Insensitivity to future repercussions after prefrontal cortex damage

View more insights in Social Sciences - Psychology - Behavioural Neuroscience

View more figures from University of Southern California

View the page of Antoine Bechara

Read the Study

Next in Behavioural Neuroscience

Metaphorical language processing and amygdala activation in non-native and native speakers

Francesca Citron | Lancaster University

Haemoglobin Concentration Improves Prediction of Cognitive Outcomes in Patients with Sickle Cell Anemia

Anna Hood | University of Manchester

Antoine Bechara highlights that real-life decision-making is impaired after a ventromedial prefrontal brain injury, despite otherwise intact intellectual functions.

Image courtesy of interviewee. February 2, 2024

Log-in or Sign-up to Faculti
Currently viewing this subject insight as a guest. You have insight(s) remaining for this month. Login to view 8000+ figures on the platform.

Generating Workspace...

Export as PDF

This video video discusses a pivotal neurological case from 1868 involving a man named Phineas Gage, who survived an accident in which an iron tamping bar penetrated his skull and front brain. Remarkably, he did not experience any neurological deficits post-accident but exhibited significant changes in personality, becoming impulsive and demonstrating poor judgment. This video video case led to the study of the ventromedial prefrontal cortex's role in decision-making and the development of the Iowa Gambling Task (IGT) in the 1990s.

The Iowa Gambling Task was created to assess decision-making deficits, particularly in patients with prefrontal cortex damage, as traditional cognitive tests failed to detect such issues. The IGT simulates real-life decision-making by presenting participants with four decks of cards associated with various rewards and penalties. Two decks provide immediate but ultimately poor long-term returns, while the other two offer safer, more beneficial outcomes over time. Normal participants learn to choose advantageous decks, while those with damage to the prefrontal cortex struggle to do so.

The speaker explains the importance of incorporating emotional elements (rewards and punishments) into psychological testing, a novel approach at the time. They also highlight the connection between cognitive functions and emotional responses within the brain, specifically how the prefrontal cortex integrates these aspects into decision-making—a concept supported by the Somatic Marker Hypothesis. Damage to this brain area disconnects cognitive reasoning from emotional feedback, leading to impaired decision-making, which is observed in various psychiatric conditions, including substance abuse disorders and psychopathy.

The speaker concludes by noting the relevance of this line of research to understanding more contemporary behavioral issues, including debates around the addictive nature of excessive internet use compared to traditional substance abuse. Overall, the text underscores the complexity of decision-making processes and the critical role of the prefrontal cortex in facilitating effective judgments and emotional responses.

Language:

Export as PDF

X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.115 --> 00:03.045
This is actually a classic, paper,

00:03.265 --> 00:07.925
and it goes back in history to a very, very old case

00:08.585 --> 00:10.485
in 1868.

00:10.825 --> 00:14.925
Uh, pH g I dunno if you've heard that name,

00:14.925 --> 00:18.925
but this is a well known, neurological case

00:19.175 --> 00:23.485
where actually, this is someone who had an accident

00:23.495 --> 00:25.165
where an explosion happened

00:25.905 --> 00:30.245
and an iron temping bar went through the front of his head.

00:30.315 --> 00:31.965
It's like a bullet, but, but,

00:32.025 --> 00:36.085
but it was, it was, an an iron temping bar.

00:36.625 --> 00:41.165
So the, remarkable thing about it is

00:41.165 --> 00:43.765
that not only he survived the accident,

00:43.765 --> 00:46.765
because remember in those days, there were no antibiotics

00:46.865 --> 00:48.845
and, and nothing, of this sort.

00:49.305 --> 00:52.725
Uh, he didn't have any neurological deficits at all.

00:53.105 --> 00:55.525
So, so that was

00:56.155 --> 00:58.245
what was puzzling about that case.

00:58.425 --> 01:01.165
And then of course, all the work that happened since

01:01.555 --> 01:06.525
that time, patients who, get damage in

01:06.525 --> 01:08.445
that particular part of the brain,

01:08.545 --> 01:11.045
and, you know, it doesn't damage other surrounding area.

