| Objective:Obsessive-compulsive disorder(OCD)is a refractory mental disorder characterized by obsessive-compulsive thinking and behavior,often accompanied by anxiety and depression,which seriously affects the social function and quality of life of patients.Group Cognitive Behavior Therapy(GCBT)has been increasingly used in the treatment of obsessive-compulsive disorder because of its high efficiency,economy and interaction among group members.The changes of network topological attributes in OCD patients with group cognitive behavioral therapy are not clear,and the changes of functional connectivity of cognitive function related networks(default mode network,dorsal attention network,fronto-parietal network and salience network)are also not clear.In this study,resting functional magnetic resonance imaging data and neuropsychological assessment data were collected to explore the changes of brain network before and after group cognitive behavior treatment,and to conduct correlation analysis with neuropsychological assessment,so as to provide theoretical basis for clinical applicationMethods:The samples were from Shanghai Mental Health Center outpatient.33 OCD patients who had never taken drugs or had not taken drugs for more than 8 weeks were into the study and 26 healthy controls were recruited from the society.After obtaining informed consent,we collected the general demographic data,cognitive neurological assessment and magnetic resonance data.The patients with obsessive-compulsive disorder entered group cognitive behavioral therapy for 12 weeks.The patients were followed up with clinical scales for 2 week,4 week,6 week,8 week and 12 week respectively.At the end of 12 week,cognitive neurological assessment and magnetic resonance data were collected again.We compare the general demographic data of the two groups by using two sample t-test.Based on the platform of MATLAB 2012a,GRETNA software is used to analyze the brain network topology and small world attribute values of the baseline obsessive-compulsive disorder group and the healthy control group,and the brain network topology and small world attribute values of the obsessive-compulsive disorder group before and after GCBT.Then the obsessive-compulsive disorder group is grouped according to the Y-BOCS reduction rate of 30%(the effective group vs ineffective group),the brain network topology and small world attributes were compared between baseline and after GCBT.Then the general demographic data of obsessive-compulsive disorder group before and after GCBT were compared by two-sample t-test.The default mode network,dorsal attention network,fronto-parietal network and salience network seeds were selected according to previous literature to compare the intra-network and inter-network functional connectivity before and after GCBT.The neuropsychological assessment of obsessive-compulsive disorder group vs healthy control group and before and after GCBT were compared by two-sample t-test.Pearson correlation analysis was applied between the functional connectivity of cognitive network and neuropsychological assessment.Results:A total of 33 patients with obsessive-compulsive disorder and 26 healthy controls were enrolled in the study.There were no significant differences in gender,age and years of education between the two groups.There were significant differences in baseline HAMD and HAMA between the two groups.The small world attributes of all subjects at each threshold were>1,suggesting that the small world attributes of all subjects' brain networks were not destroyed;there was statistical significance between the two groups of a;and there was significant difference between the two groups of Eglob,Cp and y(p<0.05).Compared with HC,the clustering coefficients of OCD in 38 brain regions increased significantly,mainly in the frontal lobe,cingulate gyrus,occipital lobe and parietal lobe,as well as temporal lobe,talus fissure,cuneiform lobe,lingual gyrus and putamen.The average shortest path length was prolonged in 13 brain regions,mainly in parahippocampal gyrus,caudate nucleus,putamen,globus pallidus and thalamus,as well as amygdala and supramarginal gyrus.The average shortest path length decreased in 13 brain regions,mainly in cingulate gyrus,cuneiform lobe,anterior occipital gyrus and lingual gyrus.Compared with HC,the global efficiency of OCD was decreased in 35 brain regions,mainly located in frontal lobe,insula,olfactory cortex,posterior cingulate gyrus,hippocampus,amygdala,superior marginal gyrus,caudate nucleus,putamen,globus pallidus and middle temporal gyrus,and ganglia,posterior central gyrus and parahippocampal gyrus.OCD had 8 brain regions with posterior central gyrus and parahippocampal gyrus.At the end of 12 weeks,3 patients dropped out,10 patients were ineffective(33.3%)and 20 patients were effective(66.7%)in OCD group.Clustering coefficients of left posterior cingulate gyrus,left posterior central gyrus and left paracentral lobule decreased;the shortest path length of bilateral cingulate gyrus decreased and global efficiency increased;clustering coefficients and shortest path length decreased in default network,limbic system and classical CSTC loop,and global efficiency and local efficiency increased in the effective group compared with the ineffective groupThere was significant difference in Y-BOCS,HAMD and HAMA scores.DMN and DAN have changed after GCBT,showing significant decrease in functional connectivity within DMN and DAN networks,while functional connectivity between DMN-DAN,DMN-FPN,DMN-SAN and DAN-SAN has decreased.There were significant statistical differences between OCD and healthy control groups in general cognitive function assessment,complex figure recall score and organizational score,short and long delayed recall in auditory vocabulary test,SDMT correct number,PASAT correct number,STT-B,Hanoi test and speech fluency test.After 12 weeks GCBT,results of neuropsychological assessment applying two-sample t-test showed that:Rey-O imitation time,Rey-O recall score,Rey-0 recall score,AVLT-N1-N6,STT-A,CSC,and Hanoi Tower's four disc steps and time-consuming were significantPearson correlation analysis of neuropsychological assessment data and cognitive network change functional connectivity after GCBT indicated that:reduced functional connectivity in DMN was negatively correlated with Rey-0 recall score,SDMT correct number,CST-C-total score;positively correlated with STT-A test time-consuming and Hannot test time-consuming;positively correlated with DAN and STT-A test time-consuming;negatively correlated with DMN-DAN and Rey-0 imitation time and Hannot time-consuming;Imitation time was negatively correlated with STT-A test time;DMN-FPN was negatively correlated with AVLT-N1 and N4 scores?Conclusions:1.GCBT change the Clustering coefficient and shortest path length of cingulate gyrus changed after GCBT.There were differences in topological attributes of default network,limbic system and CSTC loops between effective group and ineffective group.GCBT change the abnormal functional connectivity intra and inter default network,dorsal attention network,fronto-parietal network and salience network2.Decreased functional connectivity of default network and dorsal attention network is associated with attention,memory and executive function in patients with obsessive-compulsive disorder. |
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