Decision-making and cognitive abilities: A review of associations between Iowa Gambling Task performance, executive functions, and intelligence

The experience of effort in ADHD: a scoping review

Background

Mental effort plays a critical role in regulating cognition. However, the experience of mental effort may differ for individuals with Attention-Deficit/Hyperactivity Disorder (ADHD), a disorder for which sustained mental effort 'avoidance' or 'dislike' is a criterion in the DSM. We conducted a scoping review to characterize the literature on the experiences of effort in ADHD.

Methods

This systematic scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews and Joanna Briggs Methodology. PsycINFO (OVID), PsycINFO (ProQuest) and PubMed were searched for studies published in English before February 14, 2023. Studies must have included an ADHD population or a measure of ADHD symptomatology, in addition to a self-report measure of the experience of effort or the use of an effort preference paradigm. Two researchers reviewed all abstracts, and one researcher reviewed full-text articles.

Results

Only 12 studies met the inclusion criteria. Several gaps and inconsistencies in the research were identified in terms of method, definitions of effort, measurements of ADHD, and sample characteristics. Moreover, the pattern of results on the experience of effort was mixed.

Conclusion

Despite its diagnostic and conceptual significance, the experience of mental effort in ADHD is not well studied. Critical gaps were identified in the existing literature. A three-facet conceptualization of effort is proposed-specifically, task-elicited effort, volitionally exerted effort, and the affect associated with engaging in effort - to guide future explorations of the experience of effort in ADHD.

Exploring the impact of smartphone addiction on decision-making behavior in college students: an fNIRS study based on the Iowa Gambling Task

The pervasive use of smartphones, while enhancing accessibility to information and communication, has raised concerns about its potential negative effects on physical and mental health, including the impairment of decision-making abilities. This study investigates the influence of smartphone addiction on decision-making in college students. A sample of 80 individuals aged 17 to 26 was selected and divided into two groups based on their Smartphone Addiction Scale-Short Version (SAS-SV) scores. Participants underwent the Iowa Gambling Task (IGT) to evaluate their decision-making in risky and uncertain conditions, while fNIRS recorded their prefrontal cortex activity. The study found that individuals prone to smartphone addiction tend to make riskier choices in risky situations. However, when faced with decisions based on ambiguity, the smartphone addiction group showed increased brain activity in the dlPFC (specifically in channels 4, 9, and 11) compared to when making risky decisions. Despite this increased brain activation, there was no observable difference in behavior between the addiction-prone and control groups in ambiguous scenarios. Notably, the left dlPFC (e.g., channel 4) exhibited significantly higher activation in the addiction group compared to the control group. Findings suggest that smartphone addiction can detrimentally influence decision-making, behaviorally and neurologically, particularly in uncertain contexts. This study supports the classification of smartphone addiction as a genuine addiction and underscores its significance in psychiatric research. In essence, our research underscores the adverse effects of excessive smartphone use on decision-making processes, reinforcing the necessity to treat smartphone addiction as a pressing public health issue.

Lateral Orbitofrontal Cortex Encodes Presence of Risk and Subjective Risk Preference During Decision-Making

Adaptive decision-making requires consideration of objective risks and rewards associated with each option, as well as subjective preference for risky/safe alternatives. Inaccurate risk/reward estimations can engender excessive risk-taking, a central trait in many psychiatric disorders. The lateral orbitofrontal cortex (lOFC) has been linked to many disorders associated with excessively risky behavior and is ideally situated to mediate risky decision-making. Here, we used single-unit electrophysiology to measure neuronal activity from lOFC of freely moving rats performing in a punishment-based risky decision-making task. Subjects chose between a small, safe reward and a large reward associated with either 0% or 50% risk of concurrent punishment. lOFC activity repeatedly encoded current risk in the environment throughout the decision-making sequence, signaling risk before, during, and after a choice. In addition, lOFC encoded reward magnitude, although this information was only evident during action selection. A Random Forest classifier successfully used neural data accurately to predict the risk of punishment in any given trial, and the ability to predict choice via lOFC activity differentiated between and risk-preferring and risk-averse rats. Finally, risk preferring subjects demonstrated reduced lOFC encoding of risk and increased encoding of reward magnitude. These findings suggest lOFC may serve as a central decision-making hub in which external, environmental information converges with internal, subjective information to guide decision-making in the face of punishment risk.

Bittersweet memories and somatic marker hypothesis: adaptive control in emotional recall facilitates long-term decision-making in the Iowa Gambling Task

The somatic marker hypothesis states that emotional recall and its somatic influence guide long-term decision-making. However, the mechanism through which decision-making benefits from emotional recall is unclear; whether emotional recall and the induced affect increase the regulatory demand or amplify the affect state that requires inhibition. It is unclear if controlling the automatic flow of emotion in recall improves adaptive decision-making. Two studies examine the hypothesis that affect control in emotional recall facilitates inhibitory control and benefits long-term decision-making. In Experiment 1 (n = 137), affect control was assessed in emotional recall to examine if switching of affect in recall of positive and negative valence (order: positive-negative memory recall vs. negative-positive memory recall) is linked with long-term decision-making. Results for long-term decision-making showed that negative-positive recall sequence was associated with higher long-term decision-making, whereas automatic frequency-based decision-making remained unaffected by the recall sequence. In experiment 2 (n = 71, all male), emotional recall (positive vs. negative), recall specificity (i.e., specific vs. overgeneralized recall), and post-recall mood regulation (post-recall positive mood regulation vs. no regulation) was expected to facilitate long-term decision-making. Results showed that emotional recall and post-recall mood regulation (i.e., negative recall - positive mood and positive recall - negative mood) were associated with higher long-term decision-making (decks C' and D'). Results of frequency decision-making showed that positive emotional recall, and poor recall specificity led to infrequent punishment deck choices (decks B' and D'). Hierarchical regression indicated that emotional recall increased infrequent deck choices and accounted for 10% of choices made, recall specificity increased the explanatory power to 19%, and higher recall specificity was associated with fewer infrequent punishment deck choices. Affect control engaged via negative emotional recall, post-recall mood regulation, and recall specificity might be a potential mechanism through which affect control in emotional recall might facilitate long-term decision-making.

Risky decision-making in major depressive disorder: A three-level meta-analysis

Background

Individuals with major depressive disorder (MDD) are usually observed making inappropriate risky decisions. However, whether and to what extent MDD is associated with impairments in risky decision-making remains unclear. We performed a three-level meta-analysis to explore the relationship between risky decision-making and MDD.

Method

We searched the Web of Science, PubMed, Scopus, and PsycINFO databases up to February 7, 2023, and calculated Hedges' g to demonstrate the difference in risky decision-making between MDD patients and healthy controls (HCs). The moderating effect of sample and task characteristics were also revealed.

