Neuropsychological correlates of decision-making in ambiguous and risky situations

Shades of decision making in multiple sclerosis: A systematic review on economic, medical and under risk conditions choices

BACKGROUND

Multiple Sclerosis (MS), a chronic and demyelinating disorder of the central nervous system, is often associated with challenges in decision-making (DM). This systematic review aims to evaluate the performance of patients with different subtypes of MS in DM tasks, focusing on connections with cognitive impairments, emotional changes, and brain structural alterations.

METHODS

We conducted a systematic search, following PRISMA guidelines, for all peer-reviewed articles. We searched the following databases: Scopus, PubMed, and Web of Science. This review has been registered in the Prospective Register of Systematic Reviews (PROSPERO 2024) with the number CRD42024503190.

RESULTS

Our electronic searches identified 443 papers. After reading the full text of the selected publications and applying predefined inclusion criteria, we included 18 studies based on their pertinence and relevance to the topic.

CONCLUSION

This review highlights the multifaceted nature of DM deficits in individuals with MS. These difficulties result from cognitive impairments such as working memory, brain structural changes, and emotional processing challenges including depression. Our findings present a comprehensive synthesis of the complexities surrounding DM in MS, emphasizing the need for future research to better understand these relationships and their implications for enhancing patient quality of life and autonomy in DM processes.

Value-based decision-making deficits in non-suicidal self-injury: A systematic review and meta-analysis

Non-suicidal self-injury (NSSI) is a significant global mental health issue. However, whether the deficit in value-based decision-making processing is the consistently key mechanisms of NSSI across studies with heterogeneous decision-making tasks remains uncertain. Hence, we reviewed literature on value-based decision-making and its moderating factors in NSSI, and then conducted a meta-analysis on studies in NSSI, specifically with Iowa Gambling Task. In total, 31 studies with 8417 participants aged from 8 to 50 were included in the systematic review of and 8 studies with 657 participants aged from 10 to 37 included in the meta-analysis. We found consistent impairments in value-based decision-making processing among individuals who engage in NSSI. Importantly, age is a significant moderator, with adolescents with NSSI performance worse, exhibiting increased reward sensitivity and preference for immediate rewards compared to other age groups. These results suggest the important role of value-based decision making in NSSI behaviors, especially during the development of adolescents. Our work provides new insights and integrative evidence for decision-making based prevention and intervention of NSSI.

Hyposensitivity to losses under risk but hypersensitivity to gains under ambiguity during feedback evaluation

Uncertainty is ubiquitous in human life and can be fractioned into risk (known probability distribution) and ambiguity (unknown probability distribution), each with distinct functional correlates. This event-related potential study examined how contextual valence influences the dissociation between risk and ambiguity during feedback evaluation through the lens of neural dynamics. We manipulated contextual valence as a gain versus a loss context. In the gain context, decisions resulted in either gains or nongains, while in the loss context, decisions led to losses or nonlosses. We recorded EEG from 40 participants while they completed a wheel-of-fortune task under conditions of risk and ambiguity in both contexts. We observed a stronger valence effect on the P3a in the loss context under risk, but a stronger valence effect on the P3b in the gain context under ambiguity. Further comparisons revealed that feedback evaluation was primarily driven by a smaller P3a in response to losses under risk, but by a larger P3a and P3b in response to gains under ambiguity. Parametric analyses found that both the reward positivity and P3a for gains and nongains were modulated by winning probability under risk, while the P3a for gains was influenced by ambiguity level under ambiguity. Our findings demonstrate the dissociable influences of contextual valence on feedback-related neural dynamics based on uncertainty type, supporting a critical role of valence-asymmetry in distinguishing risk from ambiguity.

Dissociable effects of perceived control on reward-related neural dynamics under risk and ambiguity

Perceived control plays a crucial role in risk-taking behavior, but its neural effect on reward dynamics in risky and ambiguous decision making remains unclear. Here, we addressed this issue by measuring participants' (N = 40) EEG activity while they were performing a wheel-of-fortune task. Participants either made choices themselves (a high control condition) or followed the computer's choice (a low control condition) under risky or ambiguous decision contexts. Behavioral and rating data showed a stronger control effect in the risky compared to the ambiguous decision context. In parallel, we found an effect of perceived control on choice evaluation (indexed by the cue-P3) in the risky but not ambiguous context. However, the control effect was more pronounced during feedback anticipation (indexed by the stimulus-preceding negativity) and outcome appraisal (indexed by delta oscillation) in the ambiguous context compared to the risky context. Together, our findings suggest that experiencing control alters reward dynamics in uncertain decision making, with dissociable effects between risk and ambiguity.

Jumping to Conclusions: Mechanisms of Cognitive Control in Decision-Making Under Uncertainty

Cognitive control encompasses mental processes that regulate thoughts and actions to achieve specific goals. It is essential in decision-making, facilitating attention management, impulse inhibition, and adaptation to new information-skills critical for rational choices, particularly under uncertainty. In jumping to conclusions (JTC), where individuals make premature decisions based on limited evidence, cognitive control deficits are often implicated. Cognitive stability helps maintain focus and resist distractions but may lead to premature conclusions if excessive. In contrast, cognitive flexibility supports adaptive decision-making by incorporating new information but may foster hasty decisions if insufficient. This study examined JTC and cognitive control mechanisms in 200 university students. Participants completed the Box Task under varied uncertainty conditions, tasks assessing stability (Flanker-Simon Task) and flexibility (Letter-Number Task), and the BIS/BAS questionnaire. Cluster analysis identified three evidence-gathering profiles: minimal, moderate, and extensive. Significant differences were found between clusters in both flexibility and stability, with individuals in the extensive evidence-gathering cluster showing superior cognitive control. However, higher uncertainty amplified the reliance on flexibility, highlighting its role in adapting to challenging conditions, while stability remained unaffected. No significant association emerged between BIS/BAS indices and Box Task performance. These findings emphasize the interplay between uncertainty, cognitive control, and decision-making, underscoring the need for further research to refine interventions targeting decision-making biases.

Decision-making using the Iowa gambling test in unaffected first-degree relatives of obsessive-compulsive disorder: Comparison with healthy controls and patients with obsessive-compulsive disorder

Decision-making has been suggested as an endophenotype candidate for obsessive-compulsive disorder (OCD). However, few studies have examined whether decision-making under ambiguity is an endophenotype of OCD. This study aimed to investigate decision-making under ambiguity, as assessed by the Iowa Gambling Task (IGT), in patients with OCD and unaffected first-degree relatives (UFDR). Forty-seven non-medicated, non-co-morbid patients with OCD, 30 UFDR, and 47 healthy controls (HC) were compared in terms of decision-making using the IGT. The correlation between obsessive-compulsive symptoms and IGT performance was also investigated. Patients with OCD and UFDR performed worse than HC on the IGT. No correlation was found between obsessive-compulsive symptoms and IGT performance. A deficit in decision-making under ambiguity may be a trait and an endophenotype candidate for OCD.