01:11.105 --> 01:13.765
You know, the ventral medial prefrontal cortex,

01:13.955 --> 01:17.765
usually they don't have any neurological deficits,

01:17.765 --> 01:19.645
so they don't have memory impairments,

01:19.785 --> 01:24.205
no language impairments, no paralysis, nothing of this sort.

01:24.265 --> 01:27.525
But there is a big change in their, personality.

01:27.555 --> 01:29.245
They become impo impulsive.

01:29.385 --> 01:33.805
And one of the main, defects that one begins

01:33.845 --> 01:36.405
to observe, and mostly, usually it's the people

01:36.585 --> 01:40.445
around the person, is that they have poor judgment

01:40.585 --> 01:42.005
and poor decision making.

01:42.185 --> 01:46.605
So they tend, they begin to make choices,

01:47.035 --> 01:49.165
that is, shortsighted.

01:49.385 --> 01:50.485
You know, that is, you know,

01:50.485 --> 01:53.285
if it has immediate con consequences

01:53.945 --> 01:57.885
and some long term negative consequences, they tend to focus

01:58.505 --> 02:02.805
on the, on the immediate for, so for this longest time

02:03.295 --> 02:04.845
until the 1990s,

02:04.845 --> 02:09.445
because that paper was published in 1994,

02:09.895 --> 02:14.365
there were no clinical tests that could capture

02:15.075 --> 02:18.405
that deficit in patients who suffer from that problem.

02:18.865 --> 02:20.285
So they come to the clinic,

02:20.835 --> 02:23.285
they don't have any neurological deficits,

02:23.555 --> 02:26.205
they don't have any cognitive deficits,

02:26.345 --> 02:29.125
so the reasoning ability is intact.

02:29.785 --> 02:32.725
Uh, their memory, their language, everything seems

02:32.785 --> 02:34.325
to be, normal.

02:34.865 --> 02:39.005
So there was no instrument that can capture that deficit.

02:39.385 --> 02:44.325
And that was the, the basis for that study

02:44.785 --> 02:48.685
and the development of that task that you see in that study

02:48.795 --> 02:52.405
that is now widely known as the Iowa Gambling Task

02:52.585 --> 02:54.405
or the IIGT.

02:55.025 --> 02:59.685
So, so the idea was to create sort

02:59.685 --> 03:03.485
of a, a laboratory model that

03:03.715 --> 03:08.005
that would capture the deficit in, in those patients.

03:08.105 --> 03:12.165
And, and, and the, the modeling of the real life,

03:12.325 --> 03:16.365
decision making is basically setting up a situation

03:16.455 --> 03:20.925
where you have choices that have some immediate reward

03:20.985 --> 03:23.285
or immediate punishment,

03:23.625 --> 03:26.645
but there are consequences that you could lose

03:27.265 --> 03:31.565
or you could, you could win in, in making decisions based on

03:31.565 --> 03:36.045
that, for example, how do you, how do you

03:36.785 --> 03:39.885
elicit reward in punishment in humans,

03:40.065 --> 03:42.365
in animal paradigms is very easy.

03:42.905 --> 03:46.085
You know, you can get, give them a food palate or,

03:46.105 --> 03:49.365
or a sweet taste or something of that sort.

03:49.825 --> 03:53.405
Uh, but in humans, what would drive a human, you know,

03:53.825 --> 03:57.805
for reward and for a punishment, and the answer is money.

03:58.025 --> 04:01.325
And we didn't have to use real money.

04:01.665 --> 04:05.405
We just used points and, and fake fake money.

04:06.105 --> 04:08.245
And, and it's a big motivator.

04:08.465 --> 04:13.405
So, so, so this is what the task is all about, is

04:13.405 --> 04:17.085
that, you know, you have choices between four decks

04:17.085 --> 04:20.965
of cards, and if you picked from any deck,

04:21.465 --> 04:25.765
you could win a, a certain amount, of money,

04:26.385 --> 04:28.165
but every once in a while,

04:28.265 --> 04:31.405
and it's unpredictable, you could stand

04:31.945 --> 04:34.205
to lose a certain amount of money.

