Do amnesic patients with Korsakoff’s syndrome use feedback when making decisions under risky conditions? An experimental investigation with the Game of Dice Task with and without feedback

Priming effects of a slot machine game and amphetamine on probabilistic risk-taking in people with gambling disorder and healthy controls

INTRODUCTION

The Game of Dice Task (GDT) captures probabilistic risk-taking, which is an important feature of addictions and integral to gambling disorder (GD). No research appears to have assessed effects of gambling-specific priming manipulations or the pharmacological basis of such effects on the GDT.

AIMS

To investigate effects of slot machine gambling (Slots) and d-amphetamine (AMPH; 20 mg) on risk-taking in people with GD and healthy controls (HCs) (n = 30/group). The role of dopamine (DA) was assessed by pre-treating participants with the D2 receptor (D2R)-preferring antagonist, haloperidol (HAL; 3-mg) or mixed D1R-D2R antagonist, fluphenazine (FLU; 3-mg).

HYPOTHESES

Slots and AMPH will each increase risk-taking based on fewer (less probable) possible outcomes selected (POS) and poorer net monetary outcomes (NMO; gains minus losses) on the GDT, with stronger effects in Group GD. If DA mediates these effects, outcomes will vary with pre-treatment.

METHOD

Participants attended a pre-experimental baseline session and 4 test sessions. Antagonist Group (HAL, FLU) was manipulated between-participants. Pre-treatment (antagonist, placebo) was manipulated within-participants and counterbalanced over sessions for Slots and AMPH test phases. Moderator/mediator effects of trait and neuropsychological factors and GD severity (South Oaks Gambling Screen; SOGS) were explored via covariance.

RESULTS

AMPH led to an escalation in risky POS over trial blocks in both groups, regardless of pre-treatment. Cognitive inflexibility (high perseveration-proneness) moderated this effect in Group HC. In Group GD, SOGS selectively predicted riskier POS on AMPH sessions. Group GD achieved poorer NMO vs. Group HC on the pre-experimental baseline and Placebo-Slots sessions. Group HC selectively displayed poorer NMO on the Antagonist-Slots session.

CONCLUSIONS

The GDT can detect behavioral and pharmacological priming effects. Cognitive inflexibility and symptom severity moderate AMPH-induced risk-taking in HC and GD participants, respectively. Sensitization-related "wanting" of risk may contribute to the latter effect in people with GD.

"Ten dollars today or 50 dollars after one month?" Temporal discounting in Korsakoff syndrome

OBJECTIVE

Little research has investigated decision making in patients with Korsakoff syndrome (KS). Specifically, to our knowledge, there is a lack of research investigating whether patients with KS may tend to prefer immediate over future rewards (i.e., temporal discounting). Further, we investigated the relationship between temporal discounting and inhibition.

METHODS

We, for the first time, invited patients with KS and control participants to perform a temporal discounting task, in which they answered questions probing preferences between an immediate, but smaller amount of money, and a delayed, but larger amount of money (e.g., "would you prefer 10 dollars today or 50 dollars after one month?"). Furthermore, inhibition was measured using the Stroop Colour Word Test.

RESULTS

Analysis demonstrated higher temporal discounting in patients with KS than in control participants. Temporal discounting in both populations was significantly correlated with inhibition.

CONCLUSIONS

Patients with KS may have difficulties to suppress the temptation of smaller, but immediate, rewards.