A demonstration of superior judgement? Exploring league of legends players' performance in risky and ambiguous decision-making tasks

In three studies, we investigated how League of Legends (LOL) game experience and game skill relate to players' performance in the Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), and Probability Discounting Task (PDT). Additionally, the present study examined the relationship between players' in-game risk preferences and their performance in three types of decision-making tasks. To achieve this, we utilized a self-developed League of Legends Risk Propensity Scale (LRPS) to characterize LOL players' in-game risk preferences. The LRPS demonstrated appropriate reliability and validity in this study. Overall, our results indicated that the differences between LOL players' and non-players' decision-making performance were significant only in the PDT. Moreover, among LOL players, the relationship between game skill and decision-making performance was significant in the IGT (especially in the last sixty trials) and the PDT, but not in the BART. Furthermore, LRPS scores could predict performance in the PDT, but not in the IGT or BART. Our results suggest that experience and game skill in LOL are primarily linked to players' performance in risky decision-making tasks. Similarly, participants' in-game risk preferences in LOL are only related to their performance in the risky decision-making process, not in the ambiguous decision-making process. We propose that LOL players' in-game ambiguous decision-making processes may exhibit domain-specific characteristics.

Relationship between punishment sensitivity and risk-taking propensity

Previous research has shown that, in both laboratory and real-world contexts, punishment sensitivity is associated with lower risk-taking propensity. The neural underpinnings of the association between punishment sensitivity and risk-taking, however, remain largely unknown. To address this issue, we implemented resting-state functional connectivity (RSFC) and voxel-based morphometry (VBM) methodologies to investigate the neural basis of their relationship in the current study (N=594). The behavioral results confirmed a negative association between punishment sensitivity and risk-taking propensity, which supports the hypothesis. The VBM results demonstrated a positive correlation between punishment sensitivity and gray matter volume in the right orbitofrontal cortex (ROFC). Furthermore, the results of the RSFC analysis revealed that the functional connectivity between ROFC and the right medial temporal gyrus (RMTG) was positively associated with punishment sensitivity. Notably, mediation analysis demonstrated that punishment sensitivity acted as a complete mediator in the influence of ROFC-RMTG functional connectivity on risk-taking. These findings suggest that ROFC-RMTG functional connectivity may be the neural basis underlying the effect of punishment sensitivity on risk-taking propensity, which provides a new perspective for understanding the relationship between punishment sensitivity and risk-taking propensity.

Neural responses to decision-making in suicide attempters with youth major depressive disorder

An improved understanding of the factors associated with suicidal attempts in youth suffering from depression is crucial for the identification and prevention of future suicide risk. However, there is limited understanding of how neural activity is modified during the process of decision-making. Our study aimed to investigate the neural responses in suicide attempters with major depressive disorder (MDD) during decision-making. Electroencephalography (EEG) was recorded from 79 individuals aged 16-25 with MDD, including 39 with past suicide attempts (SA group) and 40 without (NSA group), as well as from 40 age- and sex- matched healthy controls (HCs) during the Iowa Gambling Task (IGT). All participants completed diagnostic interviews, self-report questionnaires. Our study examined feedback processing by measuring the feedback-related negativity (FRN), ΔFN (FRN-loss minus FRN-gain), and the P300 as electrophysiological indicators of feedback evaluation. The SA group showed poorest IGT performance. SA group and NSA group, compared with HC group, exhibited specific deficits in decision-making (i.e., exhibited smaller (i.e., blunted) ΔFN). Post hoc analysis found that the SA group was the least sensitive to gains and the most sensitive to losses. In addition, we also found that the larger the value of ΔFN, the better the decision-making ability and the lower the impulsivity. Our study highlights the link between suicide attempts and impaired decision-making in individuals with major depressive disorder. These findings constitute an important step in gaining a better understanding of the specific reward-related abnormalities that could contribute to the young MDD patients with suicide attempts.

Diurnal biological effects of correlated colour temperature and its exposure timing on alertness, cognition, and mood in an enclosed environment

Artificial lighting, which profits from the non-visual effects of light, is a potentially promising solution to support residents' psychophysiological health and performance at specific times of the day in enclosed environments. However, few studies have investigated the non-visual effects of daytime correlated colour temperature (CCT) and its exposure timing on human alertness, cognition, and mood. However, the neural mechanisms underlying these effects are largely unknown. The current study evaluated the effects of daytime CCT and its exposure timing on markers of subjective experience, cognitive performance, and cerebral activity in a simulated enclosed environment. Forty-two participants participated a single-blind laboratory study with a 4 within (CCT: 4000 K vs. 6500 K vs. 8500 K vs. 12,000 K) × 2 between (exposure timing: morning vs. afternoon) mixed design. The results showed time of the day dependent benefits of the daytime CCT on subjective experience, vigilant attention, response inhibition, working memory, emotional perception, and risk decisions. The results of the electroencephalogram (EEG) revealed that lower-frequency EEG bands, including theta, alpha, and alpha-theta, were quite sensitive to daytime CCT intervention, which provides a valuable reference for trying to establish the underlying mechanisms that support the performance-enhancement effects of exposure to CCT in the daytime. However, the results revealed no consistent intervention pattern across these measurements. Therefore, future studies should consider personalised optimisation of daytime CCT for different cognitive demands.

Exploring decision-making performance in young adults with mental health disorders: a comparative study using the Cambridge gambling task

Decision-making deficits, assessed cognitively, are often associated with mental health symptoms, however, this relationship is not fully understood. This paper explores the relationship between mental health disorders and decision-making, using the Cambridge Gambling Task (CGT). Our study investigated how decision-making varied across 20 different mental health conditions compared to controls in a sample of 572 young adults from the Minneapolis and Chicago metropolitan areas, using a computerized laboratory-based task. Almost all mental health conditions were associated with at least mild (i.e. at least small effect size) impairment in all three studied parameters of the CGT (risk adjustment, quality of decision-making and overall proportion of bet). Notably, binge eating disorder had the largest cognitive impairment and gambling disorder had moderate impairment. Post-traumatic stress disorder (PTSD) was associated with impaired decision-making while obsessive-compulsive disorder (OCD) and depression showed moderate impairment. Additionally, half of the disorders assessed had moderate to large impairment in risk adjustment.These findings suggest that mental health conditions may have a more complex cognitive profile than previously thought, and a better understanding of these impairments may aid in risk assessment and targeted clinical interventions. This study underscores the need for further research to determine the causal pathways between mental health conditions and cognition, as well as to better understand the day-to-day impact of such deficits.

Recognition of emotional face expressions in patients with restless legs syndrome

OBJECTIVE

Restless legs syndrome (RLS) is one of the commonest neurologic diseases. Along with sensory and motor symptoms, cognitive impairment and psychiatric features can be seen with RLS. The present study, was planned to look for evidence of cognitive impairment by evaluating facial emotion recognition (FER) in patients with RLS.

