The role of ventromedial prefrontal cortex in decision making: judgment under uncertainty or judgment per se?

Ventromedial prefrontal cortex (VMF) is thought to be important in human decision making, but studies to date have focused on decision making under conditions of uncertainty, including risky or ambiguous decisions. Other lines of evidence suggest that this area of the brain represents quite basic information about the relative "economic" value of options, predicting a role for this region in value-based decision making even in the absence of uncertainty. We tested this prediction in human subjects with VMF damage. Preference judgment is a simple form of value-based decision making under certainty. We asked whether VMF damage in humans would lead to inconsistent preference judgments in a simple pairwise choice task. Twenty-one participants with focal damage to the frontal lobes were compared with 19 age- and education-matched control subjects. Subjects with VMF damage were significantly more inconsistent in their preferences than controls, whereas those with frontal damage that spared the VMF performed normally. These results argue that VMF plays a necessary role in certain as well as uncertain decision making in humans.