Human VMPFC encodes early signatures of confidence in perceptual decisions.

Choice confidence, an individual's internal estimate of judgment accuracy, plays a critical role in adaptive behaviour, yet its neural representations during decision formation remain underexplored. Here, we recorded simultaneous EEG-fMRI while participants performed a direction discrimination task and rated their confidence on each trial. Using multivariate single-trial discriminant analysis of the EEG, we identified a stimulus-independent component encoding confidence, which appeared prior to subjects' explicit choice and confidence report, and was consistent with a confidence measure predicted by an accumulation-to-bound model of decision-making. Importantly, trial-to-trial variability in this electrophysiologically-derived confidence signal was uniquely associated with fMRI responses in the ventromedial prefrontal cortex (VMPFC), a region not typically associated with confidence for perceptual decisions. Furthermore, activity in the VMPFC was functionally coupled with regions of the frontal cortex linked to perceptual decision-making and metacognition. Our results suggest that the VMPFC holds an early confidence representation arising from decision dynamics, preceding and potentially informing metacognitive evaluation.