Brain Network Underlying Executive Functions in Gambling and Alcohol Use Disorders: An Activation Likelihood Estimation Meta-Analysis of fMRI Studies

Quaglieri, Alessandro; Mari, Emanuela; Boccia, Maddalena; Piccardi, Laura; Guariglia, Cecilia; Giannini, Anna Maria · 2020 · Crossref

DOI: 10.3390/brainsci10060353

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Summary

This study investigates the neural correlates of executive functions in Gambling Disorder (GD) and Alcohol Use Disorder (AUD) to determine whether these conditions share common neurobiological mechanisms or exhibit distinct patterns of brain activation. Motivated by the high comorbidity between GD and AUD and their classification within the same spectrum of addictive disorders in the DSM-5, the authors sought to compare the neural networks underlying decision-making, impulsivity, and inhibitory control in both populations. Previous literature suggested shared features such as craving, loss of control, and deficits in executive functions, but direct comparisons of their neurofunctional profiles were lacking. To address this, the researchers conducted an Activation Likelihood Estimation (ALE) meta-analysis of 34 functional magnetic resonance imaging (fMRI) studies. The study selection followed PRISMA guidelines, identifying papers from PubMed and Web of Science that used whole-brain fMRI analysis in adults diagnosed with GD or AUD, excluding those with comorbid substance dependencies. Included studies required participants to perform tasks engaging decision-making processes, such as the Iowa Gambling Task, delay discounting, or cue reactivity paradigms. The meta-analysis compared brain activation and deactivation patterns in individuals with GD or AUD against healthy controls (HC). The results revealed distinct neural alterations for each disorder. Individuals with GD showed greater bilateral activation compared to HC, primarily located in the head and body of the caudate, the right middle frontal gyrus, the right putamen, and the hypothalamus. In contrast, AUD was associated with enhanced activation in the right lentiform nucleus, right middle frontal gyrus, and precuneus. Additionally, AUD participants exhibited significant clusters of deactivation in the bilateral middle frontal gyrus, the left middle cingulate cortex, and the inferior portion of the left putamen. These findings indicate that while both disorders involve the frontal-striatal circuits critical for executive control, the specific loci and direction of neural changes differ. The significance of this work lies in providing the first meta-analytic evidence that GD and AUD are associated with specific, albeit different, neural alterations in the executive function network. By moving beyond single-study limitations, the authors demonstrate that although GD and AUD share clinical and phenomenological similarities, their underlying neurofunctional profiles are not identical. This distinction supports the view that while both are addictive disorders, they may involve divergent mechanisms in reward processing and inhibitory control, which has implications for understanding the etiology of addiction and developing targeted therapeutic interventions.

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