Abstract

Pathological gambling (PG) shares clinical characteristics with substance-use disorders and is thus discussed as a behavioral addiction. Recent neuroimaging studies on PG report functional changes in prefrontal structures and the mesolimbic reward system. While an imbalance between these structures has been related to addictive behavior, whether their dysfunction in PG is reflected in the interaction between them remains unclear. We addressed this question using functional connectivity resting-state fMRI in male subjects with PG and controls. Seed-based functional connectivity was computed using two regions-of-interest, based on the results of a previous voxel-based morphometry study, located in the prefrontal cortex and the mesolimbic reward system (right middle frontal gyrus and right ventral striatum). PG patients demonstrated increased connectivity from the right middle frontal gyrus to the right striatum as compared to controls, which was also positively correlated with nonplanning aspect of impulsiveness, smoking and craving scores in the PG group. Moreover, PG patients demonstrated decreased connectivity from the right middle frontal gyrus to other prefrontal areas as compared to controls. The right ventral striatum demonstrated increased connectivity to the right superior and middle frontal gyrus and left cerebellum in PG patients as compared to controls. The increased connectivity to the cerebellum was positively correlated with smoking in the PG group. Our results provide further evidence for alterations in functional connectivity in PG with increased connectivity between prefrontal regions and the reward system, similar to connectivity changes reported in substance use disorder.

Highlights

  • Pathological gambling (PG) is a psychiatric disorder characterized by persistent and recurrent maladaptive gambling behavior

  • Clinical and psychometric data We Found Significantly Higher Scores for Gambling Severity (KFG, Gambling Symptom Assessment Scale (G-SAS)), Craving for Gambling (VAS) and Impulsiveness (BIS-10) in PG Patients as Compared to Controls (Table 1)

  • We found that PG patients demonstrate increased functional connectivity between regions of the prefrontal cortex (PFC) and mesolimbic reward system, as well as reduced connectivity in the area of the PFC

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Summary

Introduction

Pathological gambling (PG) is a psychiatric disorder characterized by persistent and recurrent maladaptive gambling behavior. Studies on cocaine abuse / dependence demonstrated increased functional connectivity between ventral striatum and ventromedial PFC [45] and reduced prefrontal interhemispheric connectivity [39] Together, these resting-state studies demonstrate that the interaction between PFC and the mesolimbic reward system is altered in patients with substance use disorders. By using a graph-theoretical approach, they observed increased functional connectivity between caudate and anterior cingulate in PG patients as compared to controls It remains unclear whether PG patients demonstrate similar alterations in the interaction between PFC and the core structure of the reward system (i.e., ventral striatum) as reflected by functional connectivity findings in substance-related addictions. Since activation studies of PG found an association between symptom severity [27] as well as impulsiveness [25] and evidence of brain functional alteration, we assumed that these behavioral measures as well as smoking behavior as an additional marker for addictive behavior would be related to functional alteration of the relevant networks in the PG group

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