Studied decision-making impairments in patients with pathological gambling (PG). 25 male patients diagnosed with PG according to the criteria of the 10th International Classification of Diseases (ICD-10) and the 4th Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), were compared to 25 healthy males. Mean age across subject groups was 40 years. Additional standardized measures of cognitive functions, interference susceptibility, sensation seeking, and personality were also obtained. The game of dice task, which involves a risk situation with explicit rules for gains and losses, was implemented. A comparison of group results showed substantial performance deficits in PG patients compared to controls. The frequency of PG patients' risky decisions correlated with indicators of executive functioning and feedback processing. The findings suggest that underlying impairments in dorsolateral prefrontal and orbitofrontal cortical functioning are responsible for PG patients' risky decisions. Future studies will compare PG patients' decision-making performance on tasks with explicit and implicit rules.