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1.  Decision Making and Drug Abuse Among HIV+ Men Who Have Sex with Men: A Preliminary Report from the Chicago Multicenter AIDS Cohort Study 
HIV+ substance dependent individuals (SDIs) make significantly poorer decisions compared with HIV− SDIs, but the neurocognitive mechanisms underlying this impairment have not been identified. We administered the Iowa Gambling Task, a measure of decision making under uncertain risk, and the Cups Task, a measure of decision making under specified risk, to a group of 56 HIV+ and 23 HIV− men who have sex with men (MSMs) with a history of substance dependence enrolled in the Multicenter AIDS Cohort Study. The IGT provides no explicit information regarding the contingencies for each possible choice, and the probability of each outcome remains ambiguous at least for the early trials; in contrast, the Cups Task provides explicit information about the probability of each outcome. The HIV+ group made significantly poorer decisions on the IGT compared with the HIV− group. Cups Task performance did not differ significantly between HIV− and HIV+ groups. Exploratory analyses of the IGT data suggested that HIV+ subjects tended to perform more poorly during the early learning phase when uncertainty about specific outcomes was greatest. Additionally, performance on the final two trial blocks was significantly correlated with Stroop Interference scores, suggesting IGT performance is driven increasingly by executive control during the later portion of the task. Potential cognitive mechanisms to be explored in later studies are discussed, including impairment in implicit learning processing
doi:10.1080/13803395.2013.799122
PMCID: PMC3700610  PMID: 23701366
HIV; drug abuse; decision making; executive function; AIDS; neurocognition
2.  Propensity for risk taking and trait impulsivity in the Iowa Gambling Task 
The Iowa Gambling Task (IGT) is sensitive to decision making impairments in several clinical groups with frontal impairment. However the complexity of the IGT, particularly in terms of its learning requirements, makes it difficult to know whether disadvantageous (risky) selections in this task reflect deliberate risk taking or a failure to recognise risk. To determine whether propensity for risk taking contributes to IGT performance, we correlated IGT selections with a measure of propensity for risk taking from the Balloon Analogue Risk Task (BART), taking into account potential moderating effects of IGT learning requirements, and trait impulsivity, which is associated with learning difficulties. We found that IGT and BART performance were related, but only in the later stages of the IGT, and only in participants with low trait impulsivity. This finding suggests that IGT performance may reflect different underlying processes in individuals with low and high trait impulsivity. In individuals with low trait impulsivity, it appears that risky selections in the IGT reflect in part, propensity for risk seeking, but only after the development of explicit knowledge of IGT risks after a period of learning.
doi:10.1016/j.paid.2010.11.013
PMCID: PMC3042697  PMID: 21359157
Impulsivity; risk taking; decision making; Iowa Gambling Task (IGT); Balloon Analogue Risk Task (BART)
3.  Risk/Reward Decision-Making in Schizophrenia: A Preliminary Examination of the Influence of Tobacco Smoking and Relationship to Wisconsin Card Sorting Task Performance 
Schizophrenia research  2009;110(1-3):156.
Background
Individuals with schizophrenia show deficits in cognitive functioning, as evidenced by deficits on neurocognitive tasks such as the Wisconsin Card Sorting Task (WCST). Studies of risk/reward decision-making in individuals with schizophrenia have yielded mixed results, and few studies have examined systematically the relationship between these domains and their relationship with clinical factors.
Method
Thirty-two smokers with schizophrenia, ten non-smokers with schizophrenia, nine non-psychiatric non-smokers and ten non-psychiatric smokers were administered computerized versions of the Iowa Gambling Task (IGT) and the WCST. Smokers were allowed to smoke ad libitum during designated breaks in order to prevent deprivation.
Results
Subjects with schizophrenia performed significantly worse than non-psychiatric controls on both the IGT and the WCST, and performance on these tasks was significantly correlated across subject groups. Among women with schizophrenia, smokers performed significantly better than non-smokers on the IGT.
Conclusions
Individuals with schizophrenia performed worse than controls on the IGT, suggesting impairments in risk/reward decision-making. Correlations between IGT and WCST performance suggest a shared element underlying task performance, such as a deficit in set-shifting or perseverance. Further research is needed to establish the relationship between cigarette smoking and IGT performance in schizophrenia.
doi:10.1016/j.schres.2009.01.012
PMCID: PMC2817985  PMID: 19269138
Schizophrenia; decision-making; gambling; nicotine; executive functioning; dorsolateral prefrontal cortex (dlPFC); ventromedial prefrontal cortex (vmPFC)
4.  Influence of Antisocial and Psychopathic Traits on Decision-Making Biases in Alcoholics 
Background
Although decision-making processes have become a principal target of study among addiction researchers, few studies have specifically examined decision making among individuals with alcohol dependence (AD) and findings to date are mixed. The present study examined the relationship between AD and decision-making, and tested whether different facets of antisocial and psychopathic traits explain this association.
Methods
Participants were men with AD (n = 22), AD and comorbid antisocial personality disorder (AD+ASPD; n = 17), or a history of recreational alcohol use, but no current or lifetime symptoms of a substance use disorder, conduct disorder, or ASPD (n = 21). Decision making was tested using the Iowa Gambling Task (IGT).
