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Diminished Decision-Making Capacity
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
The brain location in question for diminished decision-making capacity is often the ventromedial prefrontal cortex (vmPFC) which is located near the front of your skull (Schneider & Koenigs, 2017). The vmPFC isn't really one specific place in the brain, but more of a highly complex and interconnected brain region that is involved in a lot of different brain disorders (Hiser & Koenigs, 2018). This complexity is an important point. When comparing the symptoms of people with damage in this region to people with brain damage located somewhere other than prefrontal regions, the people with the vmPFC damage showed more “blunted emotional experience, apathy, low emotional expressiveness, inappropriate affect, poor frustration tolerance, irritability, lability, indecisiveness, poor judgment, social inappropriateness, lack of planning, lack of initiation and persistence, and lack of insight” (Barrash et al., 2000, p. 355). Each symptom from this wide variety may be involved in diminished decision-making capacity. Evidence from a variety of studies suggests that people with damage to the vmPFC have trouble “both generating feasible options and choosing the best decision” (Schneider & Koenigs, 2017, p. 86). This may appear as symptoms of inhibition inhibition, acquired decision paralysis, or both.
Recognising and engaging with problems with executive control
Published in Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster, Addressing Brain Injury in Under-Resourced Settings, 2017
Ross Balchin, Rudi Coetzer, Christian Salas, Jan Webster
The various parts of the frontal lobes participate differentially in the regulation of behaviour (Stuss, 2009). Take a look at Figure 9.2. The dorsolateral prefrontal cortex (DLPFC) relates to high-level cognitive skills, such as problem solving, strategy selection and evaluating outcomes. The ventrolateral prefrontal cortex (VLPFC) is associated with behavioural and emotional regulation (inhibition), as is the ventromedial prefrontal cortex (VMPFC).
The Relation of Alcohol-Induced Brain Changes to Cognitive Function
Published in Jenny Svanberg, Adrienne Withall, Brian Draper, Stephen Bowden, Alcohol and the Adult Brain, 2014
Beaunieux Hélène, Eustache Francis, Pitel Anne-Lise
Several regions belonging to the somatic marker brain network are known to be damaged in chronic alcoholism, especially the frontal cortices, amygdala, hippocampus, striatum and cerebellum. Le Berre et al. (2014) reported that decision-making deficits in alcoholism are associated with reduced gray matter volume in the ventromedial prefrontal cortex (gyrus rectus and pregenual anterior cingulate cortex), the dorsal portion of the anterior cingulate cortex and the hippocampal formation (Figure 8.6). These results suggest that decision-making deficits in this group may result from impairment of both impulsive and reflective brain networks. These deficits may lead people with alcoholism to suffer from “myopia” for the future, contributing to their tendency to choose instant gratification (i.e., the immediate advantages of their alcohol consumption). This “myopia” may dim the person's awareness of the problems arising from substance abuse and may keep them in denial about their illness (Verdejo-García and Pérez-García, 2008).
Nonconformist tendencies related to risky choices in female methamphetamine abstainers
Published in The American Journal of Drug and Alcohol Abuse, 2020
Shuguang Wei, Quanying Liu, Michael Harrington, Jinxiu Sun, Hao Yu, Jie Han, Ming Hao, Haiyan Wu, Xun Liu
The nonconformity observed in female methamphetamine abstainers here may also echo previous neuroimaging studies. Chung et al. found that the ventromedial prefrontal cortex encodes the added utility conferred by others’ choices and predicts the likelihood of conforming to those choices. In particular, when participants conformed their behavior in opposition to their innate attitudes toward risky choices, activation in the anterior insula and dorsal anterior cingulate cortex increased (26). These findings point to the functional roles of the insula, dorsal anterior cingulate cortex, and ventromedial prefrontal cortex in linking individual risk preferences with perceptions of social influence and conformity (or not). Such insula, anterior cingulate cortex, and prefrontal cortex hypoactivations are often linked to disrupted cognitive control and decision-making in methamphetamine users (62–64). We recommend future neuroimaging investigation on this topic, as the dysfunction of the insula, anterior cingulate cortex, and prefrontal cortex may account for the nonconforming tendency shown in female methamphetamine abstainers in the current study.
A Narrative Coherence Standard for the Evaluation of Decisional Capacity: Turning Back the Clock
Published in AJOB Neuroscience, 2020
Manuel Trachsel, Paul S. Appelbaum
Putting aside these specific cases, there are indeed clinical situations in which the current criteria for decisional capacity seem at first sight to be insufficient. As an example, it is known that emotions have a crucial function in decision making. For instance, patients with lesions in the ventromedial prefrontal cortex, described at length by Antonio Damasio (see Appelbaum, 1998; Damasio, 1994), seem to lack the emotional responsivity that would allow appropriate decisions to be made. Tranel, Bechara, and Denburg (2002) have described cases in which, after tumors had been resected from the frontal lobe, patients showed a lack of emotional processing and at the same time, intact cognitive functioning. “Despite their fully restored intellectual capacities, these patients make disastrous decisions in complex everyday situations by virtue of their “hard-wired” inability to incorporate affective cues into their decision-making process” (Hermann et al. 2016, 3). As one of us has argued elsewhere (Appelbaum, 1998), however, it has never been clear that these people would not be identified as decisionally incapable under current criteria, nor that the problem is common enough and the relevant impairment in emotional capacity can be defined with sufficient clarity and assessed with adequate reliability to warrant incorporation into the traditional set of criteria for decisional competence.
Functional Changes in Brain Activity After Hypnosis: Neurobiological Mechanisms and Application to Patients with a Specific Phobia—Limitations and Future Directions
Published in International Journal of Clinical and Experimental Hypnosis, 2019
Ulrike Halsband, Thomas Gerhard Wolf
Future studies should be devoted to the link between physiological parameters and neuroimaging studies. Thayer, Åhs, Fredrikson, Sollers, and Wager (2012) performed a meta-analysis of neuroimaging studies on the relationship between heart rate variability and regional cerebral blood flow. The authors succeeded to identify a number of brain regions, including the amygdala and ventromedial prefrontal cortex, in which significant associations across studies were found. It is known that these areas are involved in the perception of threat. The study points to the importance of heart rate variability as a potential marker of stress and its link to brain activity changes. Future studies are needed to disentangle the link between physiological parameters and the correlations with cognitive, somatic and behavioral symptoms.