The Wisconsin Card Sorting Test, the Wechsler Memory Scale Revised, and the Verbal Associative Fluency Test in Assessing Executive Function Abnormality in Pathological Gamblers

Donatella Marazziti, Giorgio Consoli, Mario Catena Dell’Osso, Marina Carlini, Michela Picchetti, Ciro Conversano, Francesca Golia
US Psychiatry, 2010;3:32-35
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Abstract

It is hypothesized that pathological gambling (PG) may result from the interaction of environmental factors with a genetic vulnerability and/or dysfunctions of different neurotransmitters and brain areas. Our study aimed to evaluate a group of PG patients of both sexes by means of neuropsychological test battery, including the Wisconsin Card Sorting Test (WCST), the Wechsler Memory Scale revised (WMS-R), and the Verbal Associative Fluency Test (FAS), in comparison with matched healthy control subjects. On the WCST, the PG patients had difficulty creating alternative methods of problem-solving and showed a decreased efficiency as they progressed, as documented by their scores on the other tests. Our results seem to confirm altered functioning of the prefrontal areas in PG, which might provoke a sort of cognitive ‘lack of flexibility’ that may represent a factor of vulnerability to the development of impulsive and/or compulsive behaviours, such as those typical of PG.
Keywords
Pathological gambling, pathophysiology, neuropsychological tests, Wisconsin Card Sorting Test, Wechsler Memory Scale revised, Verbal Associative Fluency Test
Disclosure The authors have no conflicts of interest to declare.
Received: April 30, 2008 Accepted January 01, 2009
Correspondence: Donatella Marazziti, MD, Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, University of Pisa, Via Roma 67, 56100 Pisa, Italy. E: mainacarlini@libero.it

Pathological gambling (PG) was first recognized as a psychiatric entity in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).1 According to DSM-IV-TR2 criteria, it is believed to be etiologically and genetically linked to the impulse-control and addiction disorder,3 and is defined by the presence of persistent and maladaptive gambling behaviors that provoke familial, occupational, and social impairment.

Epidemiological data identified those mainly at risk of developing PG as men, adolescents, ethnic minorities, and patients with other psychiatric disorders,4 and it has recently been observed that PG prevalence in women and teenagers is rapidly increasing.5,6 The growing bid of experiencing gambling through the Internet, cognitive deficits, and familial history of PG or alcohol dependence can be considered as additional risk factors.7–10

The presence of comorbid psychiatric disorders such as mood disorders and substance abuse has been widely demonstrated in PG patients,11–14 sometimes considered as a trigger or as a consequence of PG. The pathophysiology underlying PG, although still unknown, is believed to be the result of either environmental or individual factors, or both, such as genetic vulnerability of dopamine receptors, biochemical imbalance of serotonin and dopamine pathways and abnormalities in different brain areas.

The gambling task is a specific test aimed at evaluating self-control with regard to reward mechanisms and is utilized to assess decision-making, dysfunctions of which have been demonstrated to be associated with ventromedial prefrontal cortex alterations.15–17 According to this test, PG patients, obsessive–compulsive patients, and cocaine, opiate, and alcohol abusers shared similar deficits, such as repeating errors despite being aware that they are making a mistake.18,19 This theory is supported by recent data: PG and alcohol-dependent patients presented a decrease of executive functioning performance on inhibition, time estimation, cognitive flexibility, and planning tasks by means of a comprehensive neuropsychological battery.20 The reverse Stroop task was recently utilized to examine the ability to filter superfluous information, which was significantly impaired in PG patients, leading to their decision-making dysfunctions.21

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The Wisconsin Card Sorting Test, the Wechsler Memory Scale Revised, and the Verbal Associative Fluency Test in Assessing Executive Function Abnormality in Pathological Gamblers

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