Results
Across groups, participants reported similar levels of awareness of the contingencies of the task, but the AD groups with and without ASPD had poorer IGT performance compared to controls (p < .05). A block-by-block analysis revealed that while AD had slow, but steady improvement across the task, AD+ASPD exhibited initial improvement followed by a significant decrease in advantageous decision-making during the last 20 trials (p < .05). This was further confirmed via evidence that impulsive/antisocial personality traits, but not psychopathic traits, mediated poor IGT performance beyond ASPD diagnosis.
Conclusions
AD males favored risky choices regardless of whether they met criteria for ASPD. However, decision making deficits were more pronounced among those with ASPD, and personality traits characterized by impulsive and antisocial tendencies mediated the relationship between AD and decision-making.
doi:10.1111/j.1530-0277.2009.00901.x
PMCID: PMC2846168  PMID: 19298325
Alcohol Dependence; Antisocial Personality Disorder; Psychopathy; Decision-Making
5.  Iowa gambling task performance in euthymic bipolar I disorder: A meta-analysis and empirical study 
Journal of affective disorders  2012;150(1):115-122.
Background
The Iowa Gambling Task (IGT) has been recommended as an index of reward sensitivity, which is elevated in bipolar disorder. We conducted a meta-analysis of IGT performance in euthymic bipolar I disorder compared with control participants. Findings indicated that people with bipolar disorder make more risky choices than control participants, though the effect is small (g=0.35). It is not clear which of the many processes involved in IGT performance are involved in producing the observed group difference.
Methods
Fifty-five euthymic people with bipolar disorder and 39 control participants completed the IGT. The Expectancy Valence Model was used to examine differences in IGT. We also examined whether variation in IGT performance within the bipolar group was related to current mood, illness course, impulsivity, or demographics.
Results
Bipolar and control groups did not differ on the total number of risky choices, rate of learning, or any of the parameters of the Expectancy Valence Model. IGT performance in bipolar disorder was not related to any of the examined individual differences.
Limitations
It is possible that there are group differences that are too small to detect at our sample size or that are not amenable to study via the Expectancy Valence Model.
Conclusions
We were unable to identify group differences on the IGT or correlates of IGT performance within bipolar disorder. Though the IGT may serve as a useful model for decision-making, its structure may make it unsuitable for behavioral assessment of reward sensitivity independent of punishment sensitivity.
doi:10.1016/j.jad.2012.11.027
PMCID: PMC3716836  PMID: 23219060
Bipolar disorder; Mania; Iowa Gambling Task; Decision-making; Reward sensitivity
6.  Computational Modeling Reveals Distinct Effects of HIV and History of Drug Use on Decision-Making Processes in Women 
PLoS ONE  2013;8(8):e68962.
Objective
Drug users and HIV-seropositive individuals often show deficits in decision-making; however the nature of these deficits is not well understood. Recent studies have employed computational modeling approaches to disentangle the psychological processes involved in decision-making. Although such approaches have been used successfully with a number of clinical groups including drug users, no study to date has used computational modeling to examine the effects of HIV on decision-making. In this study, we use this approach to investigate the effects of HIV and drug use on decision-making processes in women, who remain a relatively understudied population.
Method
Fifty-seven women enrolled in the Women's Interagency HIV Study (WIHS) were classified into one of four groups based on their HIV status and history of crack cocaine and/or heroin drug use (DU): HIV+/DU+ (n = 14); HIV+/DU− (n = 17); HIV−/DU+ (n = 14); and HIV−/DU− (n = 12). We measured decision-making with the Iowa Gambling Task (IGT) and examined behavioral performance and model parameters derived from the best-fitting computational model of the IGT.
Results
Although groups showed similar behavioral performance, HIV and DU exhibited differential relationship to model parameters. Specifically, DU was associated with compromised learning/memory and reduced loss aversion, whereas HIV was associated with reduced loss aversion, but was not related to other model parameters.
Conclusions
Results reveal that HIV and DU have differential associations with distinct decision-making processes in women. This study contributes to a growing line of literature which shows that different psychological processes may underlie similar behavioral performance in various clinical groups and may be associated with distinct functional outcomes.
doi:10.1371/journal.pone.0068962
PMCID: PMC3737214  PMID: 23950880
7.  Emotional decision-making and its dissociable components in schizophrenia and schizoaffective disorder: A behavioural and MRI investigation 
Neuropsychologia  2008;46(7-3):2002-2012.
Cognitive decision-making is known to be deficient, but relatively less is known about emotional decision-making in schizophrenia. The Iowa gambling task (IGT) is considered a reliable probe of emotional decision-making and believed to reflect orbitofrontal cortex (OFC) function. The expectancy-valence model of IGT performance implicates three dissociable components, namely, attention to reward, memory for past, relative to recent, outcomes and impulsivity in emotional decision-making. We examined IGT performance, its three components, and their grey matter volume (GMV) correlates in 75 stable patients with schizophrenia, relative to 25 healthy individuals. Patients, relative to controls, showed impaired IGT performance and poor memory for past, relative to recent, outcomes. IGT performance correlated with GMV in the OFC in controls, but not patients. There were associations between (a) attention to reward and GMV in the frontal, temporal, parietal and striatal regions in controls, and in the temporal and thalamic regions in patients, (b) memory for past outcomes and GMV in the temporal region in controls, and the frontal and temporal regions in patients, and (c) low impulsivity and greater GMV in the frontal, temporal, posterior cingulate and occipital regions in controls, and in the frontal, temporal and posterior cingulate regions in patients. Most IGT-GMV associations were stronger in controls. It is concluded that (i) poor memory, rather than less attention to reward or impulsivity, contributes to IGT performance deficit, and (ii) the relationship of IGT performance and its components with GMVs especially in the frontal and temporal lobes is lost or attenuated in schizophrenia.
