Neurocognitive functioning in gambling: A systematic review of comparisons with other psychiatric and comorbid...

Gambling Disorder is recognized as a behavioural addiction with clinical and neurobiological similarities to substance use disorders and overlaps with other psychiatric conditions and comorbidities. While research has documented cognitive impairments in gamblers, most studies have compared this population with healthy controls or viewed it only through the lens of substance use. However, some studies have examined neurocognitive functioning with other psychiatric and comorbid conditions. Synthesizing this literature is important, given the high comorbidity rates, to clarify shared versus disorder-specific cognitive functioning and refine the clinical characterization of gambling for more accurate assessment and intervention.

A systematic search across 4 databases conducted in May' 2025 retrieved 22,058 records, out of which 316 full-text articles were assessed and 30 studies included. Screening reliability was good (Cohen's κ = 0.88), and overall study quality assessed using the Joanna-Briggs-Critical-Appraisal-Checklists for cross-sectional studies came up to 6.63 (SD = 1.03).

Results indicated that most impaired performance was found among cocaine-dependent individuals and gamblers with comorbid attention-deficit/hyperactivity disorder, followed by those with eating disorders, obsessive-compulsive disorder, and substance dependence. Gamblers with no comorbidities or with comorbid depression indicated intermediate functioning, where performance was better among methamphetamine and alcohol-dependent individuals and those with gaming disorder. More preserved cognition was reported among smokers and individuals with Tourette syndrome smokers.

Findings showed both shared and distinct patterns of neurocognitive functioning between gambling disorder, substance use disorders comorbid conditions and other psychiatric disorders, supporting reconsideration of assessment frameworks and targeted interventions that draw on the cognitive perspectives identified in this study.