Results

Across 73 effect sizes in 39 cross-sectional studies, MDD patients exhibited greater risk-seeking than HCs (Hedges' g = 0.187, p = .030). Furthermore, age (p = .068), region (p = .005), and task type (p < .001) were found to have moderating effects. Specifically, patients preferred risk-seeking over HCs as age increased. European patients showed significantly increased risk-seeking compared to American and Asian patients. Patients in the Iowa Gambling Task (IGT) exhibited a notable rise in risk-seeking compared to other tasks, along with an increased risk aversion in the Balloon Analogue Risk Task (BART). The multiple-moderator analysis showed that only task type had significant effects, which may be explained by a tentative framework of "operationalization-mechanism-measure" specificity.

Conclusions

MDD patients generally exhibit higher risk-seeking than HCs. It implies that impaired risky decision-making might be a noteworthy symptom of depression, which should be placed more emphasis for clinical management and psycho-education.

Do older adults make more risky decisions in the Hungry Donkey Task or in the Iowa Gambling Task?

The Iowa Gambling Task (IGT) and the Hungry Donkey Task (HDT) are well-known tasks employed to assess decisions under ambiguity. Although the two tasks are equal in terms of wins and losses, they differ in terms of the recipient: while in the IGT participants make decisions for themselves, in the HDT decisions are made to help a hungry donkey. Decisions for themselves versus another one in a situation of ambiguity are particularly important in the field of aging because of older adults' changes in motivational and other-oriented behavior. The present study aimed to test whether older adults make different decisions under ambiguity for themselves than for another one (i.e., the hungry donkey) as compared to younger adults. Forty-five young adults (M = 23.31; SD = 1.58) and 45 older adults (M = 72.47; SD = 5.49) performed the IGT and the HDT. In addition, participants performed tasks on working memory, set-shifting, and inhibition. Results showed age-related differences in the HDT but not in the IGT. Older adults, compared to younger adults, made disadvantageous decisions to help the hungry donkey as compared to themselves. Interestingly, this pattern of results is not explained by the age-related decline in cognitive functioning. The findings seem to suggest that older adults' decisions made under the condition of ambiguity are affected by motivational and emotional changes associated with aging.

Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks

Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.

A systematic review and meta-analysis of risky decision-making in specific domains of problematic use of the internet: Evidence across different decision-making tasks

This systematic review summarizes empirical evidence on risky decision-making (objective risk and ambiguity) in specific domains of problematic use of the internet (PUI) focusing on online addictive behaviors. We conducted a pre-registered (PROSPERO: CRD42020188452) PubMed search for PUI domains: gaming, social-network use, online buying-shopping, online pornography use, and unspecified PUI. We used the Newcastle-Ottawa Scale for quality assessment. Relevant studies were identified only for gaming (n = 19), social-network use (n = 8), unspecified PUI (n = 7), and online gambling (n = 1). The meta-analyses included 25 studies (2498 participants) comparing PUI and control groups regarding decision-making performance under objective risk and ambiguity. Across PUI domains, individuals with PUI compared to control participants showed more disadvantageous decision-making in measures of objective risk (g = -0.42 [-0.69, -0.16], p = .002) but not ambiguity (g = -0.22 [-0.47, -0.04], p = .096). PUI domain and gender were significant moderators. In the risk domain, effects were particularly present in gaming disorder, especially in exclusively male samples. Overall, the paucity of empirical studies in the considered area necessitates further research to identify probable gender- and disorder-specific cognitive relationships.

The COMT gene modulates the relationship between bilingual adaptation in executive function and decision-making: an EEG study

Bilingual adaptive control mechanisms appear to be linked to congenital genetic factors such as dopamine (DA) genes. However, it is unclear as to whether acquired cognitive exercise can vanquish innate influences that allow bilingual executive advantages to be shown in other cognitive areas. In the present study, we examine the relationship between gene-dependent executive control and decision-making by targeting the enzyme catecholamine-O-methyltransferase (COMT) and employing electroencephalography (EEG). Chinese-English bilinguals (N = 101) participated in a language switching task and the Iowa Gambling Task (IGT). The findings showed that COMT Val158Met polymorphism played a complex role in decision-making and bilingual executive control processing: Bilinguals with Valine (Val) homozygotes had poorer performance in the IGT, while Methionine (Met) carriers had larger switch costs in the language switching task. Second, the cross-task relationships varied among bilinguals with different COMT genotypes: Bilinguals with Met allele genotypes showed larger switch costs and better performance on the IGT. These findings suggest that bilinguals who carry Met allele are equipped with more efficient adaptive mechanisms of executive functions that are generalized to other cognitive domains.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-022-09867-2.

Executive functions and borderline personality features in adolescents with major depressive disorder

Background

Executive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF).

Methods

We examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child's EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity.

Results

Over the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries.

Conclusion

On average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF.

Clinical trial registration

www.ClinicalTrials.gov, identifier NCT03167307.

Microfoundations of Adaptive Search in Complex Tasks: The Role of Cognitive Abilities and Styles

Problem-solving in complex environments requires a cognitively demanding search for task solutions. Managing this search process presents a major challenge in organizations. We contribute to the literature on this topic by providing new evidence on the cognitive antecedents that shape how individuals search when engaged in complex problem-solving tasks. We present results from three laboratory studies, wherein 335 individuals solved a complex task. In doing so, they generated behavioral data coupled with survey-based measurements of the individuals’ cognitive styles and performance-based tests of their cognitive abilities. Our data analysis contributes to the current literature by documenting systematic heterogeneity in the persistence and distance of search that can be explained by the participants’ level of creativity, attention to detail, and executive functions. We extend the research on the microfoundations of adaptive search by linking cognitive antecedents with a complex search task, widening our insight into what search behavior certain cognitive microfoundations lead to, and showing how managers can more effectively shape organizational search.

History: This paper has been accepted for the Organization Science Special Issue on Experiments in Organizational Theory.

Supplemental Material: The online appendix is available at https://doi.org/10.1287/orsc.2023.1654 .

The Bangor Gambling Task: Computerized replication and reappraisal of an emotion-based decision task

Emotion-based decision making (EBDM) is the capacity to make decisions based on prior emotional consequences of actions. Several neuropsychological tasks, using different gambling paradigms and with different levels of complexity, have been designed to assess EBDM. The Bangor Gambling Task (BGT) was created as a brief and simple card gambling-task to assess EBDM. BGT contains a single-card deck and requires participants to decide whether to gamble or not, which can result in wins or losses. Unknown to the participant, the winning probabilities decrease throughout the task (from 0.75 in the first block to 0.25 in the fifth block), requiring participants to reduce their gambling probability to avoid long-term losses. A few studies have offered evidence regarding the BGT convergent validity. However, there are no computerized versions of BGT available, thus slowing the process of gathering information to explore the EBDM mechanisms behind the task, its validity, and clinical usefulness. In this article, we present a computerized version of the BGT using the Matlab environment and make all our code available. We explore BGT's replicability and analyze its probabilistic structure, providing trial-level and block-level analyses. Eighty-one participants performed the computerized version, which followed the same structure as the original version. It took participants 8.5 ± 3.3 minutes to complete the task, which is faster than the paper version. Replicating previous studies, participants diminished their gambling probability throughout the task, learning to inhibit the initially rewarded gambling behavior. This change in gambling probability could be considered a proxy for EBDM. Our analyses suggest that the last blocks are especially sensitive to capturing deficits in EBDM, and we propose some modifications to BGT's original version to enhance the initial exploratory and learning phase. Our results show that the BGT constitutes a quick and simple task to evaluate EBDM capacities.