doi:10.1016/j.neuropsychologia.2008.01.022
PMCID: PMC2845814  PMID: 18329673
Reward; Impulsivity; Memory; Iowa gambling task; Grey matter
8.  Risky Decision-making in Older Adults without Cognitive Deficits: an fMRI study of VMPFC using the Iowa Gambling Task 
Social neuroscience  2011;7(2):178-190.
Some older adults without neurological disease exhibit impaired decision-making in risky, non-transparent situations, like the Iowa Gambling Task (IGT). The prefrontal cortices are particularly vulnerable to age-related decline, and numerous studies implicate the ventromedial prefrontal cortex (VMPFC) in successful IGT performance. However, the relationship between IGT performance and VMPFC function in older adults has not yet been tested using fMRI. In the present study older adults with seemingly no cognitive impairments performed the IGT and a non-gambling control task during fMRI. Group analyses indicate that in these older adults, regardless of IGT performance level, a right VMPFC sub-region is activated during the IGT, while successful IGT performance is correlated with left VMPFC activation, suggesting that bilateral VMPFC during risky, non-transparent situations may contribute to successful decision-making in older adults. Individual subject analyses reveal substantial variation regarding the extent and location of VMPFC activation during the IGT, a finding not captured in the group analysis: there is no correlation between IGT performance and extent of activation in the right VMPFC, although there is such a correlation between left VMPFC activation and IGT performance.
doi:10.1080/17470919.2011.588340
PMCID: PMC3423187  PMID: 21864197
9.  Predictors of Decision-Making on the Iowa Gambling Task: Independent Effects of Lifetime History of Substance Use Disorders and Performance on the Trail Making Test 
Brain and cognition  2007;66(3):243-252.
Poor decision-making and executive function deficits are frequently observed in individuals with substance use disorders (SUDs), and executive deficits may contribute to poor decision-making in this population. This study examined the influence of lifetime history of an alcohol, cocaine, heroin, or polysubstance use disorder on decision-making as measured by the Iowa Gambling Task (IGT) after controlling for executive ability, demographic characteristics, and current substance use. Participants (131 with lifetime history of SUD and 37 controls) completed the IGT and two neuropsychological tests: the Trail Making Test and the Controlled Oral Word Association Test. Control participants performed significantly better than those with a lifetime SUD history on the IGT, but performance on the neuropsychological tests was comparable for the two groups. A lifetime SUD diagnosis was associated with performance on the IGT after controlling for covariates, and Trail Making Test performance was associated with IGT performance in both SUD and control participants.
doi:10.1016/j.bandc.2007.09.001
PMCID: PMC2292486  PMID: 17942206
decision-making; substance use disorder; executive ability; neuropsychological tests; Iowa Gambling Task; Trail Making Test; Controlled Oral Word Association Test
10.  Risky decision-making in HIV-associated neurocognitive disorders (HAND) 
The Clinical neuropsychologist  2012;27(2):256-275.
Individuals infected with HIV show moderate deficits in decision-making, but the ecological relevance of such deficits on everyday functioning has not previously been described. This study sought to examine the magnitude, cognitive correlates, and everyday functioning impact of risky decision-making impairment in HIV-associated neurocognitive disorders (HAND). Participants included 68 HIV+ individuals with HAND, 78 HIV+ individuals without HAND, and 51 HIV- comparison participants, who were administered the Iowa Gambling Task (IGT) alongside a comprehensive neuropsychological test battery and self-report measures assessing aspects of everyday functioning. HIV+ individuals with HAND performed more poorly on the IGT relative to the other two groups, most notably during the last three trial blocks. Within the HIV+ group, IGT performance during the last three trial blocks was most strongly associated with cognitive flexibility, but was not significantly related to declines in instrumental activities of daily living (IADLs), unemployment, or medication non-adherence. While overall IGT performance across the last three trial blocks may be helpful diagnostically in identifying decision-making impairment in HAND, examination of alternate, more specific metrics (e.g., individual deck selections across trial blocks) may be more useful in delineating the role of poor decision-making in HIV-related disability, and should be examined in future research.
doi:10.1080/13854046.2012.740077
PMCID: PMC3609907  PMID: 23181946
HIV; cognitive impairment; decision-making; everyday functioning; cognitive flexibility
11.  THE DIFFERENTIAL RELATIONSHIP BETWEEN COCAINE USE AND MARIJUANA USE ON DECISION-MAKING PERFORMANCE OVER REPEAT TESTING WITH THE IOWA GAMBLING TASK 
Drug and alcohol dependence  2007;90(1):2-11.
