Executive functions in obsessive–compulsive disorder: An activation likelihood estimate meta-analysis of fMRI studies

Abstract

Objectives: To identify activation changes assessed in functional magnetic resonance imaging (fMRI) studies of obsessive–compulsive disorder (OCD) through Activation Likelihood Estimate meta-analysis. Methods: We included 28 peer-reviewed standard stereotactic space studies assessing adult OCD patients (OCDpts) vs. healthy controls (HCs) with fMRI during executive task performance. Results: In within-group analyses, HCs showed task-related activations in bilateral inferior frontal gyri, right middle frontal gyrus, right inferior parietal lobule, right claustrum, bilateral cingulate gyri, and left caudate body. OCDpts showed task-related left-sided activations in the superior, medial, and inferior frontal gyri, and thalamus, and bilateral activations in the middle frontal gyri, inferior parietal lobule, and insular cortices. Subtraction analysis showed increased left middle frontal gyrus activation in OCDpts. In between-groups analyses, OCDpts hypoactivated the right caudate body, left putamen, left ACC, and right medial and middle frontal gyri. Right caudate hypoactivation persisted also after applying Family‐wise error algorithms. Conclusions: This meta-analysis confirms that during executive functioning OCDpts show a functional deficit of the right caudate body, which could represent a major neural functional correlate of their illness.

Keywords:

• Obsessive–compulsive disorder
• fMRI
• caudate
• dorso-lateral prefrontal cortex
• thalamus

Acknowledgements

We gratefully acknowledge Prof. Thomas Straube, Prof. Orhan Murat Koçak, and Prof. Kathrin Koch for providing us with additional stereotactic coordinates from their fMRI studies. We also gratefully acknowledge Prof. Peter Falkai and Prof. Oliver Gruber for providing us with additional data from their study. Furthermore, we greatly acknowledge the contribution of the Librarians of the School of Medicine and Psychology of Sapienza University, Ms. Mimma Ariano, Ms. Felicia Proietti, Ms Ales Casciaro, Ms Teresa Prioreschi, Ms Susanna Rospo, and the late Tiziana Mattei, Librarians of the Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Rome, for rendering precious bibliographical material accessible, as well as their Secretary Lucilla Martinelli for her assistance during the writing of the manuscript.

Statement of interest

In the past 2 years, S.F. participated in advisory boards for Pfizer and Lilly and received honoraria from Lilly, Bristol-Myers Squibb, Sigma Tau, Schering and Pfizer; P.G. has received research support from Lilly and Janssen, and has participated in Advisory Boards for Lilly, Otsuka, Pfizer, and Schering and received honoraria from Lilly; R.B. has participated in Advisory Boards for Lilly, Otsuka, Pfizer, and Angelini. However, support received by any author did not interfere in any form or way in the writing of this manuscript and in the views supported.

All other authors of this paper have no relevant affiliations or financial involvement with any organisation or entity with a financial interest in, or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.