Role of cognitive estimation in decision making: evidence from patients with prefrontal cortex damage.

Objective: Inconsistent results have been reported in studies examining how the prefrontal cortex influences decision-making abilities. Moreover, earlier studies have mainly documented the role of executive functions as the primary cognitive mechanism underlying deficits in decision making. However, the involvement of other cognitive domains, particularly those related to logical reasoning - such as cognitive estimation processes - has never been explored in the context of decision-making impairments. The objective of this study is to examine both the association between lesions to different regions of the prefrontal cortex and cognitive estimation with decision making, and whether their implications may vary based on the degree of uncertainty inherent in the decision task.

Method: Thirty patients with prefrontal cortex damage were compared with thirty control subjects matched by gender, age, and education on their performance on the cognitive estimation task and the Iowa Gambling Task assessing decision-making.

Results: Patients with prefrontal cortex damage were significantly impaired compared to control subjects in both these domains. Further analyses, including correlations and regression, indicated that performance on the cognitive estimation task predicts decision-making performance on the Iowa Gambling Task, especially under condition of risk. Finally, voxel-based lesion analysis identified a partially overlapping bilateral prefrontal network, centered within the ventral and dorsomedial areas and extending into the dorsolateral prefrontal cortex, associated with deficits in both cognitive estimation and decision-making.

Conclusions: This study emphasizes the importance of considering diverse cognitive domains in understanding decision-making impairments, offering new insights that could inform clinical interventions and enhance patient care.