METHODS

In this study, 80 patients with RLS and 50 healthy controls (HCs) were included. Demographic data were recorded. All patients with RLS and HCs were tested with Beck anxiety inventory (BAI), Beck depression inventory (BDI) and with Ekman's test for recognition of facial emotions.

RESULTS

Sixty-three of the patients with RLS and 37 of the HCs were female. The mean age of the patients was 45.41 ± 8.24, and the mean age of HCs was 43.12 ± 10.35. The patients and HCs were similar regarding sex, age, educational status, and marital status. Patients with RLS had FER difficulties comparing HCs. There was a negative correlation between Ekman's test scores and BDI (r = -0.311, p < 0.001) and BAI scores (r = -0.379, p < 0.001).

CONCLUSION

FER is an invaluable research topic regarding cognitive function in RLS, which may help us develop different perspectives in terms of revealing the pathophysiology and is very important for the well-being of the patients' social interactions.

The Role of Anxiety and Prosocial Behaviors on Adherence Behaviors to Prevent COVID-19 in University Students in the United States: Cross-Sectional Study

Background

In situations of acute stress, individuals may engage in prosocial behaviors or risk-taking self-oriented behaviors. The COVID-19 pandemic created large stress-promoting conditions that impacted individuals' decisions to adhere to COVID-19 preventative behaviors.

objectives

The study aimed to examine the relationship between anxiety during the pandemic and adherence behaviors to prevent the spread of COVID-19, and the moderating influence of prosocial behaviors. We hypothesized that individuals with high anxiety during COVID-19 would adhere more to preventive COVID-19 behaviors than ones with low anxiety and that this relationship would be stronger in those individuals with higher prosocial behaviors.

Methods

A web-based survey was administered through the SONA web-based participant tool of the psychology department of a university in the Northeastern United States. A final sample of 54 undergraduate students completed web-based questionnaires during the second wave of the COVID-19 pandemic, from January to May 2021, which included demographic measures and surveys on prosocial behaviors, anxiety, and COVID-19 preventive behaviors. Moderation analyses were conducted using PROCESS in SPSS.

Results

Participants reported high levels of trait and state anxiety symptoms, most of them meeting or exceeding the cutoff criteria to be clinically meaningful (state anxiety: 47/54, 87%; trait anxiety: 38/44, 86%), and over 50% highly adhered to the COVID-19 preventive behaviors of wearing a face mask, using hand sanitizer, handwashing, coughing/sneezing into their elbow or a tissue, self-quarantining, maintaining social distance, avoiding social gatherings, and avoiding nonessential travel. No significant associations were observed between prosocial behavior, anxiety types, and adherence to COVID-19 preventive behaviors. However, when moderation analyses were conducted between anxiety types and adherence to COVID-19 preventive behaviors, results demonstrated a statistically significant interaction of public prosocial behavior with state anxiety (β=-.17, t53=-2.60; P=.01), predicting engagement in COVID-19 preventative behaviors. At high levels of anxiety, low levels of prosocial public behaviors were associated with higher engagement in COVID-19 preventative behaviors. In contrast, high levels of public prosocial behavior were associated with low engagement in COVID-19 preventative behaviors at higher levels of anxiety.

Conclusions

These results provide information that can aid in the creation of interventions that could increase adherence to COVID-19 preventative behaviors (Reviewed by the Plan P #PeerRef Community).

Decision-making under conditions of explicit risk and uncertainty in autistic and typically developing adolescents and young adults

Adolescence has been characterized as a period of risky and possibly suboptimal decision-making, yet the development of decision-making in autistic adolescents is not well understood. To investigate decision-making in autism, we evaluated performance on 2 computerized tasks capturing decision-making under explicit risk and uncertainty in autistic and non-autistic adolescents/young adults ages 12-22 years. Participants completed the Game of Dice Task (32 IQ-matched participant pairs) to assess decision-making under explicit risk and the modified Iowa Gambling Task (35 IQ-matched pairs) to assess decision-making under uncertainty. Autistic participants overall made riskier decisions than non-autistic participants on the Game of Dice Task, and the odds of making riskier decisions varied by age and IQ. In contrast, the autistic group showed comparable levels of learning over trial blocks to the non-autistic group on the modified Iowa Gambling Task. For both tasks, younger autistic participants performed poorer than their non-autistic counterparts, while group differences diminished in older ages. This age-related pattern suggests positive development during adolescence on risk assessment and decision-making in autism but also implies differential developmental trajectories between groups. These findings also suggest differential performance by the risk type, with additional complex influences of IQ and fluid cognition, which warrants further investigations.

Transcranial direct current stimulation combined with cognitive training improves decision making and executive functions in opioid use disorder: a triple-blind sham-controlled pilot study

Opioid use disorder (OUD) is a chronic disorder with a considerable amount of morbidity and mortality. Despite remarkable improvement achieved by maintenance programs, an array of treatment goals were still unmet. Mounting evidence suggests that transcranial Direct Current Stimulation (tDCS) improves decision making and cognitive functions in addictive disorders. tDCS paired with a decision making task was depicted to diminish impulsivity as well.

The present study aimed to assess the effect of tDCS combined with cognitive training (CT) in OUD for the first time.

In this triple-blind randomized sham-controlled pilot study, 38 individuals with OUD from the Buprenorphine-Naloxone Maintenance Therapy program were administered 20-minutes of 2 mA active/sham tDCS over the dorsolateral prefrontal cortex with concomitant cognitive training. A selected test battery evaluating decision making under risk and ambiguity as well as executive functions, verbal fluency and working memory was utilized before and after the intervention.

Greater improvements were observed in decision making under ambiguity (p = 0.016), set shifting ability and alternating fluency while no improvements were observed in decision making under risk in the active group, compared to sham.

Deficits of decision making and executive functions have a pivotal role in the perpetuation and the relapse of the OUD. Alleviation of these impairments brought tDCS/CT forth as an expedient neuroscientifically-grounded treatment option that merits further exploration in OUD, Trial registration: NCT05568251.

Designing and psychometric assessment of the moral intelligence scale for healthcare professionals

The moral intelligence of healthcare professionals in the cardiac operating room is one of the most important aspects of professional competence. However, moral intelligence is an abstract and multidimensional concept that needs to be clarified and described based on organizational culture and environment. Therefore, there is a need to design a specific scale for measuring the moral intelligence of healthcare professionals in the cardiac operating room. This study aims to design and assess the psychometric properties of a moral intelligence scale for healthcare professionals in the cardiac operating room. The present study was a mixed method study with a sequential exploratory approach. The research was conducted in 2023-2024 in Iran. The first phase data were collected from 20 healthcare professionals and were analyzed by conventional content analysis method. In the second phase, the validity and reliability of the instrument were evaluated by involving 300 healthcare professionals in the cardiac operating room. The moral intelligence of health care professionals in the cardiac operating room was defined as moral sensitivity combined with moral commitment and moral courage for the provision of quality care that respects the principles of medical ethics. After deducing the conceptual framework, the moral intelligence scale for healthcare professionals in the cardiac operating room was developed with three dimensions: "moral sensitivity," "moral commitment," and "moral courage." 11 items were removed during testing to ensure content validity. Face validity was confirmed with impact scores > 1.5 for all items. A scale was developed through factor analysis with three factors that accounted for 73.04% of the observed variance. The instrument's reliability using Cronbach's alpha coefficient calculation was reported as 0.94 for the entire instrument. The testretest showed no statistically significant difference between the pre and post-test scores of moral intelligence (p = 0.51). The moral intelligence scale demonstrated acceptable psychometric properties. The moral intelligence scale for health care professionals in the cardiac operating room demonstrated acceptable psychometric properties. This instrument may serve to assess the moral intelligence of healthcare professionals and determine the need for educational interventions to reduce the ethical challenges and improve the moral intelligence of this healthcare.

