Highlights
- •Patients who have gone through FLR show difficulties with decision-making under ambiguity.
- •They fail to learn from feedback throughout the Iowa Gambling Task.
- •Decision-making under ambiguity was not correlated to results in executive tasks.
Abstract
Purpose
Decision-making is crucial to daily life and can impact our society as well as economic
conditions. Although the frontal lobes have been identified as important for decision-making,
this capacity has only been studied to a limited extent in frontal lobe epilepsy and
not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore
decision-making under ambiguity after FLR for epilepsy.
Methods
Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task
(IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa
Gambling Task scores included in the analysis were: total net score, separate scores
from five blocks across the test, and a change score (last block of IGT minus first
block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological
methods for assessment of executive functions, self-rating questionnaires of mental
health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated.
Results
The patient group performed inferior to controls at the final block of the IGT (p =.001). A group difference in IGT change scores was found (p =.005), reflecting the absence of a positive change in performance over time for the FLR group compared
to the control group. Correlations with tests of executive functions as well as self-rating
scales were mainly statistically nonsignificant.
Conclusions
This study shows that patients having undergone FLR for epilepsy have difficulties
with decision-making under ambiguity. The performance illustrated a failure to learn
throughout the task. Executive as well as emotional deficits may impact decision-making
processes in this patient group and need to be considered in further studies. Prospective
studies with larger cohorts are needed.
Keywords
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References
- Neuropsychological correlates of decision-making in ambiguous and risky situations.Neural Netw. 2006; 19: 1266-1276
- Impact of ambiguity and risk on decision making in mild Alzheimer's disease.Neuropsychologia. 2008; 46: 2043-2055
- The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage.Brain Cogn. 2004; 55: 30-40
- The Iowa Gambling Task and the somatic marker hypothesis: some questions and answers.Trends Cogn Sci. 2005; 9 (discussion 162-4): 159-162
- Insensitivity to future consequences following damage to human prefrontal cortex.Cognition. 1994; 50: 7-15
- Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions.Brain. 2000; 123: 2189-2202
- Decision-making and addiction (part II): myopia for the future or hypersensitivity to reward?.Neuropsychologia. 2002; 40: 1690-1705
- Decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers.Neuropsychologia. 2001; 39: 376-389
- Dissociation Of working memory from decision making within the human prefrontal cortex.J Neurosci. 1998; 18: 428-437
- Emotion, decision making and the orbitofrontal cortex.Cereb Cortex. 2000; 10: 295-307
- Decision-making in patient s with epilepsy: A systematic review and meta-analysis.Epilepsy Res. 2018; 148: 55-62
- Decision-making in temporal lobe epilepsy examined with the Iowa gambling task.Epilepsy Res. 2011; 93: 33-38
- Decision making in juvenile myoclonic epilepsy.J Neurol. 2013; 260: 839-846
- Decision making in patients with temporal lobe epilepsy.Neuropsychologia. 2009; 47: 50-58
- Decision making in ambiguous and risky situations after unilateral temporal lobe epilepsy surgery.Epilepsy Behav. 2009; 14: 665-673
- Decision making under ambiguity and under risk in mesial temporal lobe epilepsy.Neuropsychologia. 2010; 48: 194-200
- Comparison of decision-making under ambiguity in patients with temporal lobe and frontal lobe epilepsy.Epilepsy Behav. 2022; 129108636
- Decision-making impairments following insular and medial temporal lobe resection for drug-resistant epilepsy.Soc Cogn Affect Neurosci. 2017; 12: 128-137
- Dissociation between decision making under ambiguity and risk in patients with juvenile myoclonic epilepsy.Epilepsy Behav. 2019; 101106548
- Decision making under ambiguity in temporal lobe epilepsy: does the location of the underlying structural abnormality matter?.Epilepsy Behav. 2011; 20: 34-37
- Rates and predictors of long-term seizure freedom after frontal lobe epilepsy surgