Abstract
A large proportion of human social neuroscience research has focused on the issue of decision-making. Impaired decision-making is a symptomatic feature of a number of neurodegenerative diseases, but the nature of these decision-making deficits depends on the particular disease. Thus, examining the qualitative differences in decision-making impairments associated with different neurodegenerative diseases could provide valuable information regarding the underlying neural basis of decision-making. Nevertheless, few comparative reports of decision-making across patient groups exist. In this Review, we examine the neuroanatomical substrates of decision-making in relation to the neuropathological changes that occur in Alzheimer disease, frontotemporal dementia, Parkinson disease and Huntington disease. We then examine the main findings from studies of decision-making in these neurodegenerative diseases. Finally, we suggest a number of recommendations that future studies could adopt to aid our understanding of decision-making cognition.
Key Points
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Decision-making is a complex mental function influenced by multiple cognitive and behavioral processes
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Several tasks have been developed that assess different types of decision-making
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Understanding how different brain areas contribute to successful performance on decision-making tasks can help us to identify which pathological changes associated with specific neurodegenerative diseases contribute to poor decision-making
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Studies that incorporate multiple measures of decision-making in the same patient populations, as well as assessment of other cognitive and behavioral processes, could further our knowledge of decision-making cognition
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Elucidation of the processes underlying decision-making could lead to more-objective diagnostic tests for impairments in this cognitive function, as well as the development of effective rehabilitation strategies and pharmacological treatments
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References
Braak, H. & Braak, E. Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol. 82, 239–259 (1991).
Naggara, O. et al. Diffusion tensor imaging in early Alzheimer's disease. Psychiatry Res. 146, 243–249 (2006).
Schliebs, R. Basal forebrain cholinergic dysfunction in Alzheimer's disease—interrelationship with β-amyloid, inflammation and neurotrophin signaling. Neurochem. Res. 30, 895–908 (2005).
Cummings, J. L. & Cole, G. Alzheimer disease. JAMA 287, 2335–2338 (2002).
Kipps, C. M., Nestor, P. J., Fryer, T. D. & Hodges, J. R. Behavioural variant frontotemporal dementia: not all it seems? Neurocase 13, 237–247 (2007).
Rosen, H. J. et al. Patterns of brain atrophy in frontotemporal dementia and semantic dementia. Neurology 58, 198–208 (2002).
Kertesz, A., McMonagle, P., Blair, M., Davidson, W. & Munoz, D. G. The evolution and pathology of frontotemporal dementia. Brain 128, 1996–2005 (2005).
Hallidayb, J. J. Clinicopathological staging of frontotemporal dementia severity: correlation with regional atrophy. Dement. Geriatr. Cogn. Disord. 17, 311–315 (2004).
Hodges, J. R. & Miller, B. The neuropsychology of frontal variant frontotemporal dementia and semantic dementia. Introduction to the special topic papers: Part II. Neurocase 7, 113–121 (2001).
Rascovsky, K. et al. Diagnostic criteria for the behavioral variant of frontotemporal dementia (bvFTD): current limitations and future directions. Alzheimer Dis. Assoc. Disord. 21, S14–S18 (2007).
Neary, D. et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 51, 1546–1554 (1998).
Jankovic, J. Parkinson's disease: clinical features and diagnosis. J. Neurol. Neurosurg. Psychiatry 79, 368–376 (2008).
Albin, R. L., Young, A. B. & Penney, J. B. The functional anatomy of basal ganglia disorders. Trends Neurosci. 12, 366–375 (1989).
Emre, M. What causes mental dysfunction in Parkinson's disease? Mov. Disord. 18 (Suppl. 6), S63–S71 (2003).
Emre, M. et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov. Disord. 22, 1689–1707 (2007).
Weintraub, D., Moberg, P. J., Duda, J. E., Katz, I. R. & Stern, M. B. Effect of psychiatric and other nonmotor symptoms on disability in Parkinson's disease. J. Am. Geriatr. Soc. 52, 784–788 (2004).
Schrag, A. Psychiatric aspects of Parkinson's disease—an update. J. Neurol. 251, 795–804 (2004).
Burns, A., Folstein, S., Brandt, J. & Folstein, M. Clinical assessment of irritability, aggression, and apathy in Huntington and Alzheimer disease. J. Nerv. Ment. Dis. 178, 20–26 (1990).
Cummings, J. L. Behavioral and psychiatric symptoms associated with Huntington's disease. Adv. Neurol. 65, 179–186 (1995).
Brand, M., Labudda, K. & Markowitsch, H. J. Neuropsychological correlates of decision-making in ambiguous and risky situations. Neural Netw. 19, 1266–1276 (2006).
Bechara, A., Damasio, A. R., Damasio, H. & Anderson, S. W. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 50, 7–15 (1994).
Bechara, A., Damasio, H., Tranel, D. & Anderson, S. W. Dissociation of working memory from decision making within the human prefrontal cortex. J. Neurosci. 18, 428–437 (1998).
Manes, F. et al. Decision-making processes following damage to the prefrontal cortex. Brain 125, 624–639 (2002).
Dunn, B. D., Dalgleish, T. & Lawrence, A. D. The somatic marker hypothesis: a critical evaluation. Neurosci. Biobehav. Rev. 30, 239–271 (2006).
Ernst, M. et al. Decision-making in a risk-taking task: a PET study. Neuropsychopharmacology 26, 682–691 (2002).
Fellows, L. K. & Farah, M. J. Different underlying impairments in decision-making following ventromedial and dorsolateral frontal lobe damage in humans. Cereb. Cortex 15, 58–63 (2005).
Clark, L. & Manes, F. Social and emotional decision-making following frontal lobe injury. Neurocase 10, 398–403 (2004).
Roca, M. et al. Executive function and fluid intelligence after frontal lobe lesions. Brain 133, 234–247 (2009).
Buelow, M. T. & Suhr, J. A. Construct validity of the Iowa Gambling Task. Neuropsychol. Rev. 19, 102–114 (2009).
Maia, T. V. & McClelland, J. L. A reexamination of the evidence for the somatic marker hypothesis: What participants really know in the Iowa gambling task. Proc. Natl Acad. Sci. USA 101, 16075–16080 (2004).
Hsu, M., Bhatt, M., Adolphs, R., Tranel, D. & Camerer, C. F. Neural systems responding to degrees of uncertainty in human decision-making. Science 310, 1680–1683 (2005).
Alexander, G. E. & Crutcher, M. D. Functional architecture of basal ganglia circuits: neural substrates of parallel processing. Trends Neurosci. 13, 266–271 (1990).
Alexander, G. E., Crutcher, M. D. & DeLong, M. R. Basal ganglia-thalamocortical circuits: parallel substrates for motor, oculomotor, “prefrontal” and “limbic” functions. Prog. Brain Res. 85, 119–146 (1990).
Rogers, R. D. et al. Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology 20, 322–339 (1999).
Rogers, R. D. et al. Choosing between small, likely rewards and large, unlikely rewards activates inferior and orbital prefrontal cortex. J. Neurosci. 19, 9029–9038 (1999).
Brand, M. et al. Decision-making deficits of Korsakoff patients in a new gambling task with explicit rules: associations with executive functions. Neuropsychology 19, 267–277 (2005).
Sinz, H., Zamarian, L., Benke, T., Wenning, G. K. & Delazer, M. Impact of ambiguity and risk on decision making in mild Alzheimer's disease. Neuropsychologia 46, 2043–2055 (2008).
Zamarian, L., Sinz, H., Bonatti, E., Gamboz, N. & Delazer, M. Normal aging affects decisions under ambiguity, but not decisions under risk. Neuropsychology 22, 645–657 (2008).
Lejuez, C. W. et al. Evaluation of a behavioral measure of risk taking: The Balloon Analogue Risk Task (BART). J. Exp. Psychol. Appl. 8, 75–84 (2002).
Levin, I. P. & Hart, S. S. Risk preferences in young children: early evidence of individual differences in reaction to potential gains and losses. J. Behav. Decis. Mak. 16, 397–413 (2003).
Brand, M. et al. Decision-making impairments in patients with Parkinson's disease. Behav. Neurol. 15, 77–85 (2004).
Overman, W. H. et al. Performance on the IOWA card task by adolescents and adults. Neuropsychologia 42, 1838–1851 (2004).
Delazer, M., Sinz, H., Zamarian, L. & Benke, T. Decision-making with explicit and stable rules in mild Alzheimer's disease. Neuropsychologia 45, 1632–1641 (2007).
Jameson, T. L., Hinson, J. M. & Whitney, P. Components of working memory and somatic markers in decision making. Psychon. Bull. Rev. 11, 515–520 (2004).
Hinson, J. M., Jameson, T. L. & Whitney, P. Somatic markers, working memory, and decision making. Cogn. Affect. Behav. Neurosci. 2, 341–353 (2002).
Brand, M., Recknor, E., Grabenhorst, F. & Bechara, A. Decisions under ambiguity and decisions under risk: correlations with executive functions and comparisons of two different gambling tasks with implicit and explicit rules. J. Clin. Exp. Neuropsychol. 29, 86–99 (2007).
Brand, M., Grabenhorst, F., Starcke, K., Vandekerckhove, M. M. & Markowitsch, H. J. Role of the amygdala in decisions under ambiguity and decisions under risk: evidence from patients with Urbach–Wiethe disease. Neuropsychologia 45, 1305–1317 (2007).
Lee, D. Game theory and neural basis of social decision making. Nat. Neurosci. 11, 404–409 (2008).
Kable, J. W. & Glimcher, P. W. The neurobiology of decision: consensus and controversy. Neuron 63, 733–745 (2009).
Glimcher, P. W. & Rustichini, A. Neuroeconomics: the consilience of brain and decision. Science 306, 447–452 (2004).
Seymour, B. & Dolan, R. Emotion, decision making, and the amygdala. Neuron 58, 662–671 (2008).
Bechara, A. & Van Der Linden, M. Decision-making and impulse control after frontal lobe injuries. Curr. Opin. Neurol. 18, 734–739 (2005).
O'Doherty, J. P., Hampton, A. & Kim, H. Model-based fMRI and its application to reward learning and decision making. Ann. NY Acad. Sci. 1104, 35–53 (2007).
Rangel, A. & Hare, T. Neural computations associated with goal-directed choice. Curr. Opin. Neurobiol. 20, 262–270 (2010).
Rushworth, M. F., Behrens, T. E., Rudebeck, P. H. & Walton, M. E. Contrasting roles for cingulate and orbitofrontal cortex in decisions and social behaviour. Trends Cogn. Sci. 11, 168–176 (2007).
Assadi, S. M., Yücel, M. & Pantelis, C. Dopamine modulates neural networks involved in effort-based decision-making. Neurosci. Biobehav. Rev. 33, 383–393 (2009).
Marschner, A. et al. Reward-based decision-making and aging. Brain Res. Bull. 67, 382–390 (2005).
Meeks, T. W. & Jeste, D. V. Neurobiology of wisdom: a literature overview. Arch. Gen. Psychiatry 66, 355–365 (2009).
Haggard, P. Human volition: towards a neuroscience of will. Nat. Rev. Neurosci. 9, 934–946 (2008).
Clark, L., Manes, F., Antoun, N., Sahakian, B. J. & Robbins, T. W. The contributions of lesion laterality and lesion volume to decision-making impairment following frontal lobe damage. Neuropsychologia 41, 1474–1483 (2003).
Thiel, A. et al. Activation of basal ganglia loops in idiopathic Parkinson's disease: a PET study. J. Neural Transm. 110, 1289–1301 (2003).
Bolla, K. I., Eldreth, D. A., Matochik, J. A. & Cadet, J. L. Neural substrates of faulty decision-making in abstinent marijuana users. Neuroimage 26, 480–492 (2005).
Bolla, K. I. et al. Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task. Neuroimage 19, 1085–1094 (2003).
Krain, A. L., Wilson, A. M., Arbuckle, R., Castellanos, F. X. & Milham, M. P. Distinct neural mechanisms of risk and ambiguity: a meta-analysis of decision-making. Neuroimage 32, 477–484 (2006).
Li, X., Lu, Z., D'Argembeau, A., Ng, M. & Bechara, A. The Iowa Gambling Task in fMRI images. Hum. Brain Mapp. 31, 410–423 (2010).
Rahman, S., Sahakian, B. J., Hodges, J. R., Rogers, R. D. & Robbins, T. W. Specific cognitive deficits in mild frontal variant frontotemporal dementia. Brain 122, 1469–1493 (1999).
Rahman, S. et al. Methylphenidate ('Ritalin') can ameliorate abnormal risk-taking behavior in the frontal variant of frontotemporal dementia. Neuropsychopharmacology 31, 651–658 (2005).
Torralva, T. et al. The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia. Neuropsychologia 45, 342–349 (2007).
Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y. & Plumb, I. The “Reading the Mind in the Eyes” Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J. Child Psychol. Psychiatry 42, 241–251 (2001).
Stone, V. E., Baron-Cohen, S. & Knight, R. T. Frontal lobe contributions to theory of mind. J. Cogn. Neurosci. 10, 640–656 (1998).
Gregory, C. et al. Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer's disease: theoretical and practical implications. Brain 125, 752–764 (2002).
