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Neurocognitive functions in pathological gambling: a comparison with alcohol dependence, Tourette syndrome and normal controls

Open access
Goudriaan, Anna E., Oosterlaan, Jaap, De Beurs, Edwin, Van Den Brink, Wim·2006·Addiction
DOI 10.1111/j.1360-0443.2006.01380.x
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Abstract

Aims Neurocognitive functions in pathological gambling have relevance for the aetiology and treatment of this disorder, yet are poorly understood. This study therefore investigated neurocognitive impairments of executive functions in a group of carefully screened Diagnostic and Statistical Manual version IV (DSM‐IV‐TR) pathological gamblers. Performance was compared to a group of normal control participants. To study the specificity of these neurocognitive deficits, a substance dependence group (alcohol dependence) and an impulse control disorder group (Tourette syndrome) were included. Design Cross‐sectional study. Setting Addiction and general mental health treatment centres. Participants Forty‐nine pathological gamblers, 48 abstinent alcohol‐dependent patients, 46 participants with Tourette syndrome and 49 normal control participants. Measurements A comprehensive neuropsychological battery measuring executive functions as well as basic cognitive functions. Findings Both the pathological gambling and the alcohol dependent groups were characterized by diminished performance on inhibition, time estimation, cognitive flexibility and planning tasks. The Tourette syndrome group showed deficits only on inhibition tasks. Basic cognitive functions were intact in all clinical groups. Comorbid attention deficit hyperactivity disorder, antisocial personality disorder and nicotine dependence influenced the impaired functions of the clinical groups only minimally. Conclusions Carefully screened groups of pathological gamblers and alcohol dependents were characterized by diminished executive functioning, suggesting a dysfunction of frontal lobe circuitry in these disorders. The resemblance between the pathological gambling group and the alcohol dependence group suggests a common neurocognitive aetiology for these disorders. Psychosocial treatment of these disorders could benefit from assessing and targeting deficits in executive functions, as they probably influence the course of these disorders negatively.

Integrity signals

Registry

Crossref · 10.1111/j.1360-0443.2006.01380.x

Cites

105 of 105 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 48 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Pathological gamblers, alcohol-dependent patients and Tourette syndrome patients had slower stop-signal reaction times than normal controls.

    “Pairwise group comparisons revealed slower SSRTs for the PG group, the AD group and the TS group compared to the NC group.”
    Quote in the paperSubstantial claim
  • Findingown data

    Pathological gamblers named fewer correct words on the fluency task than normal controls, alcohol-dependent patients and Tourette syndrome patients.

    “The PG group named fewer correct words than the NC group, the AD group and the TS group.”
    Quote in the paperSubstantial claim
  • Findingown data

    Alcohol-dependent patients made more perseverations on the fluency task than normal controls.

    “The AD group made more perseverations compared to the NC group.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Anxiety and depression scores did not correlate with performance on the executive function measures.

    “Furthermore, anxiety and depression scores did not correlate with performance on the EF measures (all correlations: r < 0.15).”
    Quote in the paperNot a substantial claim
  • Findingown data

    South Oaks Gambling Screen scores correlated strongly with anxiety and depression.

    “the SOGS scores correlated strongly with anxiety and depression (r = 0.42 and r = 0.43, respectively, P < 0.01)”
    Quote in the paperSubstantial claim
  • May combine two claims. 19
  • Classified as probably not a substantial claim. 17

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    Findingown data

    There were no group differences or group-by-time-length interactions on the time reproduction task.

    “On the Time Reproduction Task, no main effects of group or group by time length interactions were found.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Re-analysis excluding participants with ADHD and/or antisocial personality disorder left all omnibus tests and pairwise group comparisons the same, with two exceptions.

    “Data were re-analysed excluding participants with ADHD and/or antisocial personality disorder diagnoses.Results for all omnibus tests and pairwise group comparisons remained the same.However, two exceptions should be noted.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Compared with normal controls, pathological gamblers, alcohol-dependent patients and Tourette syndrome patients reported higher levels of ADHD symptoms, anxiety and depression.

    “Compared to the NC group, the PG group, the AD group and the TS group reported higher levels of ADHD symptoms (ADHD questionnaire), anxiety (STAI) and depression (BDI).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The severity of pathological gambling in this study was comparable to that reported in a study of pathological gamblers who did not seek treatment, because the South Oaks Gambling Screen scores were similar.