Integrated versus trial specific focus improves decision-making in older preschoolers

This study explored the effect of integrated-focus (focusing on a depiction of overall gains/losses) versus trial-focus (focusing on gains/losses at each trial) on choice in a preschool variant of the Iowa Gambling task. Participants included 65 preschoolers (M = 47.82, SD = 7.29). Children completed two versions of the Preschool Gambling task, three cool executive function tasks, a moral reasoning task, and an affective perspective taking task. The results indicated that while the integrated-focus condition led to improvement in the awareness of the game, the condition effect was moderated by age for decision-making choice; older preschoolers showed improvement in decision-making in the integrated focus condition, while younger preschoolers showed no condition effect. Further analysis indicated that differences in the increase of advantageous choice across blocks and the condition effect were partly explained by these differences in awareness. Furthermore, a component of cool executive function (shifting) was associated with the latter phase of decision-making. The findings additionally indicated an association of advantageous decision-making with moral/emotional measures, suggesting that the PGT may be a potentially useful clinical tool for early assessment. Finally, the findings of the current study have implications for how hot and cool executive function abilities may work together to enable adaptive decisions.

The comparison of decision-making in ambiguous situations and galvanic skin responses as somatic markers in patients with posterior cortex epilepsy and mesial temporal lobe epilepsy with hippocampal sclerosis

INTRODUCTION

Decision-making behaviors of patients with mesial temporal lobe epilepsy (MTLE) is a subject that has been studied frequently. However, determining the neuropsychological profiles of patients with different types of epilepsy is also important. Our main purpose was to examine the decision-making behaviors of patients with posterior cortex epilepsy (PCE) through the assumptions of somatic marker hypothesis (SMH) and to compare their performances with those of a MTLE group and a control group.

METHOD

Participants comprised of 13 patients with PCE (mean age 30.92 ± 9.99 years); 14 patients with MTLE with hippocampal sclerosis (MTLE-HS) (mean age 25.53 ± 7.40 years) and 15 controls (mean age 24.60 ± 8.45 years). Decision-making performances were assessed with the Iowa gambling test (IGT) and anticipatory skin responses before each choice were recorded. A comprehensive neuropsychological test battery was also given to all participants in order to examine the relationship of decision-making with other cognitive functions.

RESULTS

Anticipatory responses before choosing from disadvantageous decks were significantly larger than choosing from advantageous decks in the PCE group (p = 0.00). No significant difference was found between the PCE and control group's total net scores. IGT total net scores was significantly correlated with Stroop test interference time (p = 0.03).

CONCLUSION

The study reveals that cognitive impairments of patients with PCE are not limited to brain's posterior areas' functions, and provides evidence for the current paradigm which understands epilepsy as a network disorder.

Reward-based decision-making in mesial temporal lobe epilepsy patients with unilateral hippocampal sclerosis pre- and post-surgery

BACKGROUND

Correct functioning of the reward processing system is critical for optimizing decision-making as well as preventing the development of addictions and/or neuropsychiatric symptoms such as depression, apathy, and anhedonia. Consequently, patients with mesial temporal lobe epilepsy due to unilateral hippocampal sclerosis (mTLE-UHS) represent an excellent opportunity to study the brain networks involved in this system.

OBJECTIVE

The aim of the current study was to evaluate decision-making and the electrophysiological correlates of feedback processing in a sample of mTLE-UHS patients, compared to healthy controls. In addition, we assessed the impact of mesial temporal lobe surgical resection on these processes, as well as general, neuropsychological functioning.

METHOD

17 mTLE-UHS patients and 17 matched healthy controls completed: [1] a computerized version of the Game of Dice Task, [2] a Standard Iowa Gambling Task, and [3] a modified ERP version of a probabilistic gambling task coupled with multichannel electroencephalography. Neuropsychological scores were also obtained both pre- and post-surgery.

RESULTS

Behavioral analyses showed a pattern of increased risk for the mTLE-UHS group in decision-making under ambiguity compared to the control group. A decrease in the amplitude of the Feedback Related Negativity (FRN), a weaker effect of valence on delta power, and a general reduction of delta and theta power in the mTLE-UHS group, as compared to the control group, were also found. The beta-gamma activity associated with the delivery of positive reward was similar in both groups. Behavioral performance and electrophysiological measures did not worsen post-surgery.

CONCLUSIONS

Patients with mTLE-UHS showed impairments in decision-making under ambiguity, particularly when they had to make decisions based on the outcomes of their choices, but not in decision-making under risk. No group differences were observed in decision-making when feedbacks were random. These results might be explained by the abnormal feedback processing seen in the EEG activity of patients with mTLE-UHS, and by concomitant impairments in working memory, and memory. These impairments may be linked to the disruption of mesial temporal lobe networks. Finally, feedback processing and decision-making under ambiguity were already affected in mTLE-UHS patients pre-surgery and did not show evidence of clear worsening post-surgery.

Executive Functions in Decision Making under Ambiguity and Risk in Healthy Adults: A Scoping Review Adopting the Hot and Cold Executive Functions Perspective

Decision making (DM) has a pivotal role in supporting individual autonomy and well-being. It is considered a complex ability exploiting many cognitive functions, among which executive functions (EFs) are crucial. Few studies analyzed the role played by EFs in DM in healthy adults under ambiguity and risk, which are common conditions for most decisions in daily life. This scoping review aims to analyze the relationships between two individual tasks widely used to assess DM under these conditions (Iowa Gambling Task and Game of Dice Task) and EFs. According to the organizing principle that conceptualizes hot and cold EFs, DM under such conditions mainly implies hot EFs, but the relationship with cold EFs is still unclear. Using such an approach, a comprehensive framework is provided, highlighting main findings and identifying possible gaps in the literature. The results suggest different roles played by cold EFs in DM under ambiguity and risk, according to the characteristics of the tasks. The findings can offer guidance to further studies and to design interventions to support DM in healthy adults.

Heterogeneity of decision-making strategies for preschoolers on a variant of the IGT

Adaptive decision-making strategies are critical for dealing with the complexity of the social world. The present study investigated the use of decision-making strategies in preschoolers and their association to prosocial behavior and peer problems. Eighty-six preschoolers aged 3- and 4-years completed the preschool decision-making task (PGT), a child variant of the Iowa Gambling task . Win-stay/lose-shift responses along with exploration (consecutive choices from the advantageous deck) and exploitation (shifting between options) were examined. Preschoolers showed a range of strategies, with 4-year-olds adapting their approach as the game progressed and making better use of feedback in comparison to 3-year-olds. Children who differed in terms of choices from the advantageous deck were distinguished by different combinations of exploration and exploitation. Furthermore, unique combinations of decision-making strategies also distinguished children who were rated as high versus low in prosocial behavior as well as children rated as having a high versus low level of peer problems. The findings suggest that consideration of strategies used in decision-making tasks could provide useful insight in a clinical setting, particularly for populations with social difficulties.

