Selective impairment of goal-directed decision-making following lesions to the human ventromedial prefrontal cortex

• Published in: Brain (London, England : 1878) Vol. 140; no. 6; pp. 1743 - 1756
• Main Authors: Reber, Justin, Feinstein, Justin S., O’Doherty, John P., Liljeholm, Mimi, Adolphs, Ralph, Tranel, Daniel
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.06.2017
• Subjects: Aged; Brain Diseases - complications; Brain Diseases - diagnostic imaging; Brain Diseases - physiopathology; Choice Behavior - physiology; Cognitive Dysfunction - diagnostic imaging; Cognitive Dysfunction - etiology; Cognitive Dysfunction - physiopathology; Female; Goals; Humans; Male; Middle Aged; Original; Prefrontal Cortex - diagnostic imaging; Prefrontal Cortex - physiopathology; Registries; Reward; reward; devaluation; decision-making; instrumental; vmPFC
• ISSN: 0006-8950; 1460-2156; 1460-2156
• DOI: 10.1093/brain/awx105

See Manohar and Akam (doi: 10.1093/brain/awx119 ) for a scientific commentary on this article. Using a food reward devaluation procedure, Reber et al . show that patients with ventromedial prefrontal cortex lesions are selectively impaired in instrumental choices following satiation. This argues for a role for the human vmPFC in goal-directed decision-making, while showing that it is not necessary for hedonic experience of outcome value. See Manohar and Akam (doi: 10.1093/brain/awx119 ) for a scientific commentary on this article. Neuroimaging studies suggest that the human ventromedial prefrontal cortex is a key region for goal-directed behaviour. However, it remains unclear whether the ventromedial prefrontal cortex is necessary for such behaviour. Here we used a canonical test from the animal literature designed to distinguish goal-directed from habit-based choice: namely, outcome devaluation. Patients with focal damage to the ventromedial prefrontal cortex showed deficits in goal-directed choice by persistently selecting actions for a food outcome that had been devalued through selective satiation. By contrast, the same patients had entirely intact acquisition of instrumental contingencies, demonstrating preserved habitual control, and also gave normal ratings of the hedonic value of the devalued food. These findings for the first time demonstrate a necessary and selective role for the human ventromedial prefrontal cortex in goal-directed choice, reconciling prior neuroimaging results in humans with lesion studies in animals, and providing a mechanistic explanation of the real-life deficits in decision-making that have been documented in patients with damage to this structure.