Effort Expenditure Increases Risk-Taking for Improbable Rewards

Previous studies have found that exerting effort can lead people to engage in risk-taking behaviors. While effort can be either cognitive or physical, risk-taking can take place in either a risky context with known outcome probabilities or an ambiguous context with unknown outcome probabilities. The goal of the current research is to investigate how effort type and decision context influence risk-taking after effort exertion. Across three experiments, we find evidence that investing effort increases risk-taking at a short timescale. Importantly, this effect is particularly noticeable when the chance of winning is low, rather than when it is uncertain. Furthermore, the increase in risk-taking happens regardless of whether the effort is cognitive or physical. These findings suggest the existence of a cost-invariant but decision context-variant mechanism for the risk-taking after-effect of effort expenditure, which helps to bring the negative emotions caused by effort exertion back to a state of emotional homeostasis.

Changes in decision-making function in patients with subacute mild traumatic brain injury

Although awareness regarding patients with mild traumatic brain injury has increased, they have not received sufficient attention in clinics; hence, many patients still experience only partial recovery. Deficits in decision-making function are frequently experienced by these patients. Accurate identification of impairment in the early stages after brain injury is particularly crucial for timely intervention and the prevention of long-term cognitive consequences. Therefore, we investigated the changes in decision-making ability under tasks of ambiguity and risk in patients with mild traumatic brain injury with a rule-based neuropsychological paradigm. In this study, patients (n = 39) and matched healthy controls (n = 38) completed general neuropsychological background tests and decision-making tasks (Iowa Gambling Task and Game of Dice Task). We found that patients had extensive cognitive impairment in general attention, memory and information processing speed in the subacute phase, and confirmed that patients had different degrees of impairment in decision-making abilities under ambiguity and risk. Furthermore, the decline of memory and executive function may be related to decision-making dysfunction.

Decision-making under ambiguity and risk and executive functions in Parkinson's disease patients: A scoping review of the studies investigating the Iowa Gambling Task and the Game of Dice

Evidence shows that patients affected by Parkinson's disease (PD) display the tendency toward making risky choices. This is due, at least in part, to the pathophysiological characteristics of the disease that affects neural areas underlying decision making (DM), in which a pivotal role is played by nonmotor corticostriatal circuits and dopamine. Executive functions (EFs), which can be impaired by PD as well, may sustain optimal choices in DM processes. However, few studies have investigated whether EFs can support PD patients to make good decisions. Adopting the scoping review approach, the present article is designed to deepen the cognitive mechanisms of DM under conditions of ambiguity and risk (that are conditions common to everyday life decisions) in PD patients without impulse control disorders. We focused our attention on the Iowa Gambling Task and the Game of Dice Task, because they are the most commonly used and reliable tasks to assess DM under ambiguity and under risk, respectively, and analyzed the performances in such tasks and their relationships with EFs tests in PD patients. The analysis supported the relationships between EFs and DM performance, especially when a higher cognitive load is required to make optimal decisions, as it happens under conditions of risk. Possible knowledge gaps and further research directions are suggested to better understand DM mechanisms in PD sustaining patients' cognitive functioning and preventing negative consequences in everyday life derived from suboptimal decisions.

Decision-making deficits in obsessive-compulsive disorder are associated with abnormality of recency and response consistency parameter in prospect valence learning model

Background

Patients with obsessive-compulsive disorder (OCD) have deficits in decision-making in the Iowa Gambling Task (IGT). However, no study has investigated the parameters of the prospect valence learning (PVL) model in the IGT for OCD.

Aims

This study aimed to investigate deficits in decision-making in OCD using the PVL model and identify whether the parameters of the PVL model were associated with obsessive-compulsive severity.

Methods

Forty-seven medication-free patients with OCD were compared with 47 healthy controls (HCs). Decision-making was measured using the total net and block net scores of the IGT. A PVL model with a decay-reinforcement learning rule (PVL-DecayRI) was used to investigate the parameters of the model. Correlation analysis was conducted between each parameter of the PVL-DecayRL and obsessive-compulsive symptoms.

Results

The total net score of patients with OCD was significantly lower than that of the HCs. The block net scores of the OCD group did not differ across the five blocks, whereas in the HCs, the fifth block net score was significantly higher than the block net scores of the first and second blocks. The values of the recency and response consistency parameters of the PVL-DecayRI in patients with OCD were significantly lower than those in HCs. The recency parameter positively correlated with the Y-BOCS obsessive score. Meanwhile, there was no correlation between consistency parameter values and symptom severity in OCD.

Conclusion

Our detailed analysis of the decision-making deficit in OCD suggests that the most recent outcome has a small influence on the expectancy of prospect valence, as indicated by the lower recency parameter, and is characterized by more impulsive choices, as indicated by the lower consistency parameter.

Adaptations of the balloon analog risk task for neuroimaging settings: a systematic review

Introduction

The Balloon Analog Risk Task (BART), a computerized behavioral paradigm, is one of the most common tools used to assess the risk-taking propensity of an individual. Since its initial behavioral version, the BART has been adapted to neuroimaging technique to explore brain networks of risk-taking behavior. However, while there are a variety of paradigms adapted to neuroimaging to date, no consensus has been reached on the best paradigm with the appropriate parameters to study the brain during risk-taking assessed by the BART. In this review of the literature, we aimed to identify the most appropriate BART parameters to adapt the initial paradigm to neuroimaging and increase the reliability of this tool.

Methods

A systematic review focused on the BART versions adapted to neuroimaging was performed in accordance with PRISMA guidelines.

Results

A total of 105 articles with 6,879 subjects identified from the PubMed database met the inclusion criteria. The BART was adapted in four neuroimaging techniques, mostly in functional magnetic resonance imaging or electroencephalography settings.

Discussion

First, to adapt the BART to neuroimaging, a delay was included between each trial, the total number of inflations was reduced between 12 and 30 pumps, and the number of trials was increased between 80 and 100 balloons, enabling us to respect the recording constraints of neuroimaging. Second, explicit feedback about the balloon burst limited the decisions under ambiguity associated with the first trials. Third, employing an outcome index that provides more informative measures than the standard average pump score, along with a model incorporating an exponential monotonic increase in explosion probability and a maximum explosion probability between 50 and 75%, can yield a reliable estimation of risk profile. Additionally, enhancing participant motivation can be achieved by increasing the reward in line with the risk level and implementing payment based on their performance in the BART. Although there is no universal adaptation of the BART to neuroimaging, and depending on the objectives of a study, an adjustment of parameters optimizes its evaluation and clinical utility in assessing risk-taking.