“Hot” executive functions are comparable across monolingual and bilingual elementary school children: Results from a study with the Iowa Gambling Task

Past research found performance differences between monolingual and bilingual children in the domain of executive functions (EF). Furthermore, recent studies have reported advantages in processing efficiency or mental effort in bilingual adults and children. These studies mostly focused on the investigation of “cold” EF tasks. Studies including measures of “hot” EF, i.e., tasks operating in an emotionally significant setting, are limited and hence results are inconclusive. In the present study, we extend previous research by investigating performance in a task of the “hot” EF domain by both behavioral data and mental effort via pupillary changes during task performance. Seventy-three monolingual and bilingual school children (mean age = 107.23 months, SD = 10.26) solved the Iowa Gambling Task in two different conditions. In the standard task, characterized by constant gains and occasional losses, children did not learn to improve their decision-making behavior. In a reversed task version, characterized by constant losses and occasional gains, both monolinguals and bilinguals learned to improve their decision-making behavior over the course of the task. In both versions of the task, children switched choices more often after losses than after gains. Bilinguals switched their choices less often than monolinguals in the reversed task, indicating a slightly more mature decision-making strategy. Mental effort did not differ between monolinguals and bilinguals. Conclusions of these findings for the bilingual advantage assumption will be discussed.

Decision-making and Risky Behavior in Individuals with Attention-Deficit/Hyperactivity Disorder: A 10-year Longitudinal Study

We assessed 85 children with Attention-Deficit/Hyperactivity Disorder (ADHD) and 50 typically developing children (TD) (M_age = 11.59, 57.8% boys) with the Hungry Donkey Task (HDT) at baseline and 2-year follow-up, and the Iowa Gambling Task at 10-year follow-up (75% retention). Improvement in the proportion of advantageous choices was observed from two- to 10-year follow-up, but the ADHD group improved less and was outperformed by the TD group at the 10-year follow-up. More advantageous choices on the HDT at baseline predicted less risky behavior at 10-year follow-up. Male sex and more inattentive or externalizing symptoms at baseline predicted more risky behavior.

Decision-Making Profiles and Their Associations with Cognitive Performance in Mild Cognitive Impairment

Background: It is crucial for older adults, especially those with mild cognitive impairment (MCI), to make profitable decisions routinely. However, the results regarding decision-making (DM) remain inconsistent. Objective: The present study assessed DM profiles under uncertainty conditions in individuals with MCI and their associations with multi-domain cognitive performance. Method: Fifty-three patients with MCI and forty-two age-, gender-, and education level-matched healthy controls (HCs) were administered a comprehensive neuropsychological battery test. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to assess DM competence in conditions involving ambiguity and risk, respectively. In addition, Spearman’s correlations were used to examine relationships between GDT and multi-domain cognitive performance. Result: The final capital (FC) and frequency of utilization of negative feedback (FUNF) and positive feedback (FUPF) in the GDT were lower in MCI patients than in HCs. In addition, the number of shifts between safe and risky alternatives was significantly different across groups. However, IGT performance was comparable across groups. In the MCI patients, risky DM performance was associated with language, whereas in HCs was correlated with memory and executive functions. Besides, in MCI, performance on IGT was significantly correlated with social cognition. Conclusion: Individuals with mild cognitive impairment have difficulty utilizing feedback to make optimal decisions under risky situations. The association between decision-making performance and cognitive function is divergent regarding situational uncertainty and individuals’ cognitive status. In mild cognitive impairment and normal aging, decision-making under ambiguity needs further investigation.

Contextual Factors Affecting Risky Decision Making: The Influence of Music on Task Performance and Perceived Distraction

Previous research has investigated factors that contribute to the development of different risk-taking behaviors, such as can occur on lab-based behavioral risky decision making tasks. On several of the most common tasks, participants must develop an adequate understanding of the relative risks and benefits associated with each decision in order to learn to decide advantageously. However, contextual factors can affect the decision making process and one's ability to weigh the risks and benefits of a decision. The present study investigates the extent to which music may be an additional contextual factor that can disrupt decision making and other executive functions. Across four studies we examine whether having music playing passively in the background or having participants actively listen to music affects performance on measures of risky decision making, working memory, processing speed, and problem solving. Participants reported greater distraction for rock music than classical music in the passive listening studies but did not report any differences in distraction across conditions in the active listening studies. Despite this self-reported increased level of distraction, few significant differences were found in task performance across groups and across studies. The Angling Risk Task (ART) was sensitive to differences in risk by condition, with music leading to greater risk-taking in a passive listening study, but less risk-taking in an active listening study, compared to no music. The extent to which music serves as a contextual factor disrupting performance on measures of risky decision making and other executive functions may depend in part on whether individuals are actively versus passively listening to the music.

Neural Signature of Buying Decisions in Real-World Online Shopping Scenarios – An Exploratory Electroencephalography Study Series

The neural underpinnings of decision-making are critical to understanding and predicting human behavior. However, findings from decision neuroscience are limited in their practical applicability due to the gap between experimental decision-making paradigms and real-world choices. The present manuscript investigates the neural markers of buying decisions in a fully natural purchase setting: participants are asked to use their favorite online shopping applications to buy common goods they are currently in need of. Their electroencephalography (EEG) is recorded while they view the product page for each item. EEG responses to pages for products that are eventually bought are compared to those that are discarded. Study 1 repeats this procedure in three batches with different participants, product types, and time periods. In an explorative analysis, two neural markers for buying compared to no-buying decisions are discovered over all three batches: frontal alpha asymmetry peak and frontal theta power peak. Occipital alpha power at alpha asymmetry peaks differs in only one of the three batches. No further significant markers are found. Study 2 compares the natural product search to a design in which subjects are told which product pages to view. In both settings, the frontal alpha asymmetry peak is increased for buying decisions. Frontal theta peak increase is replicated only when subjects search through product pages by themselves. The present study series represents an attempt to find neural markers of real-world decisions in a fully natural environment and explore how those markers can change due to small adjustments for the sake of experimental control. Limitations and practical applicability of the real-world approach to studying decision-making are discussed.

An informatics approach to examine decision-making impairments in the daily life of individuals with depression

Mental health informatics studies methods that collect, model, and interpret a wide variety of data to generate useful information with theoretical or clinical relevance to improve mental health and mental health care. This article presents a mental health informatics approach that is based on the decision-making theory of depression, whereby daily life data from a natural sequential decision-making task are collected and modeled using a reinforcement learning method. The model parameters are then estimated to uncover specific aspects of decision-making impairment in individuals with depression. Empirical results from a pilot study conducted to examine decision-making impairments in the daily lives of university students with depression are presented to illustrate this approach. Future research can apply and expand on this approach to investigate a variety of daily life situations and psychiatric conditions and to facilitate new informatics applications. Using this approach in mental health research may generate useful information with both theoretical and clinical relevance and high ecological validity.

