Neural correlates of cognitive control in gambling disorder: a systematic review of fMRI studies

- Impaired cognitive control over gambling behaviors represents a core feature of Gambling Disorder.
- Cognitive control can be conceptualized as the result of different sub-processes (i.e. response inhibition, conflict monitoring, decision-making and cognitive flexibility).
- Impaired activity in prefrontal areas (i.e. DLPFC, ACC, OFC) may account for impaired cognitive control, contributing to GD clinical phenomenology.
- Among prefrontal areas, OFC has been hypothesized to modulate affective/motivational aspects of cognitive control.
- Pharmacological and brain stimulation treatments may be possible strategies targeting cognitive control in GD.

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.