Metacognitive Strategy Training Improves Decision-Making Abilities in Amnestic Mild Cognitive Impairment

Mild cognitive impairment (MCI) is associated with deficits in decision-making, which is of utmost importance for daily functioning. Despite evidence of declined decision-making abilities, research on decision-making interventions for MCI is scarce. As metacognition seems to play an important role in decision-making, the present study's aim was to examine whether a metacognitive strategy training can improve MCI patients' decision-making abilities. Older adults-patients of a day care center, diagnosed with amnestic MCI (n = 55) were randomly allocated in two groups, which were matched in gender, age and educational level. Τhe experimental group (n = 27, 18 women, mean age = 70.63, mean years of education = 13.44) received the metacognitive strategy training in parallel with the cognitive and physical training programs of the day care center, and the active control group (n = 28, 21 women, mean age = 70.86, mean years of education = 13.71) received only the cognitive and physical training of the center. The metacognitive strategy training included three online meeting sessions that took place once per week. The basis of the intervention was using analytical thinking, by answering four metacognitive-strategic questions, to make decisions about everyday situations. To examine the efficacy of the training, the ability to make decisions about everyday decision-making situations and the ability to apply decision rules were measured. Both groups participated in a pre-test session and a post-test session, while the experimental group also participated in a follow-up session, one month after the post-test session. The results showed that the experimental group improved its ability to decide, based on analytical thinking, about economic and healthcare-related everyday decision-making situations after they received the metacognitive strategy training. This improvement was maintained one month later. However, the ability to apply decision rules, which requires high cognitive effort, did not improve. In conclusion, it is important that some aspects of the analytical decision-making ability of amnestic MCI patients were improved due to the present metacognitive intervention.

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.

A cognitive rehabilitation program to improve hot and cool executive dysfunction in juvenile myoclonic epilepsy: Preliminary findings

OBJECTIVE

Executive and attentional deficits are often described in Juvenile Myoclonic Epilepsy (JME). We aimed to evaluate the short-term impact of rehabilitation developed for the most frequent cognitive deficits of persons with JME.

METHODS

Thirty-three patients entered this study which consisted of 12 individual sessions once a 60-minute week, divided into planning/organization, attention, and impulsivity. Twenty-seven patients finished the protocol, and all patients had pre-and-post evaluations from neuropsychological tests and self-rating questionnaires. Generalized Estimating Equations (GEE) inferential statistics were used to verify the protocol's effect, and a 95% confidence interval was adopted.

RESULTS

We found significant improvement in selective attention (TMT A [p < 0.01] and Stroop test 2 [p = 0.03]), inhibitory control (Stroop test 3 [p = 0.02], FAS [p < 0.01], CPT commissions [p < 0.01]), mental flexibility [WCST categories p < 0.01] and implicit decision making (IGT blocks A [p < 0.01], B [p = 0.02], C [p < 0.01] and D [p < 0.01]). All components of the Behavioral Rating Index of Executive Functions metacognition index and the general quotient had significant improvement (initiative [p ≤ 0.01], working memory [p ≤ 0.01], planning and organization [p ≤ 0.01], task monitor [p = 0.02] and organization of materials [p = 0.02]). Regarding the Behavioral Regulation Index, the "Emotional Control" was improved [p = 0.03]. The attentional component and general scores of the Adult Self-Report Scale for Adults also changed significantly [p ≤ 0.01].

SIGNIFICANCE

Executive function and attention had an improvement in objective and subjective tests. The context-dependent reactive mechanism of impulsivity improved in instruments based on the ecological evaluation. Our findings, though preliminary due to a lack of controls and practice effect corrections, support that cognitive rehabilitation may be a valuable resource to alleviate cognitive deficits in patients with JME.

Decision-making impairment under ambiguity but not under risk may underlie medication overuse in patients with chronic migraine

OBJECTIVE

To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit.

BACKGROUND

Factors underlying MOH in patients with CM remain unclear. Whether the process of decision-making plays a role in MOH is still controversial. Decision-making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known.

METHODS

Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test.

RESULTS

A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age- and sex-similar healthy controls (HCs), completed this cross-sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th-75th percentile]: 8 [5-11] vs. 1 [0-4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were - 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72)  = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = -0.41, p = 0.003), suggesting that decision-making under ambiguity may be related to MOH.

CONCLUSIONS

Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH.

Decision-making abilities under risk and ambiguity in adults with traumatic brain injury: what do we know so far? A systematic review and meta-analysis

Traumatic brain injury (TBI) is a major health and socio-economic problem since it is one of the major sources of death and disability worldwide. TBI patients usually show high heterogeneity in their clinical features, including both cognitive and emotional/behavioral alterations. As it specifically concerns cognitive functioning, these patients usually show decision-making (DM) deficits. DM is commonly considered a complex and multistep process that is strictly linked to both hot and cold executive functioning and is pivotal for daily life functioning and patients' autonomy. However, the results are not always in agreement, with some studies that report huge alterations in the DM processes, while others do not. The present systematic review and meta-analysis aims to integrate past literature on this topic, providing a clear and handy picture both for researchers and clinicians. Thirteen studies addressing domain-general DM abilities were included from an initial N = 968 (from three databases). Results showed low heterogeneity between the studies (I2 = 7.90, Q (12) = 13.03, p = .37) supporting the fact that, overall, TBI patients showed lower performance in DM tasks as compared to healthy controls (k = 899, g = .48, 95% CI [0.33; 0.62]) both in tasks under ambiguity and under risk. The evidence that emerged from this meta-analysis denotes a clear deficit of DM abilities in TBI patients. However, DM tasks seemed to have good sensitivity but low specificity. A detailed description of patients' performances and the role of both bottom-up, hot executive functions and top-down control functions have been further discussed. Finally, future directions and practical implications for both researchers and clinicians have been put forward.

Decision-making under ambiguity after frontal lobe resection for epilepsy

PURPOSE

Decision-making is crucial to daily life and can impact our society as well as economic conditions. Although the frontal lobes have been identified as important for decision-making, this capacity has only been studied to a limited extent in frontal lobe epilepsy and not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore decision-making under ambiguity after FLR for epilepsy.

METHODS

Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task (IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa Gambling Task scores included in the analysis were: total net score, separate scores from five blocks across the test, and a change score (last block of IGT minus first block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological methods for assessment of executive functions, self-rating questionnaires of mental health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated.

RESULTS

The patient group performed inferior to controls at the final block of the IGT (p =.001).A group difference in IGT change scores was found (p =.005), reflectingthe absence of a positive change in performance over time for the FLR group compared to the control group. Correlations with tests of executive functions as well as self-rating scales were mainly statistically nonsignificant.