04:34.425 --> 04:38.805
So each, each deck then is associated with a conflict.

04:39.425 --> 04:42.445
You could win money and you could lose money,

04:43.025 --> 04:47.925
but, the loss sometimes is bigger than the gain

04:48.345 --> 04:49.445
and, and vice versa.

04:49.945 --> 04:52.285
So that's, that's the, the setup.

04:53.145 --> 04:54.845
And, and,

04:55.065 --> 04:57.525
and of course, so there are four decks of cards.

04:58.065 --> 05:02.405
So two of the decks, we consider them advantageous

05:02.635 --> 05:06.005
because in the short term, they give you a lot of money.

05:06.625 --> 05:10.045
In the long term, you tend to lose a lot of money,

05:10.675 --> 05:12.965
whereas there are two other choices

05:13.315 --> 05:15.485
that they are safer choices.

05:16.145 --> 05:18.285
So in the short term, a term, you

05:18.825 --> 05:23.325
win less money in the long term, you win more money.

05:23.585 --> 05:26.845
Normal people, learn to,

05:26.905 --> 05:31.445
to choose from the good decks or the advantageous decks.

05:32.125 --> 05:35.605
Patients who have damage to the prefrontal cortex,

05:35.915 --> 05:37.045
they can never do that.

05:37.265 --> 05:41.605
So they keep choosing, from the decks that lead

05:42.065 --> 05:44.605
to long term, consequences.

05:45.315 --> 05:48.725
This task is the first of its kind,

05:49.235 --> 05:54.045
because all the neuropsychological testing up to

05:54.045 --> 05:57.845
that point was a very cognitive in nature.

05:58.665 --> 06:01.325
Uh, the idea Of introducing

06:02.065 --> 06:04.645
Reward And, and punishment,

06:05.225 --> 06:08.165
Uh, It was unheard of, you know, so,

06:08.585 --> 06:10.805
So There is no such a neuropsychological

06:11.115 --> 06:13.445
Task where basically you

06:13.965 --> 06:16.885
Exchange money gains in, in money losses.

06:17.385 --> 06:19.285
So it started with Me sitting

06:19.875 --> 06:20.875
With The patients

06:21.315 --> 06:22.885
With, With, you know, with

06:23.025 --> 06:25.885
Actual, not actual decks of cards,

06:25.885 --> 06:28.125
because here's, here's the, here's the trick.

06:28.185 --> 06:30.685
So there were a lot of little subtle

06:30.785 --> 06:34.245
Things that went on before The, the

06:34.245 --> 06:35.245
Task came about.

06:36.065 --> 06:39.165
If you, if we used a real decks

06:39.165 --> 06:41.085
of cards, what people

06:42.055 --> 06:44.525
Start to make wrong associations

06:45.025 --> 06:49.005
Was with, You know,

06:49.545 --> 06:51.685
If you have jacks or queens.

06:52.025 --> 06:54.245
So in other words, they, They associate

06:55.005 --> 06:58.645
Whatever they know about card games, which has nothing to

06:58.645 --> 06:59.645
Do with the task.

06:59.745 --> 07:02.565
The task is all about what you see in that

07:02.565 --> 07:03.565
Paper. You know, this

07:03.565 --> 07:05.125
is the original manual,

07:05.865 --> 07:07.005
Uh, task.

07:07.305 --> 07:10.125
You know, you see boxes, empty boxes,

07:10.305 --> 07:12.125
it means you are winning money.

07:12.695 --> 07:15.845
Those boxes that have negative number, it means

07:16.505 --> 07:19.245
That's a, A fixed amount of money that you

07:19.245 --> 07:20.245
Will use. So

07:20.245 --> 07:22.205
it, you will lose. So it,

07:22.355 --> 07:23.885
It's not gambling at all.

