Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex

TLDR

Prior research has mapped distinct cognitive functions within the prefrontal cortex, including cognitive control and decision making. This study aims to provide definitive evidence on PFC functional specialization using a decades‑long neuropsychological dataset. Voxel‑based lesion‑symptom mapping was performed on 344 patients with focal lesions, 165 in the PFC, assessed with a comprehensive neuropsychological battery. Lesion mapping revealed two distinct PFC networks: one for cognitive control involving dorsolateral PFC and anterior cingulate, and another for value‑based decision making involving orbitofrontal, ventromedial, and frontopolar cortex, with rostral anterior cingulate linked to set‑shifting and ventral PFC essential for decision making, providing causal evidence of functional‑anatomical specificity.

Abstract

A considerable body of previous research on the prefrontal cortex (PFC) has helped characterize the regional specificity of various cognitive functions, such as cognitive control and decision making. Here we provide definitive findings on this topic, using a neuropsychological approach that takes advantage of a unique dataset accrued over several decades. We applied voxel-based lesion-symptom mapping in 344 individuals with focal lesions (165 involving the PFC) who had been tested on a comprehensive battery of neuropsychological tasks. Two distinct functional-anatomical networks were revealed within the PFC: one associated with cognitive control (response inhibition, conflict monitoring, and switching), which included the dorsolateral prefrontal cortex and anterior cingulate cortex and a second associated with value-based decision-making, which included the orbitofrontal, ventromedial, and frontopolar cortex. Furthermore, cognitive control tasks shared a common performance factor related to set shifting that was linked to the rostral anterior cingulate cortex. By contrast, regions in the ventral PFC were required for decision-making. These findings provide detailed causal evidence for a remarkable functional-anatomical specificity in the human PFC.