Temporary amnesia from sleep loss: A framework for understanding consequences of sleep deprivation

Throughout its modern history, sleep research has been concerned with both the benefits of sleep and the deleterious impact of sleep disruption for cognition, behavior, and performance. When more specifically examining the impact of sleep on memory and learning, however, research has overwhelmingly focused on how sleep following learning facilitates memory, with less attention paid to how lack of sleep prior to learning can disrupt subsequent memory. Although this imbalance in research emphasis is being more frequently addressed by current investigators, there is a need for a more organized approach to examining the effect of sleep deprivation before learning. The present review briefly describes the generally accepted approach to analyzing effects of sleep deprivation on subsequent memory and learning by means of its effects on encoding. Then, we suggest an alternative framework with which to understand sleep loss and memory in terms of temporary amnesia from sleep loss (TASL). The review covers the well-characterized properties of amnesia arising from medial temporal lobe lesions and shows how the pattern of preserved and impaired aspects of memory in amnesia may also be appearing during sleep loss. The view of the TASL framework is that amnesia and the amnesia-like deficits observed during sleep deprivation not only affect memory processes but will also be apparent in cognitive processes that rely on those memory processes, such as decision-making. Adoption of the TASL framework encourages movement away from traditional explanations based on narrowly defined domains of memory functioning, such as encoding, and taking instead a more expansive view of how brain structures that support memory, such as the hippocampus, interact with higher structures, such as the prefrontal cortex, to produce complex cognition and behavioral performance, and how this interaction may be compromised by sleep disruption.

The role of cognition and reinforcement sensitivity in older adult decision-making under explicit risk conditions

Introduction: Previous research has suggested that individual differences in executive functions, memory and reinforcement sensitivity are associated with performance on behavioral decision-making tasks. Decision-making performance may also decline with age, however there is a lack of research on the interplay of cognitive and affective processes, and their impact on older adult decision-making. This study examined associations between executive functions, memory and reinforcement sensitivity on the Game of Dice Task (a measure of decision-making under explicit risk) among older adults.Method: One thousand and two older adults without cognitive impairment (aged 72-78 years) participated as part of an Australian longitudinal cohort study (the Personality and Total Health Through Life study). Decision-making sub-types were identified through cluster analysis and multinomial logistic regression was used to assess associations with measures of cognition and reinforcement sensitivity.Results: Cluster analysis identified three decision-making sub-types, which we label "advantageous," "disadvantageous" and "switching." Multivariate analyses found that relative to the mid-performing "switching" sub-type, advantageous decision-makers were more likely to be younger, male and have higher scores on a test of verbal learning. Disadvantageous decision-makers were more likely to have poorer scores on some components of executive function (set shifting, but not working memory or inhibitory control), although this effect was partly attenuated by a measure of reinforcement sensitivity (reward responsiveness).Conclusion: These results indicate that specific components of learning and executive functions are influential in decision-making under explicit risk among a sample of older adults.

On-Road Behavior in Older Drivers With Mild Cognitive Impairment

OBJECTIVES

Dementia increases the risk of unsafe driving, but this is less apparent in preclinical stages such as mild cognitive impairment (MCI). There is, however, limited detailed data on the patterns of driving errors associated with MCI. Here, we examined whether drivers with MCI exhibited different on-road error profiles compared with cognitively normal (CN) older drivers.

DESIGN

Observational.

SETTING AND PARTICIPANTS

A total of 296 licensed older drivers [mean age 75.5 (SD = 6.2) years, 120 (40.5%) women] recruited from the community.

METHOD

Participants completed a health and driving history survey, a neuropsychological test battery, and an on-road driving assessment including driver-instructed and self-navigation components. Driving assessors were blind to participant cognitive status. Participants were categorized as safe or unsafe based on a validated on-road safety scale, and as having MCI based on International Working Group diagnostic criteria. Proportion of errors incurred as a function of error type and traffic context were compared across safe and unsafe MCI and CN drivers.

RESULTS

Compared with safe CN drivers (n = 225), safe MCI drivers (n = 45) showed a similar pattern of errors in different traffic contexts. Compared with safe CN drivers, unsafe CN drivers (n = 17) were more likely to make errors in observation, speed control, lane position, and approach, and at stop/give-way signs, lane changes, and curved driving. Unsafe MCI drivers (n = 9) had additional difficulties at intersections, roundabouts, parking, straight driving, and under self-navigation conditions. A higher proportion of unsafe MCI drivers had multidomain subtype [n = 6 (67%)] than safe MCI drivers [n = 11 (25%)], odds ratio 6.2 (95% confidence interval, 1.4-29.6).

