Executive Functions and Decision-Making in Tunisian Pathological Gamblers

Pathological gambling is a complex disorder characterised by a loss of control and the persistence of behaviour despite its negative consequences. It is frequently associated with executive deficits in cognitive flexibility, inhibition, and decision-making, which contribute to the maintenance of gambling behaviour and reduce adaptive capacities. A total of 120 participants aged between 16 and 80 years, all meeting the criteria for pathological gambling, were divided into three groups: adolescents, young adults, and older adults. Executive functions were assessed using the Wisconsin Card Sorting Test (WCST), the GoStop (Stop-Signal Task), and the Iowa Gambling Task (IGT). A one-way ANOVA revealed significant effects on cognitive flexibility (WCST) and inhibition (GoStop) but not on decision-making (IGT). Post hoc Tukey tests showed that older adults made more perseverative errors and completed fewer categories on the WCST than adolescents, while young adults occupied an intermediate position without significant differences. In the GoStop task, older adults exhibited poorer inhibitory control than adolescents. On the IGT, no significant group differences were found, although a trend towards lower scores was observed in older adults. Correlation analyses indicated that perseverative errors on the WCST were strongly and negatively associated with the number of categories completed and weakly related to the GoStop and IGT scores. These findings confirm the presence of executive deficits in pathological gamblers, emerging in young adulthood and worsening with age. They highlight the need for tailored interventions focusing on impulsivity management in younger adults and improving cognitive flexibility and inhibition in older individuals.