Decision-making deficits are a robust cognitive correlate of substance abuse, but few studies have addressed the long-term differential associations of cocaine use and marijuana (MJ) use on decision-making. This study utilized the Iowa Gambling Task (IGT), a widely used measure of decision-making, to investigate the relationship between cocaine and MJ use and IGT learning. We analyzed between and within group differences across two consecutive testing sessions in abstinent users of either MJ or cocaine. We assessed long-term correlates of the use of these drugs by evaluating users after 25 days of enforced abstinence. Results showed that both cocaine users and MJ users performed worse than controls on the total IGT net score. All groups showed learning between Session 1 and Session 2, but the cocaine users showed the smallest increase in performance. The pattern of learning from the beginning to the end (block × block) of the IGT (Session 2) was different for the drug groups, with the cocaine group showing more learning than the MJ group. Dose-related measures of cocaine use (grams/week) and MJ use (joints/week) predicted IGT performance (the heavier the drug use the lower the performance). Differential correlates of cocaine use and MJ use on decision-making learning may have important implications for the development of novel treatment interventions.
doi:10.1016/j.drugalcdep.2007.02.004
PMCID: PMC1986840  PMID: 17367959
Cocaine; Marijuana; Decision-making; Learning; Iowa Gambling Task; Repeated Testing
12.  Immediate gain is long-term loss: Are there foresighted decision makers in the Iowa Gambling Task? 
Background
The Somatic Marker Hypothesis suggests that normal subjects are "foreseeable" and ventromedial prefrontal patients are "myopic" in making decisions, as the behavior shown in the Iowa Gambling Task. The present study questions previous findings because of the existing confounding between long-term outcome (expected value, EV) and gain-loss frequency variables in the Iowa Gambling Task (IGT). A newly and symmetrically designed gamble, namely the Soochow Gambling Task (SGT), with a high-contrast EV between bad (A, B) and good (C, D) decks, is conducted to clarify the issue about IGT confounding. Based on the prediction of EV (a basic assumption of IGT), participants should prefer to choose good decks C and D rather than bad decks A and B in SGT. In contrast, according to the prediction of gain-loss frequency, subjects should prefer the decks A and B because they possessed relatively the high-frequency gain.
Methods
The present experiment was performed by 48 participants (24 males and 24 females). Most subjects are college students recruited from different schools. Each subject played the computer version SGT first and completed a questionnaire for identifying their final preference. The IGT experimental procedure was mostly followed to assure a similar condition of decision uncertainty.
Results
The SGT experiment demonstrated that the prediction of gain-loss frequency is confirmed. Most subjects preferred to choose the bad decks A and B than good decks C and D. The learning curve and questionnaire data indicate that subjects can not "hunch" the EV throughout the game. Further analysis of the effect of previous choice demonstrated that immediate gain increases the probability to stay at the same deck.
Conclusion
SGT provides a balanced structure to clarify the confounding inside IGT and demonstrates that gain-loss frequency rather than EV guides decision makers in these high-ambiguity gambles. Additionally, the choice behavior is mostly following the "gain-stay, lose-randomize" strategy to cope with the uncertain situation. As demonstrated in SGT, immediate gain can bring about a long-term loss under uncertainty. This empirical result may explain some shortsighted behaviors in real life.
doi:10.1186/1744-9081-4-13
PMCID: PMC2324107  PMID: 18353176
13.  Effects of Chronic Marijuana Use on Brain Activity During Monetary Decision-Making 
Neuropsychopharmacology  2011;37(3):618-629.
Marijuana (MJ) acutely acts on cannabinoid receptors that are found in numerous brain regions, including those involved in reward processing and decision-making. However, it remains unclear how long-term, chronic MJ use alters reward-based decision-making. In the present study, using [15O]water PET imaging, we measured brain activity in chronic MJ users, who underwent monitored abstinence from MJ for approximately 24 h before imaging, and control participants, while they took part in the Iowa Gambling Task (IGT), a monetary decision making task that strongly relies on the ventromedial prefrontal cortex (vmPFC). During PET imaging, participants took part in the standard and a variant version of the IGT as well as a control task. Chronic MJ users performed equally well on the standard IGT, but significantly worse than controls on the variant IGT. Chronic MJ users and control subjects showed increased regional cerebral blood flow (rCBF) in the vmPFC on both versions of the IGT compared to the control task. In the two-group comparison, chronic MJ users showed significantly greater rCBF than controls in the vmPFC on the standard IGT and greater activity in the cerebellum on both versions of the IGT. Furthermore, duration of use, but not age of first use, was associated with greater activity in the vmPFC. Thus, chronic MJ users tend to strongly recruit neural circuitry involved in decision-making and reward processing (vmPFC), and probabilistic learning (cerebellum) when performing the IGT.
doi:10.1038/npp.2011.227
PMCID: PMC3260974  PMID: 21956445
marijuana; decision-making; ventromedial prefrontal cortex; chronic use; cerebellum; PET; addiction & substance abuse; cannabinoids; cognition; decision-making; imaging; clinical or preclinical; PET; prefrontal cortex
14.  Poor Decision Making Among Older Adults Is Related to Elevated Levels of Neuroticism 
Background
A well-studied index of reasoning and decision making is the Iowa Gambling Task (IGT). The IGT possesses many features important to medical decision making, such as weighing risks and benefits, dealing with unknown outcomes, and making decisions under uncertainty.