CONCLUSIONS

This study shows that patients having undergone FLR for epilepsy have difficulties with decision-making under ambiguity. The performance illustrated a failure to learn throughout the task. Executive as well as emotional deficits may impact decision-making processes in this patient group and need to be considered in further studies. Prospective studies with larger cohorts are needed.

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.

Distinct neural dynamics underlying risk and ambiguity during valued-based decision making

Uncertainty can be fractioned into risk and ambiguity psychologically and neurobiologically. However, whether and how risk and ambiguity are dissociated in terms of neural dynamics during value-based decision making remain elusive. The present event-related potential (ERP) study addressed these issues by asking participants to perform a wheel-of-fortune task either during a risky context (Experiment 1; N = 30) where outcome probability was known or during an ambiguous context (Experiment 2; N = 30) where outcome probability was unknown. Results revealed that the cue-P3 was more enhanced for risk versus ambiguity during the anticipatory phase, whereas the RewP was more increased for ambiguity than risk during the consummatory phase. Moreover, the SPN and the fb-P3 components were further modulated by the levels of risk and ambiguity, respectively. These findings demonstrate a neural dissociation between risk and ambiguity, which unfolds from the anticipatory phase to the consummatory phase.

Effect of visual presentation format and recall direction on letter span and error patterns in Deaf signing and hearing adults

Deaf signers consistently show shorter memory spans than hearing nonsigners, but the scope and nature of this difference remain unclear. The present study tested whether Deaf signers are biased toward flexible use of visual aspects of linguistic items. Matched samples of adult Deaf signers (N = 33) and hearing nonsigners (N = 32) performed a letter-span task with visual serial presentation, to bias phonological processing, and a simultaneous presentation, to bias visuospatial processing. We also manipulated short-term memory by varying recall direction (forward, backward). Analyses revealed reduced spans for Deaf signers compared with hearing nonsigners, backward compared with forward recall, and sequential compared with simultaneous presentation. Item-level responses indicated that Deaf signers made more errors than hearing nonsigners across three error types. Deaf signers also showed reduced item position binding compared with hearing nonsigners, which indicates differences related to item order and sequencing in tasks with printed, linguistic stimuli. Deaf signers were the only group who demonstrated reduced omission errors when switching from sequential to simultaneous presentation, suggesting flexible processing mechanisms. No group differences were found for a secondary spatial span test, indicating the scope of group differences for ordered information was limited to verbal items. Overall, results are consistent with flexible use of different memory cues in Deaf signers. A core area for future research includes evaluating reduced activation of phonological representations of linguistic items in Deaf signers. These results amplify a novel M³ model approach for evaluating how errors contribute to short-term memory differences in Deaf signers.

Risk Decision Making and Executive Function among Adolescents and Young Adults

The dual theory establishes that the decision-making process relies on two different systems, the affective system and the executive function (EF), developed during adolescence. This study analyzes the relationship between the decision-making and EF processes in a group of early adolescents (mean age = 12.51 years, SD = 0.61), where more affective impulse processes are developed, and in young adults (mean age = 19.38 years, SD = 1.97), where cognitive control processes have already matured. For this purpose, 140 participants in Spain completed the Iowa Gambling Task (IGT) to measure their risky decisions and the Wisconsin Card Sorting Task (WCST) to measure their EF. Performance on the IGT improves over blocks; however, adolescents received lower mean scores than young adults. However, controlling for age, perseverative errors were negatively associated with the mean net score on the risky blocks of IGT; thus, those who committed more perseverative errors in the WCST were more likely to take cards from the disadvantageous decks on the last blocks of the IGT. The current study shows that adolescents and adults solve ambiguous decisions by trial and error; however, adolescents are more likely to make risky decisions without attending to the long-term consequences. Following the dual theory hypothesis, the maturation of EF with age partly accounts for this difference in risky decision-making between adolescents and adults.

Deterministic and probabilistic regularities underlying risky choices are acquired in a changing decision context

Predictions supporting risky decisions could become unreliable when outcome probabilities temporarily change, making adaptation more challenging. Therefore, this study investigated whether sensitivity to the temporal structure in outcome probabilities can develop and remain persistent in a changing decision environment. In a variant of the Balloon Analogue Risk Task with 90 balloons, outcomes (rewards or balloon bursts) were predictable in the task's first and final 30 balloons and unpredictable in the middle 30 balloons. The temporal regularity underlying the predictable outcomes differed across three experimental conditions. In the deterministic condition, a repeating three-element sequence dictated the maximum number of pumps before a balloon burst. In the probabilistic condition, a single probabilistic regularity ensured that burst probability increased as a function of pumps. In the hybrid condition, a repeating sequence of three different probabilistic regularities increased burst probabilities. In every condition, the regularity was absent in the middle 30 balloons. Participants were not informed about the presence or absence of the regularity. Sensitivity to both the deterministic and hybrid regularities emerged and influenced risk taking. Unpredictable outcomes of the middle phase did not deteriorate this sensitivity. In conclusion, humans can adapt their risky choices in a changing decision environment by exploiting the statistical structure that controls how the environment changes.

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.

Decision-Making in Alzheimer's Disease: The Role of Working Memory and Executive Functions in the Iowa Gambling Task and in Tasks Inspired by Everyday Situations

BACKGROUND

Alzheimer's disease (AD) negatively impacts patients' ability to make advantageous decisions, i.e., a core ability contributing to the preservation of autonomy.

OBJECTIVE

The present study aims to analyze the changes that occur in the decision-making competence (DMC) in AD patients and to determine if these changes are related to the deterioration of executive functions and working memory.

METHOD

To this end, 20 patients with AD and 20 elderly control adults were assessed using executive, working memory, and DMC tasks. The latter comprised the Iowa Gambling Task (IGT) and a scenarios task based on situations inspired by everyday life and performed under conditions of risk and ambiguity.

RESULTS

Results revealed lower performances in AD patients than in elderly control adults for all the tasks assessing cognitive functions. The AD patients also made more strategy changes during the IGT. In the scenarios tasks, the two groups took as many ambiguous or risky decisions, but AD patients tended to take more risks in the context of gain than elderly control adults did. Switching and updating ability, as well as working memory, appeared to be involved in decisions in tasks inspired by everyday life, while inhibition was more related to the IGT performances.

CONCLUSION

Working memory and executive functions seem to be involved in decision-making, but in different ways in gambling and daily-life situations.

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.

The impact of mild cognitive impairment on decision-making under explicit risk conditions: Evidence from the Personality and Total Health (PATH) Through Life longitudinal study

OBJECTIVE

Previous research has indicated that cognition and executive function are associated with decision-making, however the impact of mild cognitive impairment (MCI) on decision-making under explicit risk conditions is unclear. This cross-sectional study examined the impact of MCI, and MCI subtypes, on decision-making on the Game of Dice Task (GDT), among a cohort of older adults.

