Moccia Lorenzo, Pettorruso Mauro, De Crescenzo Franco, De Risio Luisa, di Nuzzo Luigi, Martinotti Giovanni, Bifone Angelo, Janiri Luigi, Di Nicola Marco
Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario "A.Gemelli", Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario "A.Gemelli", Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy; Department of Physiology and Pharmacology "V. Erspamer", University of Rome Sapienza, Largo Francesco Vito 1, 00168 Rome, Italy.
Neurosci Biobehav Rev. 2017 Jul;78:104-116. doi: 10.1016/j.neubiorev.2017.04.025. Epub 2017 Apr 26.
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.
对参与赌博活动冲动的认知控制减弱是赌博障碍（GD）的核心特征。认知控制可细分为在GD临床现象学中起关键作用的几个认知子过程，如反应抑制、冲突监测、决策和认知灵活性。本文旨在系统综述功能磁共振成像（fMRI）研究，这些研究调查了GD中认知控制减弱的神经机制。我们进行了全面的文献检索，并收集了调查GD中认知控制的神经心理学和神经影像学数据。我们共纳入了14项研究，涉及499名个体。我们的结果表明，前额叶皮质活动受损可能是GD中认知控制减弱的原因，导致对赌博冲动的控制逐渐丧失。在前额叶区域中，眶额和腹内侧区域似乎是感觉整合、基于价值的决策和情感处理的一个可能节点，从而对认知控制的动机和情感方面都有贡献。最后，我们讨论了旨在恢复GD中认知控制的可能治疗方法，包括药物治疗和脑刺激治疗。