CONCLUSION AND IMPLICATIONS

Among safe drivers, MCI and CN drivers exhibit similar on-road error profiles, suggesting driver restrictions based on MCI status alone are unwarranted. However, formal evaluation is recommended in such cases, as there is evidence drivers with multiple domains of cognitive impairment may require additional interventions to support safe driving.

Frontal lobe executive dysfunction and cerebral perfusion study in alcohol dependence syndrome

BACKGROUND

Long-term alcohol use leading to frontal lobe impairment has been a cause of concern for many decades. However, there are very few studies from India of evaluation of frontal lobe executive dysfunction among alcoholics. Hence, this study was undertaken to evaluate the frontal executive dysfunction using Wisconsin Card Sorting Test (WCST) and perfusion deficits by Single-Photon Emission Computerized Tomography (SPECT) among alcohol-dependent patients.

AIM

The aim of this study is to evaluate the frontal executive dysfunction using WCST and frontal lobe perfusion deficits by SPECT among alcohol-dependent patients.

MATERIALS AND METHODS

This was a cross-sectional study involving 20 alcohol dependence syndrome patients in a tertiary care center. After ethical clearance and informed consent, all were evaluated using WCST and SPECT.

RESULTS

About 45% patients had impairment on WCST, and it was related to the duration of drinking. About 55% showed reduced frontal lobe perfusion on SPECT scan and they had a long duration of drinking compared to controls. Among the patients showing impairment on WCST subscores, more than 50% had reduced frontal lobe perfusion on SPECT.

CONCLUSION

This study not only confirmed the executive function impairment and frontal lobe perfusion deficits in alcohol-dependent patients but also showed a concomitant presence of both in patients with chronic alcohol abuse.

Decision-making in patients with temporal lobe epilepsy: Delay gratification ability is not impaired in patients with hippocampal sclerosis

BACKGROUND

Decision-making abilities have rarely been examined in patients with temporal lobe epilepsy related to hippocampal sclerosis (TLE-HS). We aimed to investigate the ability to delay gratification, a decision-making subdomain, in patients with intractable TLE-HS and to verify the association of delay gratification performance and cool executive function tests.

METHODS

We evaluated 27 patients with TLE-HS (mean age: 35.46 [±13.31] years; 7 males) and their cognitive performance was compared with that of 27 age- and gender-matched healthy controls (mean age: 35.33 [±12.05] years; 7 males), without epilepsy and psychiatric disorders. Patients were assessed using the delay discounting task (DDT) and tests of attention, shifting, inhibitory control, and concept formation. Results were correlated with clinical epilepsy variables such as age of onset, epilepsy duration, AED use, history of status epilepticus, febrile seizures, and the presence of generalized seizures. Statistical analysis was performed using one-way ANCOVA with years of education as a confounding factor.

RESULTS

Patients and controls demonstrated similar performance on DDT, showing similar discount rate (p=0.935) and probability rate (p=0.585). Delay gratification was not related to cool executive function tests (Digit Span, Stroop Color Test, Trail Making Test, Wisconsin Card Sorting Test, and Connors' CPT). History of status epilepticus, presence of generalized seizures and higher seizure frequency, age at onset, and epilepsy duration had a significant impact on DDT.

CONCLUSION

Patients with intractable TLE-HS showed unimpaired delay gratification abilities, being able to accept a higher delay and a lower amount of chance for receiving a higher reward in the future. Clinical variables related to the epilepsy severity impacted the performance on delay gratification. Impairment on cool aspects of executive function was unrelated to this decision-making domain.

