Deciding how to decide: ventromedial frontal lobe damage affects information acquisition in multi-attribute decision making

• Published in: Brain (London, England : 1878) Vol. 129; no. 4; pp. 944 - 952
• Main Author: Fellows, Lesley K.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2006; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aneurysm, Ruptured - pathology; Aneurysm, Ruptured - physiopathology; Aneurysm, Ruptured - psychology; Biological and medical sciences; Biotechnology; Brain Diseases - pathology; Brain Diseases - physiopathology; Brain Diseases - psychology; D-CTL = dorsal/lateral control group; D/LF = dorsal and/or lateral frontal lobe; Decision Making; executive function; Frontal Lobe - pathology; Frontal Lobe - physiopathology; Fundamental and applied biological sciences. Psychology; Gene therapy; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Health. Pharmaceutical industry; human; Humans; Industrial applications and implications. Economical aspects; Intracranial Aneurysm - pathology; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - psychology; lesion; Magnetic Resonance Imaging; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; prefrontal cortex; Prefrontal Cortex - physiopathology; Problem Solving; Stroke - pathology; Stroke - physiopathology; Stroke - psychology; V-CTL = ventromedial control group; VMF = ventromedial frontal lobe; Human; Executive function; Frontal lobe; Nervous system diseases; Decision making; Central nervous system; Problem solving; executive function; problem solving; prefrontal cortex; human; Prefrontal cortex; lesion; Encephalon
• ISSN: 0006-8950; 1460-2156; 1460-2156
• DOI: 10.1093/brain/awl017

Ventromedial frontal lobe (VMF) damage is associated with impaired decision making. Recent efforts to understand the functions of this brain region have focused on its role in tracking reward, punishment and risk. However, decision making is complex, and frontal lobe damage might be expected to affect it at other levels. This study used process-tracing techniques to explore the effect of VMF damage on multi-attribute decision making under certainty. Thirteen subjects with focal VMF damage were compared with 11 subjects with frontal damage that spared the VMF and 21 demographically matched healthy control subjects. Participants chose rental apartments in a standard information board task drawn from the literature on normal decision making. VMF subjects performed the decision making task in a way that differed markedly from all other groups, favouring an ‘alternative-based’ information acquisition strategy (i.e. they organized their information search around individual apartments). In contrast, both healthy control subjects and subjects with damage predominantly involving dorsal and/or lateral prefrontal cortex pursued primarily ‘attribute-based’ search strategies (in which information was acquired about categories such as rent and noise level across several apartments). This difference in the pattern of information acquisition argues for systematic differences in the underlying decision heuristics and strategies employed by subjects with VMF damage, which in turn may affect the quality of their choices. These findings suggest that the processes supported by ventral and medial prefrontal cortex need to be conceptualized more broadly, to account for changes in decision making under conditions of certainty, as well as uncertainty, following damage to these areas.