Department of Psychiatry, University of Cambridge, Cambridge, CB2 0QQ, UK.
Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.
Neuropsychopharmacology. 2019 Jul;44(8):1354-1361. doi: 10.1038/s41386-019-0393-9. Epub 2019 Apr 16.
Gambling Disorder is a prevalent psychiatric condition often linked to dysfunction of cognitive domains regulating impulsive behavior. Despite the centrality of impulsivity to neurobiological models of Gambling Disorder, a comprehensive meta-analysis of all impulsive cognitive domains has yet to be conducted. It is also not clear whether cognitive deficits in Gambling Disorder extend to those with problem (at-risk) gambling. A systematic review was undertaken of case-control studies examining the following cognitive domains in Gambling Disorder or in at-risk (problem) gambling: attentional inhibition, motor inhibition, discounting, decision-making, and reflection impulsivity. Case-control differences in cognition were identified using meta-analysis (random-effects modeling). Moderation analysis explored potential influences of age, gender, presence/absence of comorbidities in cases, geographical region, and study quality on cognitive performance. Gambling Disorder was associated with significant impairments in motor (g = 0.39-0.48) and attentional (g = 0.55) inhibition, discounting (g = 0.66), and decision-making (g = 0.63) tasks. For problem gambling, only decision-making had sufficient data for meta-analysis, yielding significant impairment versus controls (g = 0.66); however, study quality was relatively low. Insufficient data were available for meta-analysis of reflection impulsivity. There was evidence for significant publication bias only for the discounting domain, after an outlier study was excluded. Study quality overall was reasonable (mean score 71.9% of maximum), but most studies (~85%) did not screen for comorbid impulse control and related disorders. This meta-analysis indicates heightened impulsivity across a range of cognitive domains in Gambling Disorder. Decision-making impulsivity may extend to problem (at-risk) gambling, but further studies are needed to confirm such candidate cognitive vulnerability markers.
赌博障碍是一种普遍的精神疾病，通常与调节冲动行为的认知领域功能障碍有关。尽管冲动性是赌博障碍神经生物学模型的核心，但尚未对所有冲动认知领域进行全面的荟萃分析。目前也不清楚赌博障碍的认知缺陷是否会扩展到那些有问题（高危）赌博的人。本文对考察赌博障碍或高危（问题）赌博个体以下认知领域的病例对照研究进行了系统回顾：注意抑制、运动抑制、折扣、决策和冲动反射。使用荟萃分析（随机效应模型）确定认知差异的病例对照。调节分析探讨了年龄、性别、病例中合并症的存在/缺失、地理位置和研究质量对认知表现的潜在影响。与对照组相比，赌博障碍个体在运动（g=0.39-0.48）和注意（g=0.55）抑制、折扣（g=0.66）和决策（g=0.63）任务中表现出显著的认知损伤。对于问题赌博，只有决策任务有足够的数据进行荟萃分析，与对照组相比存在显著损伤（g=0.66）；然而，研究质量相对较低。由于缺乏数据，无法对反射性冲动进行荟萃分析。仅在排除一个异常值研究后，折扣领域才有证据表明存在显著的出版偏倚。总体而言，研究质量是合理的（最高分为 71.9%），但大多数研究（约 85%）没有筛查合并的冲动控制和相关障碍。这项荟萃分析表明，赌博障碍在一系列认知领域都存在冲动性增强。决策冲动性可能扩展到问题（高危）赌博，但需要进一步的研究来证实这些潜在的认知脆弱性标志物。