    “the severity of PG in our study was comparable to the severity of PG as reported in a study including pathological gamblers who did not seek treatment, as the SOGS scores in our study were similar to the SOGS scores reported in that study [90].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Eight participants were diagnosed with ADHD inattentive and/or hyperactive-impulsive subtype.

    “Eight participants were diagnosed with either ADHD inattentive subtype and/or ADHD hyperactive-impulsive subtype (see Table 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A broad range of executive function deficits was found in a carefully screened pathological gambling and alcohol dependence group, whereas only inhibition deficits were present in a Tourette syndrome group.

    “In conclusion, a broad range of EF deficits was found in a carefully screened PG and AD group, whereas in a TS group only inhibition deficits were present.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Tourette syndrome participants had a previous diagnosis by a psychiatrist or neurologist, and tic severity was assessed with the Dutch YGTSS.

    “All subjects who were included in the TS group were diagnosed previously with TS by a psychiatrist or neurologist.”
    • Also stated in: § Selection criteria and screening · plain
      “Severity of current and past verbal and motor tics was assessed with the Dutch version of the Yale Global Tic Severity Scale (YGTSS) [45].”
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    • cites [45] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several studies suggest that mild executive function dysfunctions mediate the enhanced risk for later development of substance and alcohol dependence in children with a familial risk for developing substance dependence.

    “Several studies suggest that mild dysfunctions in EFs mediate the enhanced risk for later development of substance and alcohol dependence in children with a familial risk for developing substance dependence [92][93][94].”
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    • cites [92][93][94]

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  • May combine two claims.

    Premisecitation

    Prior studies of executive functions in pathological gambling had methodological limitations including single executive function targets, small groups, failure to control comorbid disorders and medication, failure to test independence from basic cognitive functions, and lack of clinical comparison groups.

    “The most important reason for these inconsistencies concerns methodological limitations: some studies targeted only a single EF, most studies were restricted to small groups and studies often failed to assess and control for comorbid disorders and medication use.”
    • Also stated in: § INTRODUCTION · plain
      “In addition, most studies did not investigate whether deficits in EFs were independent of deficits in basic cognitive functions.”
    • Also stated in: § INTRODUCTION · plain
      “Finally, the specificity of EF deficits in PG is not known, because clinical comparison groups were not included in most of these studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

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  • May combine two claims.

    Premisecitation

    Research into executive functions in pathological gambling is scarce and its findings are inconsistent.

    “In contrast, research into EFs in PG is scarce, and findings are inconsistent (for a review see [26]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Exclusion criteria for all groups included substance abuse or dependence except alcohol in the AD group, major psychiatric disorders, current other mental disorder treatment, physical conditions affecting cognition or motor performance, psychotropic medication that could not be discontinued, non-Dutch first language, age outside 18-60, and positive urine screen for alcohol, cannabis or benzodiazep

    “Exclusion criteria for all groups were: (1) (a history of) substance abuse or dependence (section L of the Dutch CIDI)-except for alcohol abuse and dependence in the AD group; (2) (a history of) major psychiatric disorders such as schizophrenia, psychotic episodes or hospitalization for psychiatric disorders; (3) current treatment for mental disorders other than those under study in this”
    • Also stated in: § Selection criteria and screening · plain
      “(5) the use of psychotropic medication which could not be discontinued; (6) having another language than Dutch as first language; (7) age over 60 or under 18 years; (8) positive urine screen for alcohol, cannabis or benzodiazepines.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Executive functions depend on intact functioning of the prefrontal cortex and subcortico-cortical networks projecting to it.

    “EFs rely on an intact functioning of the prefrontal cortex and subcortico-cortical networks projecting to the prefrontal cortex, such as basal ganglia-thalamic and parietal networks [9][10][11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9][10][11]

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The results cannot be generalized to female or adolescent pathological gamblers.

    “The results can therefore not be generalized to female pathological gamblers, or to adolescent pathological gamblers.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Because few pathological gamblers with ADHD or antisocial personality disorder were included, it was not possible to investigate whether pathological gamblers with other comorbid disorders would have more serious executive function deficits.