Torralva, T., Roca, M., Gleichgerrcht, E., Bekinschtein, T. & Manes, F. A neuropsychological battery to detect specific executive and social cognitive impairments in early frontotemporal dementia. Brain 132, 1299–1309 (2009).
Gleichgerrcht, E., Torralva, T., Roca, M. & Manes, F. Utility of an abbreviated version of the executive and social cognition battery in the detection of executive deficits in early behavioral variant frontotemporal dementia patients. J. Int. Neuropsychol. Soc. 16, 687–694 (2010).
Manes, F. F. et al. Frontotemporal dementia presenting as pathological gambling. Nat. Rev. Neurol. 6, 347–352 (2010).
Torralva, T., Dorrego, F., Sabe, L., Chemerinski, E. & Starkstein, S. E. Impairments of social cognition and decision making in Alzheimer's disease. Int. Psychogeriatr. 12, 359–368 (2000).
Folstein, M. F., Folstein, S. E. & McHugh, P. R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12, 189–198 (1975).
Partington, J. E. & Leiter, R. Partington's Pathway Test. The Psychological Service Center Bulletin 1, 9–20 (1949).
Hamann, S., Monarch, E. S. & Goldstein, F. C. Impaired fear conditioning in Alzheimer's disease. Neuropsychologia 40, 1187–1195 (2002).
Mori, E. et al. Amygdalar volume and emotional memory in Alzheimer's disease. Am. J. Psychiatry 156, 216–222 (1999).
Herholz, K. et al. Discrimination between Alzheimer dementia and controls by automated analysis of multicenter FDG PET. Neuroimage 17, 302–316 (2002).
Chu, C. C., Tranel, D., Damasio, A. R. & Van Hoesen, G. W. The autonomic-related cortex: pathology in Alzheimer's disease. Cereb. Cortex 7, 86–95 (1997).
Taylor, A., Saint-Cyr, J. A. & Lang, A. E. Frontal lobe dysfunction in Parkinson's disease. The cortical focus of neostriatal outflow. Brain 109, 845–883 (1986).
Owen, A. M. Cognitive dysfunction in Parkinson's disease: the role of frontostriatal circuitry. Neuroscientist 10, 525–537 (2004).
Trepel, C., Fox, C. R. & Poldrack, R. A. Prospect theory on the brain? Toward a cognitive neuroscience of decision under risk. Brain Res. Cogn. Brain Res. 23, 34–50 (2005).
Agid, Y., Javoy-Agid, F. & Ruberg, M. Biochemistry of neurotransmitters in Parkinson's disease. In Movement Disord ers Vol. 2 (eds Marsden, C. D. & Fahn, S.) 166–230 (Butterworth, London, 1987).
Ouchi, Y. et al. Alterations in binding site density of dopamine transporter in the striatum, orbitofrontal cortex, and amygdala in early Parkinson's disease: compartment analysis for beta-CFT binding with positron emission tomography. Ann. Neurol. 45, 601–610 (2001).
Czernecki, V. et al. Motivation, reward, and Parkinson's disease: influence of dopatherapy. Neuropsychologia 40, 2257–2267 (2002).
Cools, R., Barker, R. A., Sahakian, B. J. & Robbins, T. W. L-Dopa medication remediates cognitive inflexibility, but increases impulsivity in patients with Parkinson's disease. Neuropsychologia 41, 1431–1441 (2003).
Perretta, J. G., Pari, G. & Beninger, R. J. Effects of Parkinson disease on two putative nondeclarative learning tasks. Cogn. Behav. Neurol. 18, 185–192 (2005).
Mimura, M., Oeda, R. & Kawamura, M. Impaired decision-making in Parkinson's disease. Parkinsonism Relat. Disord. 12, 169–175 (2006).
Kalbe, E. et al. Dissociating cognitive from affective theory of mind: a TMS study. Cortex 46, 769–780 (2009).
Hynes, C. A., Baird, A. A. & Grafton, S. T. Differential role of the orbital frontal lobe in emotional versus cognitive perspective-taking. Neuropsychologia 44, 374–383 (2006).
Shamay-Tsoory, S. G. & Aharon-Peretz, J. Dissociable prefrontal networks for cognitive and affective theory of mind: A lesion study. Neuropsychologia 45, 3054–3067 (2007).
Shamay-Tsoory, S. G., Tomer, R., Berger, B. D., Goldsher, D. & Aharon-Peretz, J. Impaired “affective theory of mind” is associated with right ventromedial prefrontal damage. Cogn. Behav. Neurol. 18, 55–67 (2005).