07:23.995 --> 07:27.605
It's a very, fixed schedule of

07:28.065 --> 07:31.085
Reward in, in, in punishment. So

07:31.165 --> 07:35.285
I really Sat down with the patients, and it's a matter

07:35.505 --> 07:37.965
Of, error In trial.

07:38.065 --> 07:39.445
You know, find the balance

07:40.385 --> 07:41.885
Of,

07:42.825 --> 07:45.365
How often you need to punish the person, how,

07:45.585 --> 07:49.685
how often you need to make the person win so

07:49.685 --> 07:51.165
that it's not very obvious.

07:51.265 --> 07:55.885
So the task, the way it is, it's very, very, subtle.

07:56.265 --> 07:59.045
So it's very hard to figure out that,

07:59.865 --> 08:02.525
You know, some decks are winners

08:02.545 --> 08:06.405
and by how much you are winning, and some decks are

08:06.625 --> 08:07.625
Losers. So it's,

08:07.625 --> 08:08.805
the,

08:09.105 --> 08:11.565
Uh, the amounts of gains and losses

08:11.785 --> 08:13.365
Are, are very, very subtle.

08:13.745 --> 08:15.445
So to avoid that,

08:16.105 --> 08:19.525
Uh, misconception about Associating

08:20.175 --> 08:22.685
Jacks and queens and kings with the game,

08:23.345 --> 08:24.405
we made the cards

08:25.205 --> 08:27.045
Discolor You, you know, red colors

08:27.425 --> 08:32.245
Or, or, black colors. Uh, people

08:32.745 --> 08:36.565
Ask me, Why did you have four decks

08:37.435 --> 08:39.525
Instead of Two decks, for example?

08:39.665 --> 08:42.525
Why not two choices, one good in one bad?

08:43.055 --> 08:46.285
Again, it's, it's the complexity. If you make it

08:46.505 --> 08:49.285
Two decks, It becomes so simple,

08:49.795 --> 08:52.005
Everybody will, will, will figure it out.

08:52.265 --> 08:54.485
So it's,

08:54.795 --> 08:56.325
It's it just error

08:56.465 --> 08:59.485
and trial kind of thing to find the right balance.

09:00.385 --> 09:03.325
And, and that's how the task came about.

09:03.545 --> 09:07.285
We started with a manual version, as you see in

09:07.285 --> 09:08.565
that particular paper,

09:08.945 --> 09:12.605
but now it's computerized, you know, the task is used

09:13.235 --> 09:16.645
worldwide and, and, and it comes on a computer.

09:17.275 --> 09:22.005
This was the very, very first test ever that

09:22.525 --> 09:27.085
captured that decision making deficit in this,

09:27.105 --> 09:29.725
in these particular, patients,

09:29.725 --> 09:32.325
because as, as we said, these patients will come

09:32.525 --> 09:36.285
to the clinic and they do well on the majority

09:36.425 --> 09:40.245
of cognitive tests that were available, at the time.

09:40.785 --> 09:44.205
So, so this was the, the very first test

09:44.835 --> 09:48.005
that allowed us to, capture

09:48.195 --> 09:49.845
that deficit in the laboratory.

09:49.865 --> 09:51.765
And this actually allowed us

09:52.225 --> 09:54.525
to study the underlying mechanisms.

09:54.525 --> 09:58.925
That is what goes wrong in, in, you know,

09:59.105 --> 10:01.485
or what is the underlying function

10:02.025 --> 10:05.525
of the ventromedial prefrontal, cortex.

10:06.105 --> 10:08.525
And, and then of course, the task,

10:09.225 --> 10:12.685
became not only specific to patients

10:12.705 --> 10:15.645
who have vented prefrontal cortex damage,

10:15.705 --> 10:20.325
but it's used now, widely, in a lot

10:20.325 --> 10:24.485
of psychs patients, patients who are thought to have

10:25.075 --> 10:26.965
frontal lobe dysfunction.