    “Due to the low numbers of pathological gamblers with ADHD or ASP included in our study, it was not possible to investigate whether pathological gamblers with other comorbid disorders would have more serious EF deficits.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Brain structure and function abnormalities involved in executive functions are present in childhood-onset impulse control disorders.

    “and abnormalities in brain structures and functions involved in EFs are present [21,24,25].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [21] source

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    • cites [24] source

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    • cites [25] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The study was approved by the Amsterdam Medical Centre Local Ethical Committee, and all participants gave written informed consent.

    “This study was approved by the Amsterdam Medical Centre Local Ethical Committee and written informed consent was given by all participants before testing.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Pathological gambling participants were diagnosed according to DSM-IV-TR criteria using the Dutch DIS, and inclusion required at least five defining criteria currently or recently.

    “The PG participants were diagnosed according to DSM-IV-TR PG criteria, using the Dutch version of section T of the Diagnostic Interview Schedule (DIS) [40].”
    • Also stated in: § Selection criteria and screening · plain
      “In order to be included in the study as a pathological gambler, at least five of the defining criteria had to be present currently or recently, i.e. up to 4 weeks prior to the assessment.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40]

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Diminished neurocognitive functions have been proposed both as vulnerability factors for developing substance dependence and as consequences of extraneous drugs on brain functions.

    “Diminished neurocognitive functions are proposed both as vulnerability factors for developing substance dependence and as the result of extraneous drugs on brain functions [12,91].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [12] source

      Not checked in the free run.

    • cites [91] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    MANOVAs were performed at domain levels, and Bonferroni-corrected pairwise group comparisons were performed only when main effects or interactions were significant at P < 0.05.

    “MANOVAs were performed at the domain levels (inhibition, time estimation and reproduction, cognitive flexibility, working memory, planning and non-EF basic cognitive tasks).Pairwise Bonferroni corrected group comparisons (PG-NC, PG-AD, PG-TS, AD-NC and TS-NC) were performed only when main effects of group or group × factor interactions were significant at the P < 0.05 level.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Alcohol-dependent participants were diagnosed according to DSM-IV-TR criteria using the Dutch CIDI, and a minimum MMSE score of 25 was required.

    “AD participants were diagnosed according to DSM-IV-TR AD criteria with section J of the Dutch version of the Clinical International Diagnostic Inventory (CIDI [43]).”
    • Also stated in: § Selection criteria and screening · plain
      “A minimum Mini-Mental State Examination (MMSE) score of 25 was required in order to exclude AD patients with severe cognitive impairment, such as alcohol-related dementia [44].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [43]

      Not checked in the free run.

    • cites [44] source

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    Study design and conductown data

    Because the alcohol dependence group differed significantly in age from the other groups, age was entered as a covariate in all analyses.

    “Because the AD group differed significantly in terms of age from the other groups, age was entered as a covariate in all analyses.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    The findings of diminished cognitive flexibility in pathological gambling compared with normal controls are consistent with two studies and inconsistent with one study.

    “The findings of diminished cognitive flexibility functions in PG compared to normal controls in our study are consistent with findings of two studies in PG, one employing the WCST [73] and one using a Verbal Fluency Task [74], but are inconsistent with a study that reported no impairments on the WCST in a smaller PG group [80].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [73] source

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    • cites [74] source

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    • cites [80] source

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  • May combine two claims.

    Study design and conductown data

    The sample consisted of adults and was predominantly male among the pathological gamblers.

    “Our sample consisted of an adult sample of predominantly male pathological gamblers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Administration order affected only Digit Span Backwards performance, so it was entered as a covariate in the working memory analyses.

    “Adding administration order as a factor in the MANOVAs affected only performance on the Digit Span Backwards task ( P < 0.01).Administration order was therefore entered as a covariate in the working memory analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Missing or excluded data ranged from zero to five per group, resulting in zero to nine missing cases per analysis.

    “The number of excluded and missing data ranged from zero to five in each group, resulting in zero to nine missing cases for each analysis.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Deficits in executive functions have been proposed as important mediators in drug bingeing.

    “Deficits in EFs are proposed as important mediators in drug bingeing [15]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Treatment of pathological gambling and alcohol dependence may benefit from interventions targeting these executive function dysfunctions.

    “Treatment of PG and AD may benefit from interventions targeting these EF dysfunctions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The executive function deficits found in pathological gambling and alcohol dependence in this study may therefore foster the continuation of these disorders, limit the impact of psychosocial treatment and promote relapse after discontinuation of pathological gambling or alcohol dependence.

