Relating neural processing of reward and loss prospect to risky decision-making in individuals with and without gambling disorder

Neuroimaging studies demonstrate alterations in fronto-striatal neurocircuitry in gambling disorder (GD) during anticipatory processing, which may influence decision-making impairments. However, to date little is known about fronto-striatal anticipatory processing and emotion-based decision-making. While undergoing neuroimaging, 28 GD and 28 healthy control (HC) participants performed the Monetary Incentive Delay Task (MIDT). Pearson correlation coefficients assessed out-of-scanner Iowa Gambling Task (IGT) performance with the neural activity during prospect (A1) processing on the MIDT across combined GD and HC groups. The HC and GD groups showed no significant difference in out-of-scanner IGT performance, although there was a trend for higher IGT scores in the HC group on the last two IGT trial blocks. Whole-brain correlations across combined HC and GD groups showed that MIDT BOLD signal in the ventral striatum/caudate/ventromedial prefrontal cortex and anterior cingulate regions during the prospect of winning positively correlated with total IGT scores. The GD group also contained a higher proportion of tobacco smokers, and correlations between neural activations in prospect on the MIDT may relate in part to gambling and/or smoking pathology. In this study, fronto-striatal activity during the prospect of reward and loss on the MIDT was related to decision-making on the IGT, with blunted activation linked to disadvantageous decision-making. The findings from this work are novel in linking brain activity during a prospect-of-reward phase with performance on a decision-making task in individuals with and without GD. Gambling disorder is a behavioural addiction characterized by persistent and recurrent betting that leads to clinically significant impairment or distress. In the present study, we aimed to study relationships between anticipatory processing of rewards and losses on the Monetary Incentive Delay Task (MIDT) and out-of-scanner measures of risk-reward decision-making on the Iowa Gambling Task (IGT). The current study focused on the anticipatory phases. The focus of the current manuscript is on the correlation of prospect-related processing activity on the MIDT with IGT performance. However, the notion that smoking status may influence neural processes relating to prospect formation and risky decision-making warrants further consideration and study. Nevertheless, it is notable that smoking status appears to contribute to the current findings, as the correlation between prospect-reward-related striatal activation and IGT scores was no longer significant once smokers were removed from analyses.