Gambling task performance in traumatic brain injury: relationships to injury severity, atrophy, lesion location, and cognitive and psychosocial outcome.
OBJECTIVE
To determine the sensitivity of the Gambling Test (GT) to the neurocognitive effects of traumatic brain injury (TBI) and to examine the cognitive, neural, and psychosocial correlates of impaired GT performance in patients with TBI.


BACKGROUND
The GT is sensitive to behavioral deficits in patients with prefrontal brain damage, especially in ventral regions. Patients with TBI and behavioral deficits often have focal ventral prefrontal damage as well as diffuse damage. Analysis of the correlates of the GT in this population has implications for interpretation of the GT in other groups.


METHODS
Seventy-one TBI patients were administered the GT, neuropsychological tests, and psychosocial outcome questionnaires. Patients also had high-resolution structural magnetic resonance imaging analyzed for both lesion location and tissue compartment volumes.


RESULTS
The GT was sensitive to TBI in general, but not to TBI severity or quantified chronic phase atrophy. Marked impairment was observed in (but not limited to) patients with large frontal lesions. There were modest correlations between the GT and tests of working memory and executive functioning as well as between self- and other-rated real-life memory, executive, and emotional problems.


CONCLUSIONS
The GT can be a useful adjunct to assessment of patients with TBI. Interpretation of GT performance in patients with complex neuropsychological deficits such as TBI should consider the influence of domain-general resources in addition to specific ventral prefrontal function.
Levine
Brian
B
Rotman Research Institute, Baycrest Centre for Geriatric Care,. University of Toronto, Ontario M6A 2E1, Canada. levine@psych.utoronto.ca
Black
Sandra E
SE
Cheung
Gordon
G
Campbell
Ann
A
O'Toole
Colleen
C
Schwartz
Michael L
ML
D000328:Adult; D001284:Atrophy; D001930:Brain Injuries / Q000523:psychology*; D016022:Case-Control Studies; D005260:Female; D005625:Frontal Lobe / Q000293:injuries / Q000473:pathology; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D013647:Task Performance and Analysis