Neural Substrates of Decision-Making in Pathological Gambling Among Young Adult Males in Lagos: A Combined fMRI and Neuropsychological Study

Pathological gambling is increasingly prevalent in urban Nigerian settings, yet no neuroscientific investigation of its decision-making substrates exists in African populations. This study examines the neural substrates of decision-making in pathological gambling among young adult males in Lagos State, South West Nigeria, using functional MRI combined with neuropsychological assessment. A case-control design will recruit 40 males with DSM-5 gambling disorder attending addiction services in Lagos and 40 matched controls. All participants will undergo fMRI while completing the Iowa Gambling Task (IGT) and Balloon Analogue Risk Task (BART) to assess reward processing and risk tolerance. Neuropsychological assessments will evaluate working memory, impulsivity, and emotional regulation. BOLD signal patterns in ventral striatum, orbitofrontal cortex, anterior insula, and anterior cingulate cortex will be compared between groups using whole-brain and region-of-interest analyses. Structural connectivity analysis using diffusion tensor imaging will examine white matter integrity in fronto-limbic pathways. This study constitutes the first neurobiological investigation of gambling disorder in an African population, generating original brain imaging data with direct implications for neuroscience-informed treatment design and prevention policy for behavioral addiction in Nigeria. Keywords: pathological gambling, fMRI, decision-making, neural substrates, Lagos