Purpose
There exists a great deal of individual variability on the IGT, particularly among older adults, and the present study examines the role of personality in IGT performance. We explored which of the five-factor model of personality traits were predictive of decision-making performance, after controlling for relevant demographic variables.
Methods
One hundred and fifty-two healthy cognitively intact adults (aged 26–85) were individually administered the IGT and the NEO Five-Factory Inventory.
Results
In the older adults, but not the younger, higher NEO neuroticism was associated with poorer IGT performance.
Conclusions
Our findings are discussed in the context of how stress may impact cognitive performance and cause dysfunction of neural systems in the brain important for decision making.
doi:10.1007/s12160-009-9094-7
PMCID: PMC4028129  PMID: 19350336
Neuroticism; Decision making; Aging; Frontal lobe; Personality; Stress
15.  Cognition and emotional decision-making in chronic low back pain: an ERPs study during Iowa gambling task 
Frontiers in Psychology  2014;5:1350.
Previous reports documented abnormalities in cognitive functions and decision-making (DM) in patients with chronic pain, but these changes are not consistent across studies. Reasons for these discordant findings might include the presence of confounders, variability in chronic pain conditions, and the use of different cognitive tests. The present study was aimed to add evidence in this field, by exploring the cognitive profile of a specific type of chronic pain, i.e., chronic low back pain (cLBP). Twenty four cLBP patients and 24 healthy controls underwent a neuropsychological battery and we focused on emotional DM abilities by means of Iowa gambling task (IGT). During IGT, behavioral responses and the electroencephalogram (EEG) were recorded in 12 patients and 12 controls. Event-related potentials (ERPs) were averaged offline from EEG epochs locked to the feedback presentation (4000 ms duration, from 2000 ms before to 2000 ms after the feedback onset) separately for wins and losses and the feedback-related negativity (FRN) and P300 peak-to-peak amplitudes were calculated. Among cognitive measures, cLBP patients scored lower than controls in the modified card sorting test (MCST) and the score in this test was significantly influenced by pain duration and intensity. Behavioral IGT results documented worse performance and the absence of a learning process during the test in cLBP patients compared to controls, with no effect of pain characteristics. ERPs findings documented abnormal feedback processing in patients during IGT. cLBP patients showed poor performance in the MCST and the IGT. Abnormal feedback processing may be secondary to impingement of chronic pain in brain areas involved in DM or suggest the presence of a predisposing factor related to pain chronification. These abnormalities might contribute to the impairment in the work and family settings that often cLBP patients report.
doi:10.3389/fpsyg.2014.01350
PMCID: PMC4243494  PMID: 25505440
chronic pain; Iowa gambling task (IGT); decision-making; event-related potentials (ERPs); low back pain
16.  Mirrored Prominent Deck B Phenomenon: Frequent Small Losses Override Infrequent Large Gains in the Inverted Iowa Gambling Task 
PLoS ONE  2012;7(10):e47202.
Since Bechara et al. pioneered its development, the Iowa Gambling Task (IGT) has been widely applied to elucidate decision behavior and medial prefrontal function. Although most decision makers can hunch the final benefits of IGT, ventromedial prefrontal lesions generate a myopic choice pattern. Additionally, the Iowa group developed a revised IGT (inverted IGT, iIGT) to confirm the IGT validity. Each iIGT trial was generated from the trial of IGT by multiplying by a “−” to create an inverted monetary value. Thus, bad decks A and B in the IGT become good decks iA and iB in the iIGT; additionally, good decks C and D in the IGT become bad decks iC and iD in the iIGT. Furthermore, IGT possessed mostly the gain trials, and iIGT possessed mainly the loss trials. Therefore, IGT is a frequent-gain–based task, and iIGT is a frequent-loss–based task. However, a growing number of IGT-related studies have identified confounding factors in IGT (i.e., gain-loss frequency), which are demonstrated by the prominent deck B phenomenon (PDB phenomenon). Nevertheless, the mirrored PDB phenomenon and guiding power of gain-loss frequency in iIGT have seldom been reexamined. This experimental finding supports the prediction based on gain-loss frequency. This study identifies the mirrored PDB phenomenon. Frequent small losses override occasional large gains in deck iB of the iIGT. Learning curve analysis generally supports the phenomenon based on gain-loss frequency rather than final outcome. In terms of iIGT and simple versions of iIGT, results of this study demonstrate that high-frequency loss, rather than a satisfactory final outcome, dominates the preference of normal decision makers under uncertainty. Furthermore, normal subjects prefer “no immediate punishment” rather than “final reward” under uncertainty.
doi:10.1371/journal.pone.0047202
PMCID: PMC3473047  PMID: 23091612
17.  Money for nothing — Atrophy correlates of gambling decision making in behavioural variant frontotemporal dementia and Alzheimer's disease☆ 
NeuroImage : Clinical  2013;2:263-272.