METHOD

Data from 245 older adult participants (aged 72-78 years) from the fourth assessment of the Personality and Total Health Through Life study were analyzed. A diagnostic algorithm identified 103 participants with MCI, with subtypes of single-domain amnestic MCI (aMCI-single; n = 38), multi-domain amnestic MCI (aMCI-multi; n = 31), and non-amnestic MCI (n = 33), who were compared with an age-, sex-, education-, and income-matched sample of 142 cognitively unimpaired older adults. Decision-making scores on the GDT (net score, single number choices, and strategy changes) were compared between groups using nonparametric tests.

RESULTS

Participants with MCI showed impaired performance on the GDT, with higher frequencies of single number choices and strategy changes. Analyses comparing MCI subtypes indicated that the aMCI-multi subtype showed increased frequency of single number choices compared to cognitively unimpaired participants. Across the sample of participants, decision-making scores were associated with measures of executive function (cognitive flexibility and set shifting).

CONCLUSION

MCI is associated with impaired decision-making performance under explicit risk conditions. Participants with impairments in multiple domains of cognition showed the clearest impairments. The GDT may have utility in discriminating between MCI subtypes.

Theoretical conceptualization of online privacy-related decision making – Introducing the tripartite self-disclosure decision model

Self-disclosures on online social networks have received increased attention in the last two decades. Researchers from different disciplines investigated manifold influencing variables, and studies applied different theories to explain why many users share very sensitive and personal information despite potential risks and negative consequences, whereas others do not. Oftentimes, it is argued that self-disclosure decisions result from a kind of rational “calculus” of risks and benefits. However, such an assumption of rationality can and has been criticized. Nevertheless, fundamental cognitive and affective mechanisms that underlie self-disclosure decision making on social networks are still under-explored. By building upon previous self-disclosure theories and models, dual-and tripartite-system perspectives of decision making, and former empirical findings, we propose a Tripartite Self-Disclosure Decision (TSDD) model that conceptualizes inner processes of online self-disclosure decision making. Central to this model is the proposed interaction of three neural and cognitive/affective systems: a reflective, an impulsive, and an interoceptive system. We further highlight individual and environmental features, which can impact individuals’ online self-disclosure decisions by (interactively) influencing the proposed inner decision-making processes targeting the aforementioned three systems. Possible short- and long-term consequences are also discussed, which in turn can affect certain model components in subsequent self-disclosure decision situations. By taking such a neurocognitive perspective, we expand current research and models, which helps to better understand potentially risky information sharing on online social networks and can support attempts to prevent users from incautious self-disclosures.

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.

Decreased sensitivity to loss of options in patients with Parkinson's disease

Humans prefer to have many options when making decisions. When there is a threat of options disappearing, humans invest more to keep these options available, indicating that they are sensitive to the loss of options. This study examined whether patients with Parkinson's disease (PD), a disease characterized by dopamine depletion, try to keep options available when options are disappearing. Twenty-seven PD patients without dementia and 27 healthy controls (HCs) performed the door game, in which participants were presented with multiple alternatives in the form of three doors, each associated with a different point distribution. The participants were asked to maximize their point earnings by finding the best door. The task included two conditions. In the shutter condition, shutters gradually closed on doors that were not chosen; once the shutters completely closed, the door was no longer available. There were no shutters in the control condition. The results revealed that the HCs switched doors more often in the shutter condition than in the control condition, indicating a tendency to keep options available. However, the PD patients did not show such differences between the two conditions. The difference in the number of switches between the shutter and control conditions in the PD patients was significantly positively correlated with the distribution of dopamine transporters in the left striatum, as measured by ¹²³I-ioflupane-SPECT (DaTSCAN) images. These results suggest that PD patients are less sensitive to the loss of options, and this decreased sensitivity may be caused by a decline in dopaminergic neurotransmission.

A fuzzy soft set based novel method to destabilize the terrorist network

This paper aims to select the appropriate node(s) to effectively destabilize the terrorist network in order to reduce the terrorist group’s effectiveness. Considerations are introduced in this literature as fuzzy soft sets. Using the weighted average combination rule and the D–S theory of evidence, we created an algorithm to determine which node(s) should be isolated from the network in order to destabilize the terrorist network. The paper may also prove that if its power and foot soldiers simultaneously decrease, terrorist groups will collapse. This paper also proposes using entropy-based centrality, vote rank centrality, and resilience centrality to neutralize the network effectively. The terrorist network considered for this study is a network of the 26/11 Mumbai attack created by Sarita Azad.

Decision-making in uncertain contexts: The role of autonomic markers in resolving indecision

Although impulsivity is associated with an increased willingness to make risky decisions, uncertainty intolerance may also contribute to maladaptive decision-making behavior, where individuals neglect to pursue potential rewards even when probabilities for success are in their favor. Several theories have sought to explain the neural systems that guide decision-making in this context, with evidence supporting a role for increased sympathetic activation. However, it remains unclear whether the sympathetic system is associated with greater apprehension in response to uncertain outcomes, or whether it serves to guide behavioral decisions in the context of this uncertainty. Furthermore, although postulated as a within-person process, most research has examined the association between decision behavior and sympathetic activation at the between-person level. We hypothesize that in the context of uncertainty between-person differences in skin conductance will be associated with longer deliberation times; whereas within-person trial-level increases in skin conductance will be associated with a tendency to reject uncertain options. Data were collected from n = 56 children aged 7-11 years, using a computerized card game in which children chose to accept or reject cards of varying point value at varying levels of probability. Skin conductance level (SCL) was recorded throughout the task. No significant between-person associations emerged. However, within-person analyses indicated that momentary deliberation time moderated the association between momentary skin-conductance and decision outcome. This moderation was such that for trials during which the individual deliberated longer (i.e., was more indecisive), a concurrent increase in skin conductance was associated with a significantly higher likelihood of rejecting the card. The within-person nature of these results suggests that skin conductance may help in resolving indecision in the context of uncertainty.

Ongoing pain facilitates emotional decision-making behaviors

Emotion toward anticipated and actual outcomes acts as a vital signal on emotional decision-making, and the Iowa Gambling Task (IGT) can mimic this decision-making process. Pain can impair emotional decision-making behaviors because it captures attention and distracts from the task at hand. Alternatively, pain may facilitate emotional decision-making behaviors by prompting alertness and mobilizing cognitive resources to maximize rewards. The present study investigated the influence of ongoing pain on emotional decision-making behaviors using the IGT. Our study recruited two groups of participants and applied capsaicin (pain group) or control cream (control group) to their forearms. We then compared performances and selections between the pain and control groups. The results revealed that participants successfully learned the required adaptive selection strategy as the task progressed. The study observed a tendency toward optimal choices for both groups under the condition of frequent–small losses. However, we observed a disadvantageous preference for the control group, but not the pain group, when faced with choices with infrequent but large losses. The study implies that a distressing pain experience motivates individuals to adjust goal-directed behaviors to maximize their rewards in a task. Thus, the finding suggests that ongoing pain facilitates emotional decision-making behaviors.

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.

