Neural correlates of cognitive control in gambling disorder: a systematic review of fMRI studies (2017)

Neurosci Biobehav Rev. 2017 Apr 26;78:104-116. doi: 10.1016/j.neubiorev.2017.04.025.

Moccia L1, Pettorruso M1, De Crescenzo F1, De Risio L1, di Nuzzo L2, Martinotti G3, Bifone A4, Janiri L1, Di Nicola M5.


Decreased cognitive control over the urge to be involved in gambling activities is a core feature of Gambling Disorder (GD). Cognitive control can be differentiated into several cognitive sub-processes pivotal in GD clinical phenomenology, such as response inhibition, conflict monitoring, decision-making, and cognitive flexibility. This article aims to systematically review fMRI studies, which investigated the neural mechanisms underlying diminished cognitive control in GD. We conducted a comprehensive literature search and collected neuropsychological and neuroimaging data investigating cognitive control in GD. We included a total of 14 studies comprising 499 individuals. Our results indicate that impaired activity in prefrontal cortex may account for decreased cognitive control in GD, contributing to the progressive loss of control over gambling urges. Among prefrontal regions, orbital and ventromedial areas seem to be a possible nexus for sensory integration, value-based decision-making and emotional processing, thus contributing to both motivational and affective aspects of cognitive control. Finally, we discussed possible therapeutic approaches aimed at the restoration of cognitive control in GD, including pharmacological and brain stimulation treatments.


Affective processing; Cognitive flexibility; Conflict monitoring; Delay discounting; Impulsivity; Iowa Gambling Task; Orbitofrontal cortex; Pathological gambling; Prefrontal cortex; Response inhibition; Reversal learning; Transcranial magnetic stimulation; Value-based decision-making