Beyond Cognition: Understanding Affective Impairments in Korsakoff Syndrome

As earlier research on Korsakoff syndrome (KS), a frequent neurological complication of alcohol-dependence (AD), mainly focused on cognition, affective impairments have been little investigated despite their crucial impact in AD. This article proposes new research avenues on this topic by combining two theoretical frameworks: (a) dual-process models, positing that addictions are due to an imbalance between underactivated reflective system and overactivated affective-automatic one; (b) continuity theory, postulating a gradual worsening of cognitive impairments from AD to KS. We suggest that this joint perspective may renew the current knowledge by clarifying the affective-automatic deficits in KS and their interactions with reflective impairments, but also by offering a direct exploration of the continuity between AD and KS regarding reflective and affective-automatic abilities.

The Effects of Age, Priming, and Working Memory on Decision-Making

In the current study, we examined the effects of priming and personality on risky decision-making while playing the Game of Dice Task (GDT). In the GDT, participants decide how risky they wish to be on each trial. In this particular study prior to playing the GDT, participants were randomly assigned to one of three priming conditions: Risk-Aversive, Risk-Seeking, or Control. In the Risk-Seeking condition, a fictional character benefitted from risky behavior while in the Risk-Aversive condition, a fictional character benefitted from exercising caution. Although not explicitly stated in the instructions, participants need to make “safe” rather than risky choices to optimize performance on the GDT. Participants were also given Daneman and Carpenter’s assessment of working memory task. Interestingly, although older adults self-reported being more cautious than younger adults on the Domain Specific Risk Attitude scale (DOSPERT), older adults made riskier decisions than younger adults on the GDT. However, after controlling for working memory, the age differences on the GDT became insignificant, indicating that working memory mediated the relation between age and risky decisions on the GDT.

Dissociation of decision making under ambiguity and decision making under risk: a neurocognitive endophenotype candidate for obsessive-compulsive disorder

Evidence in the literature suggests that executive dysfunction is regarded as an endophenotype candidate for obsessive-compulsive disorder (OCD). Decision making is an important domain of executive function. However, few studies that have investigated whether decision making is a potential endophenotype for OCD have produced inconsistent results. Differences in the findings across these studies may be attributed to several factors: different study materials, comorbidity, medication, etc. There are at least two types of decision making that differ mainly in the degree of uncertainty and how much useful information about consequences and their probabilities are provided to the decision maker: decision making under ambiguity and decision making under risk. The aim of the present study was to simultaneously examine decision making under ambiguity as assessed by the Iowa Gambling Task (IGT) and decision making under risk as measured by the Game of Dice Task (GDT) in OCD patients and their unaffected first-degree relative (UFDR) for the first time. The study analyzed 55 medication-naïve, non-depressed OCD patient probands, 55 UFDRs of the OCD patients and 55 healthy matched comparison subjects (CS) without a family history of OCD with the IGT, the GDT and a neuropsychological test battery. While the OCD patients and the UFDRs performed worse than the CS on the IGT, they were unimpaired on the GDT. Our study supports the claim that decision making under ambiguity differs from decision making under risk and suggests that dissociation of decision making under ambiguity and decision making under risk may qualify to be a neurocognitive endophenotypes for OCD.

Monitoring supports performance in a dual-task paradigm involving a risky decision-making task and a working memory task

Performing two cognitively demanding tasks at the same time is known to decrease performance. The current study investigates the underlying executive functions of a dual-tasking situation involving the simultaneous performance of decision making under explicit risk and a working memory task. It is suggested that making a decision and performing a working memory task at the same time should particularly require monitoring—an executive control process supervising behavior and the state of processing on two tasks. To test the role of a supervisory/monitoring function in such a dual-tasking situation we investigated 122 participants with the Game of Dice Task plus 2-back task (GDT plus 2-back task). This dual task requires participants to make decisions under risk and to perform a 2-back working memory task at the same time. Furthermore, a task measuring a set of several executive functions gathered in the term concept formation (Modified Card Sorting Test, MCST) and the newly developed Balanced Switching Task (BST), measuring monitoring in particular, were used. The results demonstrate that concept formation and monitoring are involved in the simultaneous performance of decision making under risk and a working memory task. In particular, the mediation analysis revealed that BST performance partially mediates the influence of MCST performance on the GDT plus 2-back task. These findings suggest that monitoring is one important subfunction for superior performance in a dual-tasking situation including decision making under risk and a working memory task.