Decision Making and Risk Propensity in Individuals with Tendencies towards Specific Internet-Use Disorders

The uncontrolled use of specific Internet applications is increasingly recognized as a mental health issue. Gaming disorder, which is one subtype of specific Internet-use disorders (sIUDs), has been included in the ICD-11 as disorder due to addictive behaviors. Addictive disorders are assumed to be accompanied by cognitive deficits as indicated by weaker performance in executive function and risky decision-making tasks. This study investigates risky decision-making in individuals with tendencies towards sIUDs including gaming, online buying-shopping, and social-networks-use disorders. A total of 293 individuals participated in the study. Based on specific screening instruments, the participants were assigned to a group with tendencies towards sIUD or a control group. Participants completed a risky decision-making task and questionnaires assessing risk-taking propensity, impulsivity, psychopathology, and perceived stress. The group with sIUD tendencies showed higher attentional impulsivity and higher levels of depression and anxiety compared to the control group. The groups did not differ in decision making and risk propensity. Decision making did not have significant effects on sIUD symptoms. Risk for developing sIUDs does not appear to be accompanied by altered general decision-making tendencies. Rather, psychological (pre-)load and attentional deficits appear to be relevant features in uncontrolled use of the Internet.

Decision-Making Under Risk and Uncertainty by Substance Abusers and Healthy Controls

Cognitive impairment characterized by high impulsivity and risk-taking has been correlated with substance-related disorders. However, it is unclear if the decision-making process is well known upon consideration of factors such as uncertainty environments, risk, and time manipulation in different decision-making procedures. The main objective of this study was to identify behavioral differences between substance abusers and healthy control participants in a behavioral test battery, including (1) two uncertainty decision-making tasks, the Balloon Analog Risk Task (BART) and the Iowa Gambling Task (IGT, trial 1-40); (2) three risk-taking tasks, the Columbia Card Task Hot version (CCT-hot), Columbia Card Task Cold version (CCT-cold), and the IGT (trial 41-100); and (3) an impulsivity task, the Delay Discounting task (DD). The second objective looked at how the six behavioral tests correlate. We worked with a sample of 54 adult participants (Substance abusers: n = 28; Healthy controls: n = 26). An anonymous survey website was created to execute all the cognitive tasks. The results showed no statistically significant differences between the groups in any of the tasks. However, the results showed an upward trend of impulsive (i.e., steeply discounting curve) and risk-taking behaviors (i.e., a low learning curve in IGT) in substance abuse participants. The factor analysis results showed four different main factors: (1) risk-taking task in the IGT (trial 40-100), (2) uncertainty task in BART, (3) impulsivity in DD, IGT (trial 1-40), and (4) deliberate process in the Columbia card task (cold and hot). We conclude that factors such as the uncertainty tasks in the BART and the first block of IGT trials, the risk cues in the CCT tasks (i.e., number of loss, number of gains, and loss cards), and the time to delivery in the DD task, can affect the complex decision-making process in both clinical and healthy groups.

P300 and delay-discounting in obsessive-compulsive disorder

Previous research showed that dysfunctions of fronto-striatal neural networks are implicated in the pathophysiology of obsessive-compulsive disorder (OCD). Accordingly, patients with OCD showed altered performances during decision-making tasks. As P300, evoked by oddball paradigms, is suggested to be related to attentional and cognitive processes and generated in the medial temporal lobe and orbitofrontal and cingulate cortices, it is of special interest in OCD research. Therefore, this study aimed to investigate P300 in OCD and its associations with brain activity during decision-making: P300, evoked by an auditory oddball paradigm, was analysed in 19 OCD patients and 19 healthy controls regarding peak latency, amplitude and source density power in parietal cortex areas by sLORETA. Afterwards, using a fMRI paradigm, Blood-oxygen-level-dependent (BOLD) contrast imaging was conducted during a delay-discounting paradigm. We hypothesised differences between groups regarding P300 characteristics and associations with frontal activity during delay-discounting. The P300 did not differ between groups, however, the P300 latency over the P4 electrode correlated negatively with the NEO-FFI score openness to experience in patients with OCD. In healthy controls, P300 source density power correlated with activity in frontal regions when processing rewards, a finding which was absent in OCD patients. To conclude, associations of P300 with frontal brain activation during delay-discounting were found, suggesting a contribution of attentional or context updating processes. Since this association was absent in patients with OCD, the findings could be interpreted as being indeed related to dysfunctions of fronto-striatal neural networks in patients with OCD.

Reward-related decision-making deficits in internet gaming disorder: a systematic review and meta-analysis

AIMS

To estimate the aggregated effect sizes of reward-related decision-making deficits in internet gaming disorder (IGD) and to explore potential moderators on the variability of effect sizes across studies.

DESIGN

Review of peer-reviewed studies comparing reward-related decision-making performance between IGD and control participants identified via PubMed, Web of Science and ProQuest databases. Random-effects modeling was conducted using Hedge's g as the effect size (ES). The effects of decision-making situation, valence, sample type, testing environment, IGD severity and self-reported impulsivity on decision-making differences were examined by moderator analyses.

SETTING

No restrictions on location.

PARTICIPANTS

Twenty-four studies (20 independent samples) were included in the meta-analysis, resulting in 604 IGD and 641 control participants and 35 ESs.

MEASURES

Reward-related decision-making differences between IGD and control groups.

FINDINGS

The overall ES for decision-making deficits in IGD was small (g = -0.45, P < 0.01). The effects were comparable across risky, ambiguous and inter-temporal decision-making. Larger aggregate ESs were identified for pure-gain and mixed compared with pure-loss decision-making. Studies based on clinical and community samples showed similar effects. No significant difference between behavioral studies and those with extra measurements was observed. Decision-making alterations were not closely associated with IGD severity or self-reported impulsivity differences at the study level.

CONCLUSIONS

Internet gaming disorder appears to be consistently associated with reward-related decision-making deficits.

Decision-Making Support for People With Alzheimer's Disease: A Narrative Review

The proportion of people with dementia has been increasing yearly, and the decision-making capacity of these people has become a major concern in fields such as the financial industry and in medical settings. In this narrative review, we discuss decision-making in people with Alzheimer’s disease (AD), and we propose the support for decision-making in people with AD, especially financial and medical decision-making. We summarize several hypotheses and theories on the decision-making capacity of people with AD. These include the frontal lobe hypothesis, physiological theory, dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, and the Person-Task-Fit (PTF) framework. Both internal and external factors can affect decision-making by people with AD. Internal factors are affected by changes in the brain and neurotransmitters, as well as alterations in cognitive ability and emotion. External factors include task characters, task contents, and situation influence. Since feedback has a significant effect on decision-making capacity, a series of suggestions may be helpful to improve this capacity, such as explicit advice, simple options, pleasant rewards, the Talking Mats approach, memory and organizational aid, support by caregivers, cognitive training and feedback. Thus, in providing decision-making support for people with AD, it is important to identify the internal and external factors that impair this process and to deal with these factors.