Health emergencies and interoceptive sensibility modulate the perception of non-evidence-based drug use: Findings from the COVID-19 outbreak

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants' interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.

Apathy is Associated with Critical Psychological Determinants of Medication Adherence in HIV Disease

Apathy is common in HIV, separable from depression, and has been associated with non-adherence to antiretroviral therapy (ART). We examined the associations between apathy and critical psychological determinants of ART adherence, as per the information-motivation-behavioral model, in 85 persons living with HIV. Apathy was measured using a composite of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation scale of the Profile of Mood States. Independent of major depressive disorder, apathy was related at small-to-medium effect sizes with motivation to adhere and self-efficacy for health-related decision-making and medication management, but not with HIV knowledge or medication management skills. These findings suggest that apathy plays a unique role in several critical health adherence determinants and support the importance of assessment and management of apathy to maximize health outcomes among individuals with HIV disease.

Decision-making, cognitive functions, impulsivity, and media multitasking expectancies in high versus low media multitaskers

In several studies, individuals who reported to frequently multitask with different media displayed reduced cognitive performance, for example in fluid intelligence and executive functioning. These cognitive functions are relevant for making advantageous decisions under both objective risk (requiring reflection and strategical planning) and ambiguous risk (requiring learning from feedback). Thus, compared to low media multitaskers (LMMs), high media multitaskers (HMMs) may perform worse in both types of decision situations. The current study investigated HMMs and LMMs in a laboratory setting with the Game of Dice Task (GDT; objective risk), the Iowa Gambling Task (IGT; ambiguous risk), various tests quantifying cognitive functions (logical reasoning, working memory, information processing, general executive functions), and self-report measures of impulsivity, media multitasking expectancies, and problematic Internet use. From 182 participants, 25 HMMs and 19 LMMs were identified using the Media Multitasking Index. Results show that HMMs compared to LMMs performed weaker on the IGT but not on the GDT. Furthermore, HMMs had slightly decreased performance in tests of logical reasoning and working memory capacity. HMMs tended to increased information processing speed but this difference was not significant. Furthermore, HMMs have more positive expectancies regarding media multitasking and reported higher tendencies toward problematic Internet use. HMMs and LMMs did not differ significantly with respect to impulsivity and executive functions. The results give a first hint that HMMs may have difficulties in decision-making under ambiguous but not under objective risk. HMMs may be more prone to errors in tasks that require feedback processing. However, HMMs appear not to be impaired in aspects of long-term strategic decision-making.

Affective decision-making in children prenatally exposed to opioids

Although opioid maintenance therapy (OMT) is currently recommended for pregnant opioid-dependent women, potential effects on children's long-term development are still largely unknown. The current study assessed the long-term cognitive development of children born to women in OMT. Particularly, children's decision-making performance was assessed with a child-friendly version of the Iowa Gambling Task. Using a prospective longitudinal design, a cohort of children was followed from birth to middle childhood. Data were collected in Norway between 2005 and 2017. Participants included 41 children (aged 9-11 years), 20 of whom had histories of prenatal methadone or buprenorphine exposure. Background data were collected from personal interviews and medical records in 2005-2006. Children's affective decision-making was assessed in 2016-2017. Results showed no main effect of group on the net scores in the gambling task, F(1, 39) = 1.44, p = 0.24, η² = 0.04, demonstrating no group differences in decision-making performance. A main effect of group was found on sensitivity to punishment, with children in the control group choosing the doors with the infrequent, but high punishment more often compared to children in the OMT group, F(1, 39) = 4.90, p = 0.03, η²  = 0.11. No main effect of group on decision-making speed was found, although results showed a significant interaction effect between group and gain, F(1, 8,194) = 4.09, p = 0.04, η²  = 0.001. Children prenatally exposed to opioids were found to have normal decision-making performance on an affective decision-making task and were able to consider future consequences when making decisions.

Validation of Oxford Cognitive Screen: Executive Function (OCS-EF), a tablet-based executive function assessment tool amongst adolescent females in rural South Africa

Short, reliable, easily administered executive function (EF) assessment tools are needed to measure EF in low- and middle-income countries, particularly in sub-Saharan Africa given the prevalence of human immunodeficiency virus (HIV)-associated neurocognitive disorder. We administered Oxford Cognitive Screen-Executive Function (OCS-EF) to 932 rural South African females (mean age 19.7 years). OCS-EF includes seven tasks: two hot inhibition tasks (a modified Iowa Gambling Task, emotional go/no-go) and five cool EF tasks, two switching tasks (visuospatial rule-finding, geometric trails) and three working memory tasks (digit recall, selection and figure drawing). We performed confirmatory factor analysis testing whether a three-factor, two-factor hot-cool, two-factor working memory and inhibition/switching, or one-factor EF model fitted the data better. The three-factor (switching, inhibition and working memory) model had the best local and global fit (χ² (11) 24.21, p = 0.012; RMSEA 0.036; CFI 0.920; CD 0.617). We demonstrated the feasibility of OCS-EF administration by trained laypeople, the tripartite structure of EF amongst adolescent females and the factorial validity of OCS-EF in this population and context. OCS-EF tablet-based cognitive assessment tool can be administered by trained laypeople and is a valid tool for assessing cognition at scale amongst adolescents in rural South Africa and similar environments.

Linking ADHD and Behavioral Assessment Through Identification of Shared Diagnostic Task-Based Functional Connections

A mixed literature implicates atypical connectivity involving attentional, reward and task inhibition networks in ADHD. The neural mechanisms underlying the utility of behavioral tasks in ADHD diagnosis are likewise underexplored. We hypothesized that a machine-learning classifier may use task-based functional connectivity to compute a joint probability function that identifies connectivity signatures that accurately predict ADHD diagnosis and performance on a clinically-relevant behavioral task, providing an explicit neural mechanism linking behavioral phenotype to diagnosis. We analyzed archival MRI and behavioral data of 80 participants (64 male) who had completed the go/no-go task from the longitudinal follow-up of the Multimodal Treatment Study of ADHD (MTA 168) (mean age = 24 years). Cross-mutual information within a functionally-defined mask measured functional connectivity for each task run. Multilayer feedforward classifier models identified the subset of functional connections that predicted clinical diagnosis (ADHD vs. Control) and split-half performance on the Iowa Gambling Task (IGT). A sample of random models trained on functional connectivity profiles predicted validation set clinical diagnosis and IGT performance with 0.91 accuracy and d' > 2.9, indicating very high sensitivity and specificity. We identified the most diagnostic functional connections between visual and ventral attentional networks and the anterior default mode network. Our results show that task-based functional connectivity is a biomarker of ADHD. Our analytic framework provides a template approach that explicitly ties behavioral assessment measures to both clinical diagnosis, and functional connectivity. This may differentiate otherwise similar diagnoses, and promote more efficacious intervention strategies.