Among three different executive functions, general executive control ability is a key predictor of decision making under objective risk

Executive functioning is supposed to have an important role in decision making under risk. Several studies reported that more advantageous decision-making behavior was accompanied by better performance in tests of executive functioning and that the decision-making process was accompanied by activations in prefrontal and subcortical brain regions associated with executive functioning. However, to what extent different components of executive functions contribute to decision making is still unclear. We tested direct and indirect effects of three executive functions on decision-making performance in a laboratory gambling task, the Game of Dice Task (GDT). Using Brand's model of decisions under risk (2006) we tested seven structural equation models with three latent variables that represent executive functions supposed to be involved in decision making. The latent variables were general control (represented by the general ability to exert attentional and behavioral self-control that is in accordance with task goals despite interfering information), concept formation (represented by categorization, rule detection, and set maintenance), and monitoring (represented by supervision of cognition and behavior). The seven models indicated that only the latent dimension general control had a direct effect on decision making under risk. Concept formation and monitoring only contributed in terms of indirect effects, when mediated by general control. Thus, several components of executive functioning seem to be involved in decision making under risk. However, general control functions seem to have a key role. They may be important for implementing the calculative and cognitively controlled processes involved in advantageous decision making under risk.

Failure to utilize feedback causes decision-making deficits among excessive Internet gamers

Internet gaming addiction (IGA) is an increasing mental health issue worldwide. Previous studies have revealed decision-making impairments in excessive Internet gamers (EIGs) with high symptoms of IGA. However, the role of feedback processing in decision-making deficits among EIGs remains unknown. The present study aimed to investigate the effect of feedback processing on decision-making deficits under risk among EIGs, using the Game of Dice Task (GDT) and a modified version of the GDT in which no feedback was provided. Twenty-six EIGs and 26 matched occasional Internet gamers (OIGs) were recruited. The results showed: (a) OIGs performed better on the original GDT than on the modified GDT (no feedback condition); however, EIGs performed similarly on both tasks; (b) EIGs and OIGs performed equally on the modified GDT; however, EIGs chose more disadvantageous options than OIGs on the original GDT; (c) EIGs utilized feedback less frequently on the original GDT relative to OIGs. These results suggest that EIGs are not able to utilize feedback to optimize their decisions, which could underlie their poor decision-making under risk.

A versatile task for assessing decision-making abilities: the truck dispatcher framework

In neuropsychological decision-making research, several different tasks are used to measure decision-making competences in patients and healthy study participants. Unfortunately, the existing tasks are often inflexible for modification, use different scenarios, and include several gambling cues. Therefore, comparisons between participants' performances in different tasks are difficult. We developed the Truck Dispatcher Framework (TDF), in which different decision-making tasks can be designed within one unitary, flexible, and real-world-oriented story line. To test the story line, TDF analogues of three standard decision-making tasks (Game of Dice Task, Probability-Associated Gambling task, Iowa Gambling Task) were developed. In three studies with brain-healthy participants, the behavior in standard decision-making tasks and the TDF analogues of those tasks were compared. Similar behaviors indicate that the TDF tasks measure decision making appropriately. Thus, the TDF is recommended for experimental and clinical research because it allows for examining decision-making competences in tasks with different demands that take place within one unitary story line.

Revisiting the continuum hypothesis: toward an in-depth exploration of executive functions in korsakoff syndrome

Korsakoff syndrome (KS) is a neurological state mostly caused by alcohol-dependence and leading to disproportionate episodic memory deficits. KS patients present more severe anterograde amnesia than Alcohol-Dependent Subjects (ADS), which led to the continuum hypothesis postulating a progressive increase in brain and cognitive damages during the evolution from ADS to KS. This hypothesis has been extensively examined for memory but is still debated for other abilities, notably executive functions (EF). EF have up to now been explored by unspecific tasks in KS, and few studies explored their interactions with memory. Exploring EF in KS by specific tasks based on current EF models could thus renew the exploration of the continuum hypothesis. This paper will propose a research program aiming at: (1) clarifying the extent of executive dysfunctions in KS by tasks focusing on specific EF subcomponents; (2) determining the differential EF deficits in ADS and KS; (3) exploring EF-memory interactions in KS with innovative tasks. At the fundamental level, this exploration will test the continuum hypothesis beyond memory. At the clinical level, it will propose new rehabilitation tools focusing on the EF specifically impaired in KS.

