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Published June 2017 | public
Journal Article

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


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.

Additional Information

© The Author (2017). Published by Oxford University Press on behalf of the Guarantors of Brain. Received: 16 December 2016; Revision Received: 27 February 2017; Accepted: 15 March 2017; Published: 24 May 2017. We would like to thank Nash Witkin, Raul Samrah, Victoria Spring, Chris Kovach, and Anthony Gómez for their contributions to this project. Funding: Supported in part by a McDonnell Foundation Collaborative Action Award [#220020387], the Kiwanis Foundation, a NIH Predoctoral Training Award [T32 GM108540], and a Conte Center from NIMH (1 P50 MH094258-04A1).

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