10:27.065 --> 10:30.125
So they don't necessarily have an injury,

10:30.345 --> 10:33.005
but there are a lot of disorders, you know, like,

10:33.115 --> 10:38.085
bipolar disorders, you know,

10:38.815 --> 10:42.645
those, those kind of conditions where, where actually,

10:43.225 --> 10:46.365
you know, substance abuse disorders, you know,

10:46.445 --> 10:48.805
those kind of disorders, there,

10:49.015 --> 10:51.205
there is impaired decision making,

10:51.345 --> 10:54.245
and these can be detected by this kind of task.

10:54.785 --> 10:58.445
You know, my previous mentor, Antonio DiMaggio, he was,

10:58.465 --> 11:01.405
he was the one who, developed

11:01.405 --> 11:04.765
that theory called the Somatic Marker Hypothesis.

11:05.385 --> 11:08.565
And, and the idea is that that part of the brain,

11:09.025 --> 11:13.125
the way it it function is that it couples

11:14.165 --> 11:18.505
two things, on, every decision,

11:18.595 --> 11:20.905
every complex decision in life,

11:21.285 --> 11:23.345
it has a cognitive component.

11:23.925 --> 11:26.705
So, you know, you have a se scenario, you have an image,

11:26.725 --> 11:29.785
you have, strategies, you have,

11:29.825 --> 11:31.145
thoughts in your mind,

11:31.805 --> 11:34.665
but there is also an emotional component.

11:34.715 --> 11:38.185
There is a marker. You know, there is something you learn

11:38.715 --> 11:42.585
throughout your life, you know, prior experiences

11:43.055 --> 11:47.465
with reward in punishment, your brain tends to

11:48.545 --> 11:52.025
register or, or, or record all those instances

11:52.245 --> 11:53.885
of reward in punishment.

11:54.225 --> 11:58.645
So basically the prefrontal cortex kind of couple,

11:58.985 --> 12:03.685
you know, that cognitive scenario to, you know,

12:03.865 --> 12:06.845
to that marker, which can be positive

12:06.905 --> 12:08.485
or a negative experience.

12:08.705 --> 12:12.965
And it's on that basis, you know, you make the decision

12:13.105 --> 12:16.125
or you bias your, your decision in one way.

12:16.425 --> 12:19.565
And that marker, in, in, in general language,

12:19.585 --> 12:23.685
people probably refer to it to a gut feeling or,

12:23.745 --> 12:25.165
or, or intuition.

12:25.425 --> 12:29.845
But in a way, the somatic marker, hypothesis

12:30.665 --> 12:33.205
was pretty much an evidence.

12:33.905 --> 12:37.165
It was a neuroscientific evidence that really

12:38.085 --> 12:41.285
describes an anatomical pathways in physi physiological

12:42.165 --> 12:46.645
pathways that are consistent with what people in general

12:47.415 --> 12:48.805
refer to gut feeling.

12:49.025 --> 12:52.845
So basically, the prefrontal cortex kind of,

12:54.005 --> 12:58.005
ties your cognitive thinking, you know, to a marker

12:58.155 --> 13:01.965
that can be positive or negative, which is a gut feeling.

13:02.435 --> 13:05.285
When you damage the prefrontal cortex, you,

13:05.665 --> 13:07.245
you disconnect the two.

13:08.025 --> 13:10.805
So, so the patient is still able

13:11.505 --> 13:14.045
to be cognitively con, intact.

13:14.115 --> 13:17.965
They could be geniuses, they could think everything,

13:18.465 --> 13:22.295
but they don't have that gut feeling

13:22.685 --> 13:24.935
that tells them not to do it.

13:24.965 --> 13:29.615
Like, let's say, trying to accept a bribe, you know,

13:29.675 --> 13:32.615
you know, that can be a very, very

13:33.365 --> 13:35.255
cognitively sophisticated thing,

13:35.275 --> 13:37.375
or let's say robbing a bank.

13:37.475 --> 13:40.975
And I'm not saying there is a different story about,

13:41.155 --> 13:44.335
you know, why, why neurological

13:44.935 --> 13:46.975
patients don't do those behaviors.