Neurodegenerative patients show often severe everyday decision making problems. Currently it is however not clear which brain atrophy regions are implicated in such decision making problems. We investigated the atrophy correlates of gambling decision making in a sample of 63 participants, including two neurodegenerative conditions (behavioural variant frontotemporal dementia — bvFTD; Alzheimer's disease — AD) as well as healthy age-matched controls. All participants were tested on the Iowa Gambling Task (IGT) and the behavioural IGT results were covaried against the T1 MRI scans of all participants to identify brain atrophy regions implicated in gambling decision making deficits. Our results showed a large variability in IGT performance for all groups with both patient groups performing especially poor on the task. Importantly, bvFTD and AD groups did not differ significantly on the behavioural performance of the IGT. However, by contrast, the atrophy gambling decision making correlates differed between bvFTD and AD, with bvFTD showing more frontal atrophy and AD showing more parietal and temporal atrophy being implicated in decision making deficits, indicating that both patient groups fail the task on different levels. Frontal (frontopolar, anterior cingulate) and parietal (retrosplenial) cortex atrophy covaried with poor performance on the IGT. Taken together, the atrophy correlates of gambling decision making show that such deficits can occur due to a failure of different neural structures, which will inform future diagnostics and treatment options to alleviate these severe everyday problems in neurodegenerative patients.
Highlights
► bvFTD and AD patients are both impaired in gambling decision making. ► However, atrophy correlates for gambling decision making differ between groups. ► Poor performance in decision making covaried with frontal atrophy in bvFTD. ► Poor performance in decision making covaried with parietal/temporal atrophy in AD. ► Gambling decision deficits can occur due to atrophy in different brain regions.
doi:10.1016/j.nicl.2013.01.011
PMCID: PMC3778267  PMID: 24179781
Behavioural variant frontotemporal dementia; Alzheimer's disease; Voxel-based morphometry; Gambling decision making; Iowa Gambling Task
18.  Effect of executive functioning, decision-making and self-reported impulsivity on the treatment outcome of pathologic gambling 
Background
Impairments in self-regulatory behaviour reflect a deficit in executive functioning and decision-making, as well as higher levels of self-reported impulsivity, and may be involved in the development and maintenance of addictive disorders. We sought to explore the association between self-reported impulsivity and neurocognitive measures, and their association with treatment outcome in pathologic gambling.
Methods
We assessed patients with pathologic gambling using executive functioning and decision-making tests and self-report measures of impulsivity. Patients underwent cognitive–behavioural therapy (CBT) for pathologic gambling.
Results
We included 88 patients (8% women) in our study. High self-reported extravagance was associated with poor performance in the Iowa Gambling Task (IGT)-ABCD version. High impulsiveness, low disorderliness, high exploratory excitability (trend), poor backward block span and poor IGT-EFGH scores (trend) predicted dropout. We observed no self-reported or neurocognitive predictors of relapse or number of treatment sessions attended.
Limitations
Most participants were slot-machine gamblers seeking treatment. No follow-up data and no control group were included in the study. The missing sample (i.e., individuals who were recruited and assessed in the pretreatment stage but who chose not to begin treatment) had higher extravagance scores than the final sample.
Conclusion
Neurocognitive reward sensitivity was related to self-reported overspending behaviour. Self-regulatory impairments (especially rash impulsiveness and punishment sensitivity) and executive dysfunction predicted only dropout of CBT in participants with pathologic gambling. Different neurocognitive processes and personality traits might mediate treatment response to psychological therapy of pathologic gambling according to the specific target variable assessed.
doi:10.1503/jpn.090095
PMCID: PMC3080512  PMID: 21138656
19.  Dissociable processes underlying decisions in the Iowa Gambling Task: a new integrative framework 
Background
The Iowa Gambling Task (IGT) is a common paradigm used to study the interactions between emotions and decision making, yet little consensus exists on the cognitive process determining participants' decisions, what affects them, and how these processes interact with each other. A novel conceptual framework is proposed according to which behavior in the IGT reflects a balance between two dissociable processes; a cognitively demanding process that tracks each option's long-term payoff, and a lower-level, automatic process that is primarily sensitive to loss frequency and magnitude.
Methods
A behavioral experiment was carried out with a modified version of IGT. In this modified version, participants went through an additional phase of interaction, designed to measure performance without further learning, in which no feedback on individual decisions was given. A secondary distractor task was presented in either the first or the second phase of the experiment. Behavioral measures of performance tracking both payoff and frequency sensitivity in choices were collected throughout the experiment.
Results
Consistent with our framework, the results confirmed that: (a) the two competing cognitive processes can be dissociated; (b) that learning from decision outcomes requires central cognitive resources to estimate long-term payoff; and (c) that the decision phase itself can be carried out during an interfering task once learning has occurred.
Conclusion
The experimental results support our novel description of the cognitive processes underlying performance in the Iowa Gambling Task. They also suggest that patients' impairments in this and other gambling paradigms can originate from a number of different causes, including a failure in allocating resources among cognitive strategies. This latter interpretation might be particularly useful in explaining the impairments of patients with ventromedial prefrontal cortex lesions and, by extension, the contribution of this brain region to human decision making.
doi:10.1186/1744-9081-5-1
PMCID: PMC2645419  PMID: 19121215
20.  Seeing the forest through the trees: improving decision making on the Iowa gambling task by shifting focus from short- to long-term outcomes 
Introduction: The present study sought to examine two methods by which to improve decision making on the Iowa Gambling Task (IGT): inducing a negative mood and providing additional learning trials.
