (VFT), and Task 3: remembrance of words (RAVLT). The block design was used in the trials, in which rest and activating tasks were alternated for five times in each task. The neuropsychological examinations revealed significant differences in the numbers of categories achieved and total errors in WCST, times of Part I in MST, scores of VFT and IFT, and the results of RAVLT between the OCD patients and healthy controls. Using functional brain imaging with f-MRI, noticeable activations were found in the superior, middle, inferior frontal gyri, and the cingulate gyrus during all tasks in both the OCD and control groups. The OCD patients had significantly higher activation in the cingulate gyrus than normal controls during Task 1 (IFT), but no significant difference was found during Task 2 (VFT). In addition, during Task 3 (RAVLT), the OCD patients showed a significantly decreased level of activation in the middle frontal gyrus. Finally, Y-BOCS scores assessing the syndrome severity were significantly associated with the results of neuropsychological examinations reflecting frontal lobe functions, showing positive correlations with the brain activities of the cingulate gyrus and negative correlations with the activations of the middle frontal gyrus. The degree of the obsessive-compulsive symptoms, frontal lobe dysfunctions, and biological abnormalities in the middle frontal gyrus and the cingulate gyrus were all associated with formation of the psychopathology of OCD. (author)