Department of Psychiatry, Academic Medical Center, Amsterdam Brain and Cognition Center, University of Amsterdam, The Netherlands.
Institute for Criminal Law and Criminology, Leiden University, The Netherlands.
Addict Biol. 2017 Nov;22(6):1590-1600. doi: 10.1111/adb.12447. Epub 2016 Sep 9.
Pathological gambling (PG) is a behavioral addiction characterized by an inability to stop gambling despite the negative consequences, which may be mediated by cognitive flexibility deficits. Indeed, impaired cognitive flexibility has previously been linked to PG and also to reduced integrity of white matter connections between the basal ganglia and the prefrontal cortex. It remains unclear, however, how white matter integrity problems relate to cognitive inflexibility seen in PG. We used a cognitive switch paradigm during functional magnetic resonance imaging in pathological gamblers (PGs; n = 26) and healthy controls (HCs; n = 26). Cognitive flexibility performance was measured behaviorally by accuracy and reaction time on the switch task, while brain activity was measured in terms of blood oxygen level-dependent responses. We also used diffusion tensor imaging on a subset of data (PGs = 21; HCs = 21) in combination with tract-based spatial statistics and probabilistic fiber tracking to assess white matter integrity between the basal ganglia and the dorsolateral prefrontal cortex. Although there were no significant group differences in either task performance, related neural activity or tract-based spatial statistics, PGs did show decreased white matter integrity between the left basal ganglia and prefrontal cortex. Our results complement and expand similar findings from a previous study in alcohol-dependent patients. Although we found no association between white matter integrity and task performance here, decreased white matter connections may contribute to a diminished ability to recruit prefrontal networks needed for regulating behavior in PG. Hence, our findings could resonate an underlying risk factor for PG, and we speculate that these findings may extend to addiction in general.
病理性赌博（PG）是一种行为成瘾，其特征是尽管存在负面后果，但仍无法停止赌博，这可能是由认知灵活性缺陷介导的。事实上，先前已经发现认知灵活性受损与 PG 以及基底神经节和前额叶皮层之间的白质连接完整性降低有关。然而，目前尚不清楚白质完整性问题与 PG 中所见的认知灵活性不足有何关系。我们在病理性赌博者（PG；n=26）和健康对照组（HC；n=26）中使用功能磁共振成像进行认知转换范式。认知灵活性表现通过切换任务的准确性和反应时间来进行行为测量，而大脑活动则通过血氧水平依赖反应来测量。我们还在数据的子集中（PG=21；HC=21）使用弥散张量成像，并结合基于束的空间统计学和概率纤维追踪来评估基底神经节和背外侧前额叶皮层之间的白质完整性。尽管在任务表现、相关神经活动或基于束的空间统计学方面，两组之间没有显著差异，但 PG 确实显示左基底神经节和前额叶皮层之间的白质完整性降低。我们的结果补充并扩展了以前在酒精依赖患者中的类似研究发现。尽管我们在这里没有发现白质完整性与任务表现之间存在关联，但白质连接减少可能会导致 PG 患者调节行为所需的前额叶网络的招募能力下降。因此，我们的研究结果可能反映了 PG 的一个潜在风险因素，我们推测这些发现可能适用于一般成瘾。
