Högskolan i Skövde

Pathological gambling (PG) is a behavioural addiction affecting approximately 1-2% of the global adult population, characterized by persistent and recurrent gambling behaviours that negatively impact personal and social functioning. Yet, little is known about the neurobiological mechanisms underlying PG. This systematic review aimed to summarise and synthesize neuroimaging studies, examining alterations in the brain’s reward processing and decision-making systems in pathological gamblers (PGs) compared to healthy controls (HC). A search in the databases PubMed, Web of Science, and Scopus identified 286 articles, of which seven utilized functional magnetic resonance imaging (fMRI) to investigate neural activity related to reward sensitivity, risk-taking and cognitive control during gambling tasks. Key findings revealed alterations in brain regions associated with reward processing and cognitive control, particularly the dorsolateral prefrontal cortex (dlPFC), ventral striatum, and insula. PGs exhibited reward-seeking behaviours outweighing their cognitive control abilities, this was reflected in inflexible strategies and poor risk evaluation that contributed to continued gambling despite negative consequences. Interestingly, neural activation in the ventral striatum appeared similar for both PGs and HC, suggesting that basic reward processing may remain intact in PGs. Limitations across the studies included small, predominantly male samples and inconsistent task designs. This review emphasizes the need for future research to employ standardized tasks and measures that better resemble real-life gambling, and to include more diverse samples to enhance understanding of the neural mechanisms underlying PG.