13:47.285 --> 13:50.135
This is a little bit of an extreme, but,

13:50.355 --> 13:53.295
but developmental people, you know, psychopathy,

13:53.295 --> 13:56.375
which is known to impact that part of the,

13:56.375 --> 13:57.455
brain, they do that.

13:57.715 --> 14:01.055
So why, for example, robbing a bank, you know,

14:01.055 --> 14:03.535
it can be very cognitively complex,

14:03.955 --> 14:07.615
but you don't have that marker, that negative marker,

14:07.875 --> 14:09.615
you know, that tells you don't do it.

14:09.795 --> 14:14.055
So the disconnect between the cognitive

14:14.625 --> 14:19.575
mechanisms and that emotional component that,

14:20.125 --> 14:21.175
puts a tag or,

14:21.315 --> 14:26.135
or puts a value on that cognitive scenario, in a way I kind

14:26.135 --> 14:30.615
of mentioned, mentioned this, is that, understanding

14:31.435 --> 14:36.175
the function of, of the prefrontal cortex, led

14:36.515 --> 14:41.415
to studies for understanding a lot of other neuropsych,

14:41.715 --> 14:45.215
neuropsychiatric disorders that are known

14:45.715 --> 14:49.655
to impact prefrontal cortex, function.

14:50.035 --> 14:53.885
Uh, I mentioned few, I mentioned substance abuse disorders.

14:54.195 --> 14:57.445
They are known to impact decision making functions.

14:57.855 --> 15:00.565
Psychology, are, are, are known

15:00.665 --> 15:03.885
to impact decision making, functions.

15:04.025 --> 15:08.245
And at least in, in, in my case, you know, beside

15:09.005 --> 15:13.405
studying neurological patients, you know, with brain damage,

15:14.365 --> 15:19.245
I led, many a career with many years of studying

15:20.205 --> 15:24.525
substance use, disorders, starting with,

15:24.745 --> 15:28.965
you know, patients who take hard drugs like heroin and,

15:29.305 --> 15:34.205
and cocaine to, modern day addictions.

15:34.365 --> 15:38.045
I call them. Uh, you know, there are, debates now,

15:38.045 --> 15:42.365
whether, for example, excessive internet use is, is a,

15:42.585 --> 15:44.405
is a form of an addiction.

15:44.665 --> 15:47.565
And, and whether this is really related

15:47.785 --> 15:50.845
to prefrontal cortex dysfunction or, or not,

15:50.985 --> 15:54.205
and at least, even though this is not related to this, I,

15:54.405 --> 15:55.885
I wanna assure everybody,

15:56.445 --> 16:01.125
although excessive internet, used,

16:02.345 --> 16:05.205
can be sometimes described as an addiction,

16:05.505 --> 16:06.725
but it's not identical.

16:06.995 --> 16:10.965
It's not the same pathology as someone who's addicted

16:11.465 --> 16:12.085
to heroin.

Neurological Insights from a Historic Case

00:00:00 - This is actually a classic, paper, and it goes back in history to a very, very old case in 1868. pH g I dunno if you've heard that name, but this is a well known, neurological case where actually, this is someone who had an accident where an explosion happened and an iron temping bar went through the front of his head.
00:00:32 - but it was, it was, an an iron temping bar. So the, remarkable thing about it is that not only he survived the accident, because remember in those days, there were no antibiotics and, and nothing, of this sort. he didn't have any neurological deficits at all. So, so that was what was puzzling about that case. And then of course, all the work that happened since
00:01:06 - that particular part of the brain, and, you know, it doesn't damage other surrounding area. You know, the ventral medial prefrontal cortex, usually they don't have any neurological deficits, so they don't have memory impairments, no language impairments, no paralysis, nothing of this sort. But there is a big change in their, personality. They become impo impulsive. And one of the main, defects that one begins
00:01:36 - around the person, is that they have poor judgment and poor decision making. So they tend, they begin to make choices, that is, shortsighted. You know, that is, you know, if it has immediate con consequences and some long term negative consequences, they tend to focus on the, on the immediate for, so for this longest time until the 1990s,
00:02:09 - there were no clinical tests that could capture that deficit in patients who suffer from that problem. So they come to the clinic, they don't have any neurological deficits, they don't have any cognitive deficits, so the reasoning ability is intact. their memory, their language, everything seems to be, normal.
00:02:39 - And that was the, the basis for that study and the development of that task that you see in that study that is now widely known as the Iowa Gambling Task or the IIGT. So, so the idea was to create sort of a, a laboratory model that that would capture the deficit in, in those patients.