    “The EF deficits as found in PG as well as AD in this study may therefore foster the continuation of these disorders, limit the impact of psychosocial treatment and promote relapse after discontinuation of PG or AD.”
    Quote in the paperSubstantial claim
28 of 28

  • The paper relies on this without support.

    Several DSM-IV-TR criteria for pathological gambling resemble those of substance dependence, including loss of control, tolerance, withdrawal and negative consequences.

    “Several DSM-IV-TR criteria for PG resemble those of substance dependence, such as loss of control, tolerance, withdrawal and the experience of negative consequences due to the gambling-related behaviour”

  • The paper relies on this without support.

    Pathological gambling, substance dependence and impulse control disorders share behavioural deficits in self-regulation, manifested as an impaired ability to inhibit the urge for the desired behaviour or drug.

    “these disorders are all characterized by behavioural deficits in self-regulation, as manifested in an impaired ability to inhibit the urge for the desired behaviour or drug.”

  • The paper relies on this without support.

    Executive function deficits probably influence the course of pathological gambling and alcohol dependence negatively.

    “as they probably influence the course of these disorders negatively.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • SSRT is prolonged in chronic cocaine users, chronic methamphetamine users, and alcohol-dependent subjects compared with normal controls, suggesting a response-inhibition deficit.

    “SSRT is prolonged in chronic cocaine users [51], chronic methamphetamine users [52] and alcohol-dependent subjects [48], compared with normal control subjects, suggesting a response-inhibition deficit.”

    From Response inhibition in the stop-signal paradigm (2008) · cites this paper as [48]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Normal-control sample size differs between sections

    Minor

    The abstract reports 49 normal controls, but the final-sample description and Table 1 report 50.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 6

  1. Robins L., 1998, Diagnostic Interview Schedule for DSM‐IV
  2. World Health Organisation, 1997, Composite International Diagnostic Interview
  3. Van der Ploeg H. M., 1980, Validity of the Zelf‐Beoordelings‐Vragenlijst [Dutch version of the Spielberger State–Trait Anxiety Inventory], Nederlands Tijdschrift Voor de Psychologie En Haar Grensgebieden, 35, 243
  4. Hammes J. W., 1971, De Stroop Kleur–Woord Test Handleiding [the Stroop Colour–Word Test: Manual]
  5. Heaton R. K., 1981, A Manual for the Wisconsin Card Sorting Test
  6. Luteijn F., 1983, Handleiding Groninger Intelligentietest (GIT) [Manual Groningen Intelligence Test]

Cited by

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Related

Authors
Goudriaan, A. E., Oosterlaan, J., De Beurs, E., & Van Den Brink, W.
Affiliations
  • Amsterdam Institute for Addiction Research (NL)
  • Vrije Universiteit Amsterdam (NL)
Corresponding author
Goudriaan, Anna E.
ORCID
Venue
Addiction
Publisher
Wiley
Published
2006-03-09
Volume
101
Issue
4
Pages
534-547
ISSN
  • 0965-2140 (ISSN-L)
  • 1360-0443
DOI
10.1111/j.1360-0443.2006.01380.x
OpenAlex
W2123110589
Cited by
467
References
103
Citations by year
2026: 4 · 2025: 7 · 2024: 13 · 2023: 9 · 2022: 4 · 2021: 10 · 2020: 22 · 2019: 24 · 2018: 35 · 2017: 32 · 2016: 30 · 2015: 35 · 2014: 42 · 2013: 38 · 2012: 45
FWCI
20.64
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Addiction (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
  • ZonMw
  • Nederlandse Organisatie voor Wetenschappelijk Onderzoek (96040000-4)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
Keywords
gambling addiction, executive function, alcoholism, Tourette syndrome, inhibition, cognitive flexibility, planning, time estimation, frontal lobe dysfunction, impulsivity, comorbidities, attention deficit hyperactivity disorder, antisocial personality disorder, nicotine dependence, neuropsychological assessment
MeSH terms
Adult, Alcoholism, Cognition Disorders, Female, Gambling, Tourette Syndrome, Humans, Male, Middle Aged, Neuropsychological Tests, Psychiatric Status Rating Scales, Behavior, Addictive

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