Method: In the first study, 194 undergraduate students [74 male; Mage = 19.44 (SD = 3.69)] were randomly assigned to view a series of pictures to induce a positive, negative, or neutral mood immediately prior to the IGT. In the second study, 276 undergraduate students [111 male; Mage = 19.18 (SD = 2.58)] completed a delay discounting task and back-to-back administrations of the IGT.
Results: Participants in an induced negative mood selected more from Deck C during the final trials than those in an induced positive mood. Providing additional learning trials resulted in better decision making: participants shifted their focus from the frequency of immediate gains/losses (i.e., a preference for Decks B and D) to long-term outcomes (i.e., a preference for Deck D). In addition, disadvantageous decision making on the additional learning trials was associated with larger delay discounting (i.e., a preference for more immediate but smaller rewards).
Conclusions: The present results indicate that decision making is affected by negative mood state, and that decision making can be improved by increasing the number of learning trials. In addition, the current results provide evidence of a relationship between performance on the IGT and on a separate measure of decision making, the delay discounting task. Moreover, the present results indicate that improved decision making on the IGT can be attributed to shifting focus toward long-term outcomes, as evidenced by increased selections from advantageous decks as well as correlations between the IGT and delay discounting task. Implications for the assessment of decision making using the IGT are discussed.
doi:10.3389/fpsyg.2013.00773
PMCID: PMC3798868  PMID: 24151485
decision making; Iowa gambling task; delay discounting; mood state; learning
21.  The Impact of Executive Function on Emotion Recognition and Emotion Experience in Patients with Schizophrenia 
Psychiatry Investigation  2009;6(3):156-162.
Objective
This study investigated the impact of executive function on the performance of two different affective tasks, the Facial Affect Identification Task (FAIT) and the Iowa Gambling Task (IGT), in patients with schizophrenia.
Methods
Thirty-nine patients with schizophrenia and 33 healthy controls completed the FAIT and the IGT, followed by the Wisconsin Card Sorting Test (WCST) and the intelligence quotient (IQ) test. In addition to correlation analysis, regression analysis was used to determine the extent to which the performance of the WCST, in particular, perseverative error (PE), accounted for the variation in both the FAIT and the IGT.
Results
Relative to normal controls, patients with schizophrenia showed significant impairments in the IGT, the FAIT and the WCST even after controlling for IQ. While normal controls did not show any relationships between the WCST and two affective tasks, patients with schizophrenia showed that variables in the WCST correlated not only with the FAIT total correct score (r=-0.503, p=0.001 for PE) but also with the IGT net score (r=0.385, p=0.016 for PE). The PE score was a better predictor of the performance on the FAIT (R2=0.25) than that of the performance on the IGT (R2=0.15).
Conclusion
Our findings imply that deficits in executive function in schizophrenia can affect performance on facial emotion recognition task more than performance on task based on emotion experience, that is, the feedback from the body. Therefore, more consideration is needed of the impact of executive function when interpreting the result of "conventional" facial affect recognition tests as opposed to interpreting the IGT.
doi:10.4306/pi.2009.6.3.156
PMCID: PMC2796063  PMID: 20046390
Executive function; Emotion recognition; Iowa Gambling Task; Schizophrenia
22.  Performance of Young Adult Cannabis Users on Neurocognitive Measures of Impulsive Behavior and their Relationship to Symptoms of Cannabis Use Disorders 
Recent studies suggest that abstinent cannabis users show deficits on neurocognitive laboratory tasks of impulsive behavior. But results are mixed and less is known on the performance of non-treatment seeking, young adult cannabis users. Importantly, relationships between performance on measures of impulsive behavior and symptoms of cannabis addiction remain relatively unexplored. We compared young adult current cannabis users (CU, n = 65) and non-using controls (NU, n = 65) on several laboratory measures of impulsive behavior, as well as on a measure of episodic memory commonly impacted by cannabis use. The CU group performed more poorly than the NU group on the Hopkins Verbal Learning Test-Revised Total Immediate Recall and Delayed Recall. No significant differences were observed on the measures of impulsive behavior (i.e., Iowa Gambling Task [IGT], Go-Stop Task, Monetary Choice Questionnaire, Balloon Analogue Risk Task). We examined relationships between neurocognitive performance and symptoms of cannabis use disorder symptoms (DSM-IV CUD) among the CU group, which revealed that poorer IGT performance was associated with more symptoms of DSM-IV CUD. Our results show poorer memory performance among young adult cannabis users relative to healthy controls, but no differences on measures of impulsive behavior. However, performance on a specific type of impulsive behavior (i.e., poorer decision-making) was associated with more cannabis use disorder symptoms. These results provide preliminary evidence to suggest that decision-making deficits may be more strongly associated with problems experienced from cannabis use, rather than solely being a consequence of cannabis use, per se.
doi:10.1080/13803395.2012.703642
PMCID: PMC3488122  PMID: 22882144
cannabis; addiction; decision-making; neuropsychology; memory; cognitive effects
23.  Iowa Gambling Task in Schizophrenia: A Review and New Data in Patients with Schizophrenia and Co-Occurring Cannabis Use Disorders 
Schizophrenia research  2007;92(1-3):74-84.