Decision-making under risk is improved by both dopaminergic medication and subthalamic stimulation in Parkinson's disease

Inconsistent findings regarding the effects of dopaminergic medication (MED) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) on decision making processes and impulsivity in Parkinson's disease (PD) patients have been reported. This study investigated the influence of MED and STN-DBS on decision-making under risk. Eighteen non-demented PD patients, treated with both MED and STN-DBS (64.3±10.2years, UPDRS III MED off, DBS off 45.5±17.1) were tested with the Game of Dice Task (GDT) which probes decision-making under risk during four conditions: MED on/DBS on, MED on/DBS off, MED off/DBS on, and MED off/DBS off. Task performance across conditions was compared analyzing two GDT-parameters: (i) the "net score" indicating advantageous decisions, and (ii) the patient's ability to use negative feedback. Significantly higher GDT net scores were observed in Med on in contrast to Med off conditions as well as in DBS on versus DBS off conditions. However, no effect of therapy for the patient's ability to make use of negative feedback could be detected. The data suggest a positive influence of both MED and STN-DBS on making decisions under risk in PD patients, an effect which seems to be mediated by mechanisms other than the use of negative feedback.

Neuropsychologie der pathologischen Internetnutzung

Zielsetzung: Ziel dieses Übersichtsartikels ist es, aktuelle Forschungsarbeiten zur Neuropsychologie der pathologischen Internetnutzung zusammenzufassen. Methodik: Kriteriengeleitete Literaturauswahl. Ergebnisse: Neuropsychologische Studien berichten, dass Personen mit pathologischer Internetnutzung unvorteilhafte Entscheidungen treffen, da sie kurzfristig belohnende Handlungsalternativen bevorzugen und dabei mögliche längerfristige, negative Konsequenzen, weniger beachten. Auch scheint die Verarbeitung von internetbezogenen Reizen mit kognitiven Funktionen, beispielsweise Arbeitsgedächtnisleistungen, zu interferieren. Bildgebungs- und neuropsychologische Befunde veranschaulichen, dass Cue-Reactivity, Craving und Entscheidungsverhalten wichtige Konzepte für das Verständnis des Phänomens der pathologischen Internetnutzung sind. Schlussfolgerungen: Befunde zu neurokognitiven Funktionen und zu Hirnkorrelaten der Verarbeitung internetbezogener Reize bei Personen mit spezifischer pathologischer Internetnutzung (z. B. von Onlinespielen) sind vergleichbar mit denen zu Personen mit Substanzabhängigkeit oder pathologischem Glücksspiel und sprechen für die Klassifikation einer pathologischen Internetnutzung als Verhaltenssucht.

Function and dysfunction of prefrontal brain circuitry in alcoholic Korsakoff's syndrome

The signature symptom of alcohol-induced persisting amnestic disorder, more commonly referred to as alcoholic Korsakoff's syndrome (KS), is anterograde amnesia, or memory loss for recent events, and until the mid 20th Century, the putative brain damage was considered to be in diencephalic and medial temporal lobe structures. Overall intelligence, as measured by standardized IQ tests, usually remains intact. Preservation of IQ occurs because memories formed before the onset of prolonged heavy drinking--the types of information and abilities tapped by intelligence tests--remain relatively well preserved compared with memories recently acquired. However, clinical and experimental evidence has shown that neurobehavioral dysfunction in alcoholic patients with KS does include nonmnemonic abilities, and further brain damage involves extensive frontal and limbic circuitries. Among the abnormalities are confabulation, disruption of elements of executive functioning and cognitive control, and emotional impairments. Here, we discuss the relationship between neurobehavioral impairments in KS and alcoholism-related brain damage. More specifically, we examine the role of damage to prefrontal brain systems in the neuropsychological profile of alcoholic KS.

