Cognitive Inflexibility in Gamblers is Primarily Present in Reward-Related Decision Making

Abstract

One hallmark of gambling disorder (GD) is the observation that gamblers have problems stopping their gambling behavior once it is initiated. On a neuropsychological level, it has been hypothesized that this is the result of a cognitive inflexibility. The present study investigated cognitive inflexibility in patients with GD using a task involving cognitive inflexibility with a reward element (i.e., reversal learning) and a task measuring general cognitive inflexibility without such a component (i.e., response perseveration). For this purpose, scores of a reward-based reversal learning task (probabilistic reversal learning task) and the Wisconsin card sorting task were compared between a group of treatment seeking patients with GD and a gender and age matched control group. The results show that pathological gamblers have impaired performance on the neurocognitive task measuring reward-based cognitive inflexibility. However, no difference between the groups is observed regarding non-reward-based cognitive inflexibility. This suggests that cognitive inflexibility in GD is the result of an aberrant reward-based learning, and not based on a more general problem with cognitive flexibility. The pattern of observed problems is suggestive of a dysfunction of the orbitofrontal cortex, the ventrolateral prefrontal cortex, and the ventral regions of the striatum in gamblers. Relevance for the neurocognition of problematic gambling is discussed.

Executive Functioning in Gambling Disorder: Cognitive Profiles and Associations with Clinical Outcomes

“…With regard to response inhibition, novel studies broadly accord with earlier reports [9] showing increased stop-signal inhibition errors in GD individuals compared to healthy controls and also compared to problem gamblers not meeting criteria for GD [19••]; however, others have failed to find differences on a GoStop impulsivity paradigm [16]. In terms of flexibility, individuals with GD do not exhibit perseverative errors on the Wisconsin Card Sorting Test compared to healthy controls [20,21]. In fact, Boog et al [21] contrasted performance of GD and healthy controls in two tests tapping on different aspects of flexibility: switching an arbitrary rule (Wisconsin Card Sorting Test) versus switching previously rewarded choices (Probabilistic Reversal Learning Task).…”

“…In terms of flexibility, individuals with GD do not exhibit perseverative errors on the Wisconsin Card Sorting Test compared to healthy controls [20,21]. In fact, Boog et al [21] contrasted performance of GD and healthy controls in two tests tapping on different aspects of flexibility: switching an arbitrary rule (Wisconsin Card Sorting Test) versus switching previously rewarded choices (Probabilistic Reversal Learning Task). Controls were found to only outperform GD individuals in the reward-based Probabilistic Reversal Learning Task, thus suggesting a motivational contribution to poor flexibility in GD, rather than a general cognitive inflexibility problem.…”

“…With regard to executive functions, deficits in response inhibition and response switching after reversal of reward schedule are comparable in GD and substance use disorders (SUD) [14••, 33], although there is evidence of negative correlations between switching performance and general estimates of psychological problems or symptoms of psychopathology symptoms on the Derogatis' symptom checklistin GD [21]. With regard to decision-making, studies have consistently showed that deficits in value-based decisionmaking are similar in individuals with GD alone and individuals with GD and SUD comorbidities [18,34,35].…”

A biopsychological review of gambling disorder

“…Some of the neuropsychological dysfunctions found in pathological gamblers are marked impulsivity,13–17 cognitive rigidity,13,14,18 deficit in reaction suppression,14 imprecise response,19 disruption of inhibition process,13 slower time evaluation,13,14 disruption organizing tasks,13,20 impaired decisions (risky21 or choosing),17 deficits assessing future results,22 memory impairments,10 concentration impairments,10 impaired executive performance,10 marked novelty searching,17 marked harm prevention,17 lack of cooperation,17 poor self-directedness,17 deficits in problem-solving (finding new procedures),23 and poor efficacy 23…”

Mapping brain volumetric abnormalities in never-treated pathological gamblers

“…Previous studies have associated PG with poorer performance on neuropsychological tests involving decision-making, cognitive control and flexibility (Goudriaan et al, 2005;Fuentes et al, 2006;Odlaug et al, 2011;Grant et al, 2012;Goudriaan et al, 2014), indicating an impairment of reward processing and a potential abnormality of related brain structures such as the prefrontal cortex and ventral striatum (Boog et al, 2014).…”