FRN and P3 during the Iowa gambling task: The importance of gender

Previous research has shown gender-related psychobiological differences in risky and competitive strategies that affect win and loss outcomes. In addition, some studies have found differences in the decision-making process, with women taking longer to reach the same performance as men. However, the underlying neural mechanisms remain unclear. The present study aimed to investigate gender differences in behavioral performance and neural correlates during a decision-making task, the Iowa Gambling Task (IGT). Forty healthy young adults (23 men and 17 women) performed the IGT while the feedback-related negativity (FRN) and P3 were recorded as neural correlates of feedback processing. No gender differences were observed in the behavioral performance on the IGT after 100 and 150 trials, or in the P3 component. In women, but not in men, the FRN component showed a greater amplitude for losses than for wins. There were no significant gender-related differences in behavioral performance, and men and women revealed a similar learning process on the IGT. At the neural level, no direct differences between men and women were observed in the feedback processing stage for the FRN or P3. However, our results indicate that women showed greater sensitivity to losses than to wins during the decision-making task, as reflected in the FRN component.

The effect of concurrent reward on aversive information processing in the brain

Neural networks for the processing of appetitive and aversive information, in isolation, have been well characterized. However, how the brain integrates competing signals associated with simultaneous appetitive and aversive information is less clear. In particular, it is unknown how the presence of concurrent reward modulates the processing of an aversive event throughout the brain. Here, we utilized a four-armed bandit task in an fMRI study to measure the representation of an aversive electric shock with and without the simultaneous receipt of monetary reward. Using a region of interest (ROI) approach, we first identified regions activated by the experience of aversive electric shock, and then measured how this shock-related activation is modulated by concurrent reward using independent data. Informed by prior literature and our own preliminary data, analyses focused on the dorsolateral prefrontal cortex, anterior and posterior insula, anterior cingulate cortex, and the thalamus and somatosensory cortex. We hypothesized that the neural response to punishment in these ROIs would be attenuated by the presence of concurrent reward. However, we found no evidence of concurrent reward attenuating the neural response to punishment in any ROI and also no evidence of concurrent punishment attenuating the neural response to reward in exploratory analyses. Altogether, our findings are consistent with the idea that neural networks responsible for the processing of reward and punishment signals are largely independent of one another, and that representations of overall value or utility are arrived at through the integration of separate reward and punishment signals at later stages of information processing.

Impaired decision-making under risk in patients with functional dyspepsia

INTRODUCTION

The cognitive processing in patients with functional dyspepsia (FD) has not been well established. Decision-making is an important component of cognitive function. Most brain regions involved in decision-making are abnormal in FD patients. This study aimed to investigate the decision-making under ambiguity and risk in FD patients.

METHODS

We recruited 40 FD patients meeting Rome III criteria and 40 healthy controls (HCs) matched for age, sex, marital status, and education level. The Hamilton Anxiety Scale (HAMA) and the 17-item Hamilton Depression Scale (HAMD-17) were used to evaluate their anxiety and depression emotions. The Iowa Gambling Task (IGT) and Game of Dice Task (GDT) were used to evaluate decision-making under ambiguity and risk, respectively. Helicobacter pylori status, disease duration, dyspeptic symptom score, and the Nepean Dyspepsia Life Quality Index (NDLQI) were obtained from all patients.

RESULTS

In IGT, FD patients had a lower total net score, chose more adverse choices, and showed a slower response to change their behavior than HCs. However, there was no significant difference in the net score of the first 2 blocks between the two groups. In GDT, FD patients had a lower total net score, higher risk score, and lower use of negative feedback than HCs. In addition, FD patients showed better GDT performance than those without early satiation.

CONCLUSIONS

FD patients showed impaired decision-making under risk. The deficiency might be related to dyspeptic symptoms of FD patients.

Decision Making by People With Aphasia: A Comparison of Linguistic and Nonlinguistic Measures

Purpose Decision making involves multiple cognitive and linguistic processes. The extent to which these processes are involved depends, in part, on the conditions under which decision making is assessed. Because people with aphasia (PWA) have impaired language abilities and may also present with cognitive deficits, they may have difficulty during decision-making tasks. Yet little research exists on the decision-making abilities of PWA. Thus, the purposes of this study were to investigate the performance of PWA on linguistic and nonlinguistic decision-making measures and to explore the relationship between decision making and cognitive test performance. Method A quasi-experimental design was used to compare the performance of PWA (n = 16) and age- and education-matched control participants (n = 16) on three decision-making tasks: Making a Decision subtest from the Functional Assessment of Verbal Reasoning and Executive Strategies (linguistic decision-making task), Iowa Gambling Task (nonlinguistic decision-making task with ambiguity), and Game of Dice Task (nonlinguistic decision-making task without ambiguity). Participants also completed assessments of language, working memory, and executive functions. Scores on the three decision-making tasks were compared between groups, and cognitive influences on decision-making performance were examined using correlation analyses. Results PWA differed significantly from control participants on linguistic decision making, particularly when required to verbalize their rationale for making their decision. PWA and control participants did not differ significantly on measures of nonlinguistic decision making. Performance on multiple cognitive measures was correlated with performance on the linguistic reasoning task, as well as one of the nonlinguistic tasks (Game of Dice Task). Conclusions Decision-making tasks that are heavily dependent on language, such as those used in capacity assessments, may disadvantage PWA. Assessments of decision-making capacity should include communication supports for people with acquired communication disorders; further investigation in the areas of decision making and aphasia is needed.

A further assessment of decision-making in anorexia nervosa

Objective:

Anorexia nervosa (AN) may be associated with impaired decision-making. Cognitive processes underlying this impairment remain unclear, mainly because previous assessments of this complex cognitive function were completed with a single test. Furthermore, clinical features such as mood status may impact this association. We aim to further explore the hypothesis of altered decision-making in AN.

Method:

Sixty-three adult women with AN and 49 female controls completed a clinical assessment and were assessed by three tasks related to decision-making [Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT)].

Results:

People with AN had poorer performance on the IGT and made less risky choices on the BART, whereas performances were not different on PRLT. Notably, AN patients with a current major depressive disorder showed similar performance to those with no current major depressive disorder.

Conclusion:

These results tend to confirm an impaired decision making-process in people with AN and suggest that various cognitive processes such as inhibition to risk-taking or intolerance of uncertainty may underlie this condition Furthermore, these impairments seem unrelated to the potential co-occurent major depressive disorders.

Decision making of forensic psychiatric inpatients deemed incompetent to stand trial

This study examined decision making and its correlates among forensic psychiatric inpatients deemed incompetent to stand trial (IST). This study utilized archival data (n = 41; Mean Age = 44.27, SD = 15.89, 79.1% Male; 34.1% Caucasian). Decision making was measured using the Iowa Gambling Task (IGT), which is purported to simulate real-life decision making. Correlates included cognitive functioning, psychiatric symptom severity, and impulsivity. Participants selected more frequently from disadvantageous decks, which yield larger immediate monetary gains with a larger long-term monetary losses (Mean NET = -9.51, SD = 26.70), but avoided decks yielding frequent monetary losses (Mean GLF = 10.10, SD = 26.70). Consistently, participants selected most frequently from a deck yielding the most immediate monetary gains and the least frequent monetary losses compared to other decks (ps < 0.05). Based upon their selections, participants lost a significant amount of money (M = -$1,493.22, SD = $1,182.26). IGT outcomes were differentially associated with cognitive functioning (rs = -0.26 to 0.47), psychiatric symptom severity (rs = -0.41 to 0.37), and impulsivity (rs = -0.47 to 0.28; all ps = 0.003-0.98). Findings can guide future research, as well as guide competency restoration and decision-making interventions, for this population.