Iowa Gambling Task: Decision Making and Rewards

00:03:12 - decision making is basically setting up a situation where you have choices that have some immediate reward or immediate punishment, but there are consequences that you could lose or you could, you could win in, in making decisions based on that, for example, how do you, how do you elicit reward in punishment in humans,
00:03:42 - You know, you can get, give them a food palate or, or a sweet taste or something of that sort. but in humans, what would drive a human, you know, for reward and for a punishment, and the answer is money. And we didn't have to use real money. We just used points and, and fake fake money. And, and it's a big motivator. So, so, so this is what the task is all about, is
00:04:17 - of cards, and if you picked from any deck, you could win a, a certain amount, of money, but every once in a while, and it's unpredictable, you could stand to lose a certain amount of money. So each, each deck then is associated with a conflict. You could win money and you could lose money, but, the loss sometimes is bigger than the gain
00:04:49 - So that's, that's the, the setup. And, and, and of course, so there are four decks of cards. So two of the decks, we consider them advantageous because in the short term, they give you a lot of money. In the long term, you tend to lose a lot of money, whereas there are two other choices that they are safer choices. So in the short term, a term, you
00:05:23 - Normal people, learn to, to choose from the good decks or the advantageous decks. Patients who have damage to the prefrontal cortex, they can never do that. So they keep choosing, from the decks that lead to long term, consequences. This task is the first of its kind,
00:05:54 - that point was a very cognitive in nature. the idea Of introducing Reward And, and punishment, It was unheard of, you know, so, So There is no such a neuropsychological Task where basically you Exchange money gains in, in money losses. So it started with Me sitting

Understanding the Iowa Gambling Task Design

00:06:21 - With, With, you know, with Actual, not actual decks of cards, because here's, here's the, here's the trick. So there were a lot of little subtle Things that went on before The, the Task came about. If you, if we used a real decks of cards, what people Start to make wrong associations Was with, You know, If you have jacks or queens.
00:06:55 - Whatever they know about card games, which has nothing to Do with the task. The task is all about what you see in that Paper. You know, this is the original manual, task. You know, you see boxes, empty boxes, it means you are winning money. Those boxes that have negative number, it means That's a, A fixed amount of money that you Will use. So it, you will lose. So it,
00:07:23 - It's a very, fixed schedule of Reward in, in, in punishment. So I really Sat down with the patients, and it's a matter Of, error In trial. You know, find the balance Of, How often you need to punish the person, how, how often you need to make the person win so that it's not very obvious. So the task, the way it is, it's very, very, subtle.
00:07:59 - You know, some decks are winners and by how much you are winning, and some decks are Losers. So it's, the, the amounts of gains and losses Are, are very, very subtle. So to avoid that, misconception about Associating Jacks and queens and kings with the game, we made the cards Discolor You, you know, red colors
00:08:32 - Ask me, Why did you have four decks Instead of Two decks, for example? Why not two choices, one good in one bad? Again, it's, it's the complexity. If you make it Two decks, It becomes so simple, Everybody will, will, will figure it out. So it's, It's it just error and trial kind of thing to find the right balance.
00:09:03 - We started with a manual version, as you see in that particular paper, but now it's computerized, you know, the task is used worldwide and, and, and it comes on a computer. This was the very, very first test ever that captured that decision making deficit in this, in these particular, patients, because as, as we said, these patients will come

