Inverse Association Between Resting-State Putamen Activity and Iowa Gambling Task Performance in Patients With Obsessive-Compulsive Disorder and Control Subjects

<jats:sec><jats:title>Background</jats:title><jats:p>Symptoms of obsessive-compulsive disorder (OCD) have been conceptualized as manifestations of decision-making deficits. Patients with OCD exhibit impairment during the decision-making process, as assessed by the Iowa Gambling Task (IGT). This impairment is independent of clinical severity and disease progression. However, the association between the decision-making deficit and resting-state brain activity of patients with OCD has not been examined.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifty unmedicated patients with OCD and 55 matched control subjects completed IGT. Resting-state brain activity was examined using the fractional amplitude of low-frequency fluctuations (fALFFs). fALFF analysis focused on the slow-4 and 5 bands. Group comparisons were performed to determine the association between IGT performance and fALFFs.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There was a significant group difference in the association between the IGT total net score and slow-4 fALFFs in the left putamen (voxel height threshold of <jats:italic>p</jats:italic> &lt; 0.001; cluster size threshold of <jats:italic>p</jats:italic> &lt; 0.05; family wise error-corrected). Higher putamen slow-4 fALFFs were correlated with lower IGT scores for OCD patients (<jats:italic>r</jats:italic> = −0.485; <jats:italic>p</jats:italic> &lt; 0.0005) and higher IGT scores for control subjects (<jats:italic>r</jats:italic> = 0.402; <jats:italic>p</jats:italic> &lt; 0.005). There was no group difference in the association between the IGT total net score and slow-5 fALFFs.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>These findings in unmedicated patients demonstrate the importance of resting-state putamen activity for decision-making deficit associated with OCD, as measured by IGT. The inverse correlation may be explained by the hypersensitive response of the putamen in patients with OCD.</jats:p></jats:sec>