Differential effects of insular and ventromedial prefrontal cortex lesions on risky decision-making

By Luke Clark, Antoine Bechara, Hanna Damasio, Michael R. F. Aitken, Barbara J. Sahakian, Trevor W. Robbins. Brain : a journal of neurology, 2008

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The ventromedial prefrontal cortex (vmPFC) and insular cortex are implicated in distributed neural circuitry that supports emotional decision-making. Previous studies of patients with vmPFC lesions have focused primarily on decision-making under uncertainty, when outcome probabilities are ambiguous (e.g. the Iowa Gambling Task). It remains unclear whether vmPFC is also necessary for decision-making under risk, when outcome probabilities are explicit. It is not known whether the effect of insular damage is analogous to the effect of vmPFC damage, or whether these regions contribute differentially to choice behaviour. Four groups of participants were compared on the Cambridge Gamble Task, a well-characterized measure of risky decision-making where outcome probabilities are presented explicitly, thus minimizing additional learning and working memory demands. Patients with focal, stable lesions to the vmPFC (n = 20) and the insular cortex (n = 13) were compared against healthy subjects (n = 41) and a group of lesion controls (n = 12) with damage predominantly affecting the dorsal and lateral frontal cortex. The vmPFC and insular cortex patients showed selective and distinctive disruptions of betting behaviour. VmPFC damage was associated with increased betting regardless of the odds of winning, consistent with a role of vmPFC in biasing healthy individuals towards conservative options under risk. In contrast, patients with insular cortex lesions failed to adjust their bets by the odds of winning, consistent with a role of the insular cortex in signalling the probability of aversive outcomes. The insular group attained a lower point score on the task and experienced more ‘bankruptcies’. There were no group differences in probability judgement. These data confirm the necessary role of the vmPFC and insular regions in decision-making under risk. Poor decision-making in clinical populations can arise via multiple routes, with functionally dissociable effects of vmPFC and insular cortex damage.

Subfields: Cognitive Neuroscience, Experimental and Cognitive Psychology, General Decision Sciences

View Paper: https://www.semanticscholar.org/paper/7e5b818170bab7aa1c0bc3f5861891d251087213

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Citations in the corpus

A Neurological Study of Compulsive Buying Behaviour (2011, background): “The vmPFC generally plays an important role in planning and executing actions (Bechara et al. 1994; Bechara and Damasio 2005; Clark et al. 2008; Kringelbach 2005).”
Motivation and the Goal Theory of Current Concerns (2011, background): “Presumably, these different strands of information become integrated in prefrontal cortex, perhaps especially in its medial and orbitofrontal regions (Clark et al., 2008; Winkielman et al., 2007).”
Pro v Con Reviews: Is Food Addictive? (2012, background): “Indeed, brain lesion studies suggest that the ventromedial PFC and insula are necessary components of the distributed circuits that support emotional decisionmaking (136).”
Neurocircuitry of Addiction (2009, background): “Indeed, brain lesion studies suggest that the ventromedial prefrontal cortex and insula are necessary components of the distributed circuits that support emotional decision-making (Clark et al, 2008).”
A common role of insula in feelings, empathy and uncertainty. (2009, positive): “In addition, patients with insular damage demonstrate poor decision making during gambling experiments resulting in higher losses [ 43 ].”
Neuropsicología de las funciones ejecutivas (2010, background): “…de respuesta (Aron et al., 2007; Picton et al., 2007, Simmonds et al., 2007) y sobre la implicación de la corteza prefrontal ventromedial, la corteza prefrontal dorsolateral y la ínsula en los procesos de toma de decisiones (Bechara et al., 2000; Clark et al., 2008; Fellows y Farah, 2005).”