Understanding Decision Making Through the Brain

00:09:36 - of cognitive tests that were available, at the time. So, so this was the, the very first test that allowed us to, capture that deficit in the laboratory. And this actually allowed us to study the underlying mechanisms. That is what goes wrong in, in, you know, or what is the underlying function of the ventromedial prefrontal, cortex.
00:10:09 - became not only specific to patients who have vented prefrontal cortex damage, but it's used now, widely, in a lot of psychs patients, patients who are thought to have frontal lobe dysfunction. So they don't necessarily have an injury, but there are a lot of disorders, you know, like, bipolar disorders, you know,
00:10:43 - you know, substance abuse disorders, you know, those kind of disorders, there, there is impaired decision making, and these can be detected by this kind of task. You know, my previous mentor, Antonio DiMaggio, he was, he was the one who, developed that theory called the Somatic Marker Hypothesis. And, and the idea is that that part of the brain,
00:11:14 - two things, on, every decision, every complex decision in life, it has a cognitive component. So, you know, you have a se scenario, you have an image, you have, strategies, you have, thoughts in your mind, but there is also an emotional component. There is a marker. You know, there is something you learn throughout your life, you know, prior experiences
00:11:48 - register or, or, or record all those instances of reward in punishment. So basically the prefrontal cortex kind of couple, you know, that cognitive scenario to, you know, to that marker, which can be positive or a negative experience. And it's on that basis, you know, you make the decision
00:12:16 - And that marker, in, in, in general language, people probably refer to it to a gut feeling or, or, or intuition. But in a way, the somatic marker, hypothesis was pretty much an evidence. It was a neuroscientific evidence that really describes an anatomical pathways in physi physiological pathways that are consistent with what people in general

Prefrontal Cortex and Decision-Making Disconnect

00:12:49 - So basically, the prefrontal cortex kind of, ties your cognitive thinking, you know, to a marker that can be positive or negative, which is a gut feeling. When you damage the prefrontal cortex, you, you disconnect the two. So, so the patient is still able to be cognitively con, intact. They could be geniuses, they could think everything,
00:13:22 - that tells them not to do it. Like, let's say, trying to accept a bribe, you know, you know, that can be a very, very cognitively sophisticated thing, or let's say robbing a bank. And I'm not saying there is a different story about, you know, why, why neurological patients don't do those behaviors. This is a little bit of an extreme, but,
00:13:53 - which is known to impact that part of the, brain, they do that. So why, for example, robbing a bank, you know, it can be very cognitively complex, but you don't have that marker, that negative marker, you know, that tells you don't do it. So the disconnect between the cognitive mechanisms and that emotional component that, puts a tag or,
00:14:26 - of mentioned, mentioned this, is that, understanding the function of, of the prefrontal cortex, led to studies for understanding a lot of other neuropsych, neuropsychiatric disorders that are known to impact prefrontal cortex, function. I mentioned few, I mentioned substance abuse disorders.
00:14:57 - Psychology, are, are, are known to impact decision making, functions. And at least in, in, in my case, you know, beside studying neurological patients, you know, with brain damage, I led, many a career with many years of studying substance use, disorders, starting with,
00:15:29 - and cocaine to, modern day addictions. I call them. you know, there are, debates now, whether, for example, excessive internet use is, is a, is a form of an addiction. And, and whether this is really related to prefrontal cortex dysfunction or, or not, and at least, even though this is not related to this, I, I wanna assure everybody,

Understanding Addiction: A Nuanced Perspective

00:16:11 - can be sometimes described as an addiction, but it's not identical. It's not the same pathology as someone who's addicted to heroin.

Faculti AI can make mistakes

Research

Policy

Analysis

Data

Originals

Explainers

Podcasts

Faculti

New on Faculti

Idea Explorer

Definition

News Context

Exploratory Questions

Faculti AI Answers

Research Summaries

Insensitivity to future repercussions after prefrontal cortex damage

Next in Behavioural Neuroscience