Risky decision-making in borderline personality disorder

Impulsivity is a core feature of borderline personality disorder (BPD). Thereby, individuals with BPD are most often explicitly aware of the deleterious long-term consequences of their impulsive behaviors, but still engage in them. Therefore, the aim of the present study was to test decision-making in BPD. Female individuals with BPD (n=21) and female controls without BPD (CG; n=29) were compared on the Game of Dice Task (GDT) with regard to disadvantageous decision-making and feedback processing. In the GDT rules for reinforcement and punishment are explicitly clear and the outcome is defined by probabilities. By providing feedback about the outcome of previous decisions, the GDT is a valid measure to simulate decision-making in real life situations. Main results revealed that women with BPD make risky decisions significantly more often than the CG. Moreover, they show reduced capacities to advantageously utilize feedback. As deficits in decision-making were correlated with BPD symptom severity and impulsivity, risky decision-making may be a relevant maintenance factor for the disorder.

Excessive Internet gaming and decision making: do excessive World of Warcraft players have problems in decision making under risky conditions?

The dysfunctional behavior of excessive Internet gamers, such as preferring the immediate reward (to play World of Warcraft) despite the negative long-term consequences may be comparable with the dysfunctional behavior in substance abusers or individuals with behavioral addictions, e.g. pathological gambling. In these disorders, general decision-making deficits have been demonstrated. Hence, the aim of the present work was to examine decision-making competences of excessive World of Warcraft players. Nineteen excessive Internet gamers (EIG) and a control group (CG) consisting of 19 non-gamers were compared with respect to decision-making abilities. The Game of Dice Task (GDT) was applied to measure decision-making under risky conditions. Furthermore psychological-psychiatric symptoms were assessed in both groups. The EIG showed a reduced decision-making ability in the GDT. Furthermore the EIG group showed a higher psychological-psychiatric symptomatology in contrast to the CG. The results indicate that the reduced decision-making ability of EIG is comparable with patients with other forms of behavioral addiction (e.g. pathological gambling), impulse control disorders or substance abusers. Thus, these results suggest that excessive Internet gaming may be based on a myopia for the future, meaning that EIG prefer to play World of Warcraft despite the negative long-term consequences in social or work domains of life.

Decision-making impairments in women with binge eating disorder

Even though eating is frequently driven by overindulgence and reward rather than by energy balance, few studies so far have analyzed decision-making processes and disturbances in feedback processing in women with binge eating disorder (BED). In an experimental study, 17 women with BED (DSM-IV) and 18 overweight healthy controls (HC) were compared in the game of dice task (GDT). This task assesses decision-making under risk with explicit rules for gains and losses. Additionally, differences in dispositional activation of the behavior inhibition and behavior approach system as well as cognitive flexibility were measured. Main results revealed that women with BED make risky decisions significantly more often than HC. Moreover, they show impaired capacities to advantageously utilize feedback processing. Even though these deficits were not related to disease-specific variables, they may be important for the daily decision-making behavior of women with BED, thus being relevant as a maintenance factor for the disorder.

Decision making with and without feedback: the role of intelligence, strategies, executive functions, and cognitive styles

We investigated the effects of intelligence, decision-making strategies, and general cognitive styles on the role of feedback in making decisions under risk. A total of 100 healthy volunteers were assessed with the Game of Dice Task (GDT). A total of 50 participants performed the original GDT, and 50 participants performed a modified GDT in which no feedback was provided. A neuropsychological test battery and questionnaires assessing strategy application and cognitive styles were administered to all participants. Participants who performed the original GDT had higher net scores than those who performed the modified GDT. The benefit of feedback was moderated by participants' intelligence and strategy application.