Decision-Making by Patients With Methamphetamine Use Disorder Receiving Contingency Management Treatment: Magnitude and Frequency Effects

BACKGROUND

Individuals with substance use disorders exhibit maladaptive decision-making on the Iowa Gambling Task (IGT), which involves selecting from card decks differing in the magnitudes of rewards, and the frequency and magnitude of losses. We investigated whether baseline IGT performance could predict responses to contingency management (CM) by treatment-seeking individuals with methamphetamine use disorder (MA Use Disorder) in Cape Town, South Africa.

METHODS

Twenty-nine individuals with MA Use Disorder underwent an 8-week, escalating reinforcement, voucher-based CM treatment in a study on the suitability of CM therapy for the South African context. Along with 20 healthy control participants, they performed a computerized version of the IGT before starting CM treatment. Seventeen participants maintained abstinence from methamphetamine throughout the trial (full responders), and 12 had an incomplete response (partial responders). Performance on the IGT was scored for magnitude effect (selection of large immediate rewards with high long-term loss) and for frequency effect (preference for frequent rewards and avoidance of frequent losses). Group differences were investigated using linear mixed-effect modeling.

RESULTS

Partial responders made more selections from decks providing large, immediate rewards and long-term losses than healthy controls [p = 0.038, g = -0.77 (-1.09: -0.44)]. Full responders showed a greater, nonsignificant preference for frequent rewards and aversion to frequent losses than partial responders [p = 0.054, g = -0.63 (-0.95: -0.29)].

CONCLUSIONS

A predilection for choices based on the size and immediacy of reward may reflect a cognitive strategy that works against CM. Pretesting with a decision-making task, such as the IGT, may help in matching cognitive therapies to clients with MA Use Disorder.

The role of inhibition capacities in the Iowa gambling test performance in young tattooed women

Background

Using the Iowa Gambling Test (IGT), we demonstrated previously impaired decision- making process in young tattooed women. The purpose of the present study was to explore the associations among the three facets of impaired inhibition (response inhibition, reflection inhibition and interference inhibition) and decision-making processes in this population.

Methods

To this end, the participants of the previous study (60 tattooed women and 60 non-tattooed women) were assessed in the Go/NoGo task, a measure of response inhibition, the Matched Familiar Figure Test (MFFT), a measure of reflection inhibition and the Stroop task a measure of interference inhibition.

Results

Tattooed women were significantly slower than non-tattooed women in the Go/NoGo performance; however, no differences were detected in the MFFT and the Stroop task. A hierarchical regression analysis did not reveal any significant main effects of these inhibition measures on the IGT performance.

Conclusions

These findings do not support the hypothesis that risky decision in young tattooed women is due to impaired inhibitory control. Further studies are needed to identify the cognitive mechanisms involved in the tendency to risky decisions in young tattooed women.

Mediating role of attenuated physiological arousal on the association between psychopathic traits and fairness norm violation

The low-fear model of primary psychopathy has been supported by empirical findings such as attenuated physiological arousal in anticipation of threatening stimuli. The somatic marker hypothesis proposes that salient changes in the bodily state are processed as signals of whether a situation is good or bad and guide an individual to avoid potential adverse consequences. The present study aimed to elucidate the role that attenuated physiological arousal plays in the relationship between primary psychopathy and fairness norm violations both under the threat of punishment and under no potential for punishment. Primary psychopathy was associated with an attenuated skin conductance response prior to the choice of unfair monetary offers to another person, regardless of the potential for punishment. Attenuated skin conductance mediated the association between primary psychopathy and the choice of an unfair offer, especially in the no-punishment condition. However, in the punishment condition, primary psychopathy significantly predicted the choice of unfair offers even after controlling for the magnitude of skin conductance. The bodily response may have only a marginal effect on interpersonal decision-making under a threat of punishment. The present results suggest that the low-fear account of social norm violations as a function of primary psychopathy should be re-discussed.

Dissociation between decision making under ambiguity and risk in patients with juvenile myoclonic epilepsy

INTRODUCTION

Decision making (DM) is one aspect of impulsivity that can be defined by the ability to decide between two or more options in a given situation. To date, there are at least two types of DM that differ in the level of uncertainty, and how much information about consequences is provided. In this study, we aimed to evaluate the two domains of DM - under risk and ambiguous - with a comprehensive evaluation in a group of patients with juvenile myoclonic epilepsy (JME), and correlate with patients' characteristics, clinical variables, and neuropsychological evaluation for executive functions.

METHODS

We evaluated 35 patients with JME and 39 healthy controls using the Iowa Gambling Task for DM under ambiguity and the Game Dice Task for DM under risk. We assessed the performance in Iowa Gambling Task and Game Dice Task through net scores, safe and risky choices, besides the type of decisions across time.

RESULTS

Patients with JME had a higher number of risky choices compared to controls in the Game Dice Task. There was no significant difference between patients and controls in the Iowa Gambling Task. However, patients with higher seizure frequency had worse scores on decks C and D (safe choices) from the Iowa Gambling Task.

CONCLUSION

Patients with JME have worse performance on DM under risk. The same was not observed for DM under ambiguity. Epilepsy-related factors and the presence of psychiatric disorders, but not executive dysfunction, were associated with a lower tendency for safe choices. These findings showed a dissociation between DM processes in patients with JME and a tendency to make disadvantageous decisions with measurable risks.

Decision-Making as a Latent Construct and its Measurement Invariance in a Large Sample of Adolescent Cannabis Users

OBJECTIVE

Relative to the vast literature that employs measures of decision-making (DM), rigorous examination of their psychometric properties is sparse. This study aimed to determine whether three measures of DM assess the same construct, and to measure invariance of this construct across relevant covariates.

METHOD

Participants were 372 adolescents at risk of escalation in cannabis use. DM was assessed via four indices from the Cups Task, Game of Dice Task (GDT), and Iowa Gambling Task (IGT). We used confirmatory factor analysis to assess unidimensionality of the DM construct, and moderated nonlinear factor analysis (MNLFA) to examine its measurement invariance.

RESULTS

The unidimensional model of DM demonstrated good fit. MNLFA results revealed that sex influenced mean DM scores, such that boys had lower risk-taking behaviors. There was evidence of differential item functioning (DIF), such that IQ and age moderated the IGT intercept and GDT factor loading, respectively. Significant effects were retained in the final model, which produced participant-specific DM factor scores. These scores showed moderate stability over time.