Background:
We reviewed previous studies comparing schizophrenia patients and healthy subjects for performance on the Iowa Gambling Task (IGT) (a laboratory task designed to measure emotion-based decision-making), and found mixed results. We hypothesize that deficits in IGT performance in schizophrenia may be more specifically related to concurrent substance use disorders. To test this hypothesis, we compared schizophrenia patients with (SCZ(+)) or without (SCZ(−)) cannabis use disorders, to healthy subjects, on measures of cognition and IGT performance.
Methods:
A comprehensive battery of cognitive tests and the IGT were administered to three groups of subjects: (1) 13 subjects with DSM-IV diagnosis of schizophrenia and no concurrent substance use disorders (mean age: 28 ± 12 (SD); 54% males); (2) 14 subjects with schizophrenia and concurrent cannabis use disorders (mean age: 29 ± 9 (SD); 71% males); and (3) 20 healthy subjects (mean age 33 ± 10 (SD); 60% males).
Results:
Compared to the healthy group, both schizophrenia groups were cognitively more impaired, and did worse on IGT performance. There were no differences between SCZ(+) and SCZ(−) patients on most of the cognitive tests, and IGT performance.
Conclusions:
Schizophrenia patients show widespread impairments in several cognitive domains and emotion-based decision-making. These results are consistent with the evidence that schizophrenia reflects a dorsolateral and orbitofrontal/ventromedial prefrontal cortex dysfunction. More intriguing, it appears that the concurrent abuse of cannabis has no compounding effects on cognition, as well as emotion/affect-based decision-making.
doi:10.1016/j.schres.2007.01.005
PMCID: PMC2039912  PMID: 17379482
Schizophrenia; Cannabis; Decision-making; Iowa Gambling Task; Cognition
24.  Iowa Gambling Task: There is More to Consider than Long-Term Outcome. Using a Linear Equation Model to Disentangle the Impact of Outcome and Frequency of Gains and Losses 
The Iowa Gambling Task (IGT) has been widely used to assess differences in decision-making under uncertainty. Recently, several studies have shown that healthy subjects do not meet the basic predictions of the task (i.e., prefer options with positive long-term outcome), hence questioning its basic assumptions. Since choice options are characterized by gain and net loss frequency in addition to long-term outcome, we hypothesized that a combination of features rather than a single feature would influence participants’ choices. Offering an alternative way of modeling IGT data, we propose to use a system of linear equations to estimate weights that quantify the influence of each individual feature on decision-making in the IGT. With our proposed model it is possible to disentangle and quantify the impact of each of these features. Results from 119 healthy young subjects suggest that choice behavior is predominantly influenced by gain and loss frequency. Subjects preferred choices associated with high-frequency gains to those with low-frequency gains, regardless of long-term outcome. However, among options with low-frequency gains, subjects learned to distinguish between choices that led to advantageous and disadvantageous long-term consequences. This is reflected in the relationship between the weights for gain frequency (highest), loss frequency (intermediate), and long-term outcome (lowest). Further, cluster analysis of estimated feature weights revealed sub-groups of participants with distinct weight patterns and associated advantageous decision behavior. However, subjects in general do not learn to solely base their preference for particular decks on expected long-term outcome. Consequently, long-term outcome alone is not able to drive choice behavior on the IGT. In sum, our model facilitates a more focused conclusion about the factors guiding decision-making in the IGT. In addition, differences between clinical groups can be assessed for each factor individually.
doi:10.3389/fnins.2012.00061
PMCID: PMC3350871  PMID: 22593730
Iowa Gambling Task; gain frequency; loss frequency; reward; linear equation model
25.  The cognitive processes underlying affective decision-making predicting adolescent smoking behaviors in a longitudinal study 
This study investigates the relationship between three different cognitive processes underlying the Iowa Gambling Task (IGT) and adolescent smoking behaviors in a longitudinal study. We conducted a longitudinal study of 181 Chinese adolescents in Chengdu City, China. The participants were followed from 10th to 11th grade. When they were in the 10th grade (Time 1), we tested these adolescents' decision-making using the IGT and working memory capacity using the Self-ordered Pointing Test (SOPT). Self-report questionnaires were used to assess school academic performance and smoking behaviors. The same questionnaires were completed again at the 1-year follow-up (Time 2). The Expectancy-Valence (EV) Model was applied to distill the IGT performance into three different underlying psychological components: (i) a motivational component which indicates the subjective weight the adolescents assign to gains vs. losses; (ii) a learning-rate component which indicates the sensitivity to recent outcomes vs. past experiences; and (iii) a response component which indicates how consistent the adolescents are between learning and responding. The subjective weight to gains vs. losses at Time 1 significantly predicted current smokers and current smoking levels at Time 2, controlling for demographic variables and baseline smoking behaviors. Therefore, by decomposing the IGT into three different psychological components, we found that the motivational process of weight gain vs. losses may serve as a neuropsychological marker to predict adolescent smoking behaviors in a general youth population.
doi:10.3389/fpsyg.2013.00685
PMCID: PMC3787307  PMID: 24101911
adolescents; smoking; decision-making; EV model; Iowa Gambling Task (IGT); longitudinal study

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