Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions
Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions
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DOI：
10.1093/brain/123.11.2189
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发表时间：
2000-11-01
期刊：
影响因子：
14.5
通讯作者：
Damasio, H
中科院分区：
文献类型：
--
作者：
Bechara, A;Tranel, D;Damasio, H
在模拟现实生活决策的赌博任务中，双侧腹内侧前额叶皮层（VM）损伤的患者会选择立即产生高收益的选择，尽管未来损失更高。在这项研究中，我们讨论了可能解释这种行为的三种可能性：（i）对奖励过敏； (ii) 对惩罚不敏感； (iii) 对未来后果不敏感，因此行为总是以眼前的前景为指导。为此，我们设计了原始赌博任务的一个变体，其中有利的牌组会产生很高的立即惩罚，但未来的奖励甚至更高。不利的套牌产生的即时惩罚较低，但未来的奖励甚至较低。我们测量了受试者受到奖励或惩罚后的皮肤电导反应（SCR）。患有 VM 损伤的患者在赌博任务的原始版本和变体版本中都选择了不利的牌组。 VM病变患者在接受奖励或惩罚后的SCR与对照组没有显着差异。在第二个实验中，我们研究了增加原始任务的不利牌组中的延迟惩罚或减少变体任务的时间不利牌组中的延迟奖励是否会将VM病变患者的行为转向有利的策略，两种操作均未能将VM病变患者的行为从不利的牌组中转移。这些结果表明，VM 病变患者对未来的后果（无论是积极的还是消极的）不敏感，并且主要受眼前前景的指导。 VM病变患者的这种“对未来的近视”在面对严重的不良后果时仍然存在，即未来惩罚的增加或未来奖励的减少。
On a gambling task that models real-life decisions, patients with bilateral lesions of the ventromedial prefrontal cortex (VM) opt for choices that yield high immediate gains in spite of higher future losses, In this study, we addressed three possibilities that may account for this behaviour: (i) hypersensitivity to reward; (ii) insensitivity to punishment; and (iii) insensitivity to future consequences, such that behaviour is always guided by immediate prospects. For this purpose, we designed a variant of the original gambling task in which the advantageous decks yielded high immediate punishment but even higher future reward. The disadvantageous decks yielded low immediate punishment but even lower future reward. We measured the skin conductance responses (SCRs) of subjects after they had received a reward or punishment. Patients with VM lesions opted for the disadvantageous decks in both the original and variant versions of the gambling task. The SCRs of VM lesion patients after they had received a reward or punishment were not significantly different from those of controls. In a second experiment, we investigated whether increasing the delayed punishment in the disadvantageous decks of the original task or decreasing the delayed reward in time disadvantageous decks of the variant task would shift the behaviour of VM lesion patients towards an advantageous strategy, Both manipulations failed to shift the behaviour of VM lesion patients away from the disadvantageous decks. These results suggest that patients with VM lesions are insensitive to future consequences, positive or negative, and are primarily guided by immediate prospects. This 'myopia for the future' in VM lesion patients persists in the face of severe adverse consequences, i.e. rising future punishment or declining future reward.