CONCLUSIONS

Indices from three DM tasks loaded significantly onto a single factor, suggesting that these DM tasks assess a single underlying construct. We suggest that this construct represents the ability to make optimal choices that maximize rewards in the presence of risk. Our final DM factor accounts for DIF caused by covariates, making it comparable across adolescents with different characteristics. (JINS, 2019, 25, 661-667).

Pre-specified Anxiety Predicts Future Decision-Making Performances Under Different Temporally Constrained Conditions

In real-life circumstances, people occasionally require making forced decisions when encountering unpredictable events and situations that yield socially and privately unfavorable consequences. In order to prevent future negative consequences, it is beneficial to successfully predict future decision-making behaviors based on various types of information, including behavioral traits and/or psychological states. For this prospective purpose, the present study used the Iowa Gambling Task, which simulates multiple aspects of real-life decision-making processes, such as choice preference, selection and evaluation of output feedback, and investigated how anxiety profiles predict decision-making performances under conditions with different temporal pressures on task execution. To conduct a temporally causal analysis, we assessed the trait and state anxiety profiles of 33 young participants prior to the task and analyzed their subsequent decision-making performances. We separated two disadvantageous card decks with high rewards and losses into high- and middle-risk decks, and calculated local performance indexes for decision-making immediately after salient penalty events for the high-risk deck in addition to traditional global performance indexes concerning overall trial outcomes such as final winnings and net scores. For global decision-making, higher trait anxiety predicted more risky choices solely in the self-paced condition without temporal pressure. For local decision-making, state anxiety predicted risk-taking performances differently in the self- and forced-paced conditions. In the self-paced condition, higher state anxiety predicted higher risk-avoidance. In the forced-paced condition, higher state anxiety predicted more frequent choices of the middle-risk deck. These findings suggest not only that pre-specified anxiety profiles can effectively predict future decision-making behaviors under different temporal pressures, but also newly indicate that behavioral mechanisms for moderate risk-taking under an emergent condition should be focused on to effectively prevent future unfavorable consequences when actually encountering negative events.

Decision-Making Deficits in Elderly Can Be Alleviated by Attention Training

Decision-making is an important everyday function that deteriorates during normal aging. Here, we asked whether value-based decision-making can be improved in the elderly by cognitive training. We compared the effects of two training regimens on the performance in the Iowa Gambling Task (IGT), a real-life decision-making simulation task. Elderly participants (age 62–75 years) were randomized into three matched groups. The filter training (FT) group performed a selective attention task and the memory training (MT) group performed a memory storage task on five consecutive days. The control group (CG) did not perform another task besides the IGT. Only the FT group showed an improvement in IGT performance over the five days—the overall gain rose and the prominent deck B phenomenon decreased. The latter refers to the selection of cards associated with high gains and rare losses, which are nevertheless a disadvantageous choice as the frequent losses lead to a negative net outcome. As the deck B phenomenon has been associated with impaired cognitive abilities in aging, the positive effect of FT here is of special importance. In sum, attention training seems superior in improving decision-making in the elderly.

Effect of transcranial direct current stimulation on decision making and cognitive flexibility in gambling disorder

Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F_1,16 = 8.128, p = 0.01, ɳp² =0.33) and better cognitive flexibility (F_1,16 =8.782, p = 0.009, ɳp² = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder.Trial registration: Clinicaltrials.gov NCT03477799.

Narcissism and risky decisions: a neurophysiological approach

Narcissists are prone to risky decision-making, but why? This study tested—via behavioral and event-related potential (ERP) measures—two accounts: deficiencies in error monitoring and deficiencies in action updating. High and low narcissists were engaged in a monetary gambling task by choosing between a high-risk and a low-risk option while the electroencephalogram (EEG) was being recorded. Two ERP components relevant to outcome evaluation—feedback-related negativity (FRN) and P3—were analyzed, with the FRN serving as an index of error monitoring and the P3 as an index of action updating. Generally, high and low narcissists differed in the high-risk condition but not in the low-risk condition. At the behavioral level, high (vs low) narcissists made riskier decisions following high-risk decision outcomes, which was in line with past findings; at the neurophysiological level, while no FRN difference emerged between high and low narcissists, the outcome valence effect (positive vs negative) on the P3 was stronger among low narcissists than high narcissists following high-risk decision outcomes. One possible interpretation of the results is that narcissism is associated with reduced action updating. The findings contribute to the understanding of narcissistic decision-making and self-regulation.

Competence to Consent and Its Relationship With Cognitive Function in Patients With Schizophrenia

Decisional capacity to consent is an emerging ethical and legal concept, and is closely related to self-determination of patients facing important medical decisions or research participations. Recently, the MacArthur Competence Assessment Tool (MacCAT), a semi-structured interview consisting of four dimensions (Understanding, Appreciation, Reasoning, and Expression of a Choice), was developed to assess the decisional capacity. Decision-making capacity in a group of patients with schizophrenia, as measured by the MacCAT, has been shown to be impaired in comparison with healthy control people. However, this does not necessarily mean the presence of impaired decisional capacity in all cases. Considering the real-world practice of obtaining informed consent from patients with schizophrenia, it is important to evaluate the relationship between psychopathological features and decisional capacity of the illness. Negative symptoms of schizophrenia have been demonstrated to be related to the ability to understand information relevant to the decision, reason rationally, and appreciate a situation and its consequences. On the other hand, positive symptoms, such as delusions and hallucinations have been an inconsistent correlate of poor capacity. Furthermore, some studies indicate that impairment of cognitive function, a core symptom of schizophrenia, could be more largely associated with decisional capacity than positive and negative symptoms. Therefore, it is reasonable to assume cognitive enhancement would enlarge the capacity to consent and promote autonomy in medical treatment and research participation in patients with schizophrenia. Further studies are warranted to elucidate this and related issues.

Inhibitory mechanisms involved in Stroop-matching and stop-signal tasks and the role of impulsivity

Stroop-like and stop-signal tasks are commonly used to evaluate "inhibition", a multifaceted concept fundamental to better understanding of executive functions. Both tasks demand inhibitory processes for their execution; the first requires inhibition of an irrelevant attribute, while the second involves the inhibition of a prepotent motor response. Impulsivity and decision-making represent two other factors that could be associated to executive control and to inhibitory dyscontrol. In this study we developed a behavioral protocol combining the Stroop-matching (a variation of the classic Stroop task) and the stop-signal tasks to investigate possible interactions between the inhibitory mechanisms involved in both tasks. Moreover, we searched for associations between behavioral performance of healthy participants, and self-reported impulsivity and decision-making processes assessed by the BIS-11 scale and IGT, respectively. Our results showed that the primary-task reaction time in the Stroop-matching task influenced the ability to inhibit motor responses in the stop-signal task. Moreover, impulsiveness scores (but not decision-making) were associated to behavioral performance. Importantly, motor and attentional impulsiveness correlated differently to performance depending on the existence of stop-signal trials in the task. Our protocol revealed promising findings concerning the interaction between different inhibitory processes and their association with impulsivity levels.