Pagonabarraga, J. et al. Controlled study of decision-making and cognitive impairment in Parkinson's disease. Mov. Disord. 22, 1430–1435 (2007).
Kobayakawa, M., Koyama, S., Mimura, M. & Kawamura, M. Decision making in Parkinson's disease: Analysis of behavioral and physiological patterns in the Iowa gambling task. Mov. Disord. 23, 547–552 (2007).
Bechara, A., Damasio, H. & Damasio, A. R. Role of the amygdala in decision-making. Ann. NY Acad. Sci. 985, 356–369 (2003).
Ibarretxe-Bilbao, N. et al. Neuroanatomical correlates of impaired decision-making and facial emotion recognition in early Parkinson's disease. Eur. J. Neurosci. 30, 1162–1171 (2009).
Euteneuer, F. et al. Dissociation of decision-making under ambiguity and decision-making under risk in patients with Parkinson's disease: a neuropsychological and psychophysiological study. Neuropsychologia 47, 2882–2890 (2009).
Delazer, M. et al. Decision making under risk and under ambiguity in Parkinson's disease. Neuropsychologia 47, 1901–1908 (2009).
Poletti, M. et al. Decision making in de novo Parkinson's disease. Mov. Disord. 25, 1432–1436 (2010).
Vonsattel, J. P. et al. Neuropathological classification of Huntington's disease. J. Neuropathol. Exp. Neurol. 44, 559–577 (1985).
Watkins, L. H. et al. Impaired planning but intact decision making in early Huntington's disease: implications for specific fronto-striatal pathology. Neuropsychologia 38, 1112–1125 (2000).
Baker, S. C. et al. Neural systems engaged by planning: a PET study of the Tower of London task. Neuropsychologia 34, 515–526 (1996).
Owen, A. M. et al. Dopamine-dependent frontostriatal planning deficits in early Parkinson's disease. Neuropsychology 9, 126–140 (1995).
Stout, J. C., Rodawalt, W. C. & Siemers, E. R. Risky decision making in Huntington's disease. J. Int. Neuropsychol. Soc. 7, 92–101 (2001).
Busemeyer, J. R. & Stout, J. C. A contribution of cognitive decision models to clinical assessment: decomposing performance on the Bechara gambling task. Psychol. Assess. 14, 253–262 (2002).
Campbell, M. C., Stout, J. C. & Finn, P. R. Reduced autonomic responsiveness to gambling task losses in Huntington's disease. J. Int. Neuropsychol. Soc. 10, 239–245 (2004).
Hutchinson, J. & Gigerenzer, G. Simple heuristics and rules of thumb: where psychologists and behavioural biologists might meet. Behav. Processes 69, 97–124 (2005).
Kahneman, D. & Tversky, A. Prospect theory: an analysis of decision under risk. Econometrica 47, 263–291 (1979).
Bolla, K. I. et al. Orbitofrontal cortex dysfunction in abstinent cocaine abusers performing a decision-making task. Neuroimage 19, 1085–1094 (2003).
Fukui, H., Murai, T., Fukuyama, H., Hayashi, T. & Hanakawa, T. Functional activity related to risk anticipation during performance of the Iowa Gambling Task. Neuroimage 24, 253–259 (2005).
Christakou, A., Brammer, M., Giampietro, V. & Rubia, K. Right ventromedial and dorsolateral prefrontal cortices mediate adaptive decisions under ambiguity by integrating choice utility and outcome evaluation. J. Neurosci. 29, 11020–11028 (2009).
San Martín, R., Manes, F., Hurtado, E., Isla, P. & Ibañez, A. Size and probability of rewards modulate the feedback error-related negativity associated with wins but not losses in a monetarily rewarded gambling task. NeuroImage 51, 1194–1204 (2010).
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This Review was supported by a FINECO grant.
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E. Gleichgerrcht and A. Ibáñez researched the data for the article, provided substantial contributions to discussions of the content, and contributed to the writing, reviewing and editing of the manuscript. M. Roca, T. Torralva and F. Manes provided substantial contributions to discussions of the content, and contributed to the writing, reviewing and editing of the manuscript.
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Gleichgerrcht, E., Ibáñez, A., Roca, M. et al. Decision-making cognition in neurodegenerative diseases. Nat Rev Neurol 6, 611–623 (2010). https://doi.org/10.1038/nrneurol.2010.148
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DOI: https://doi.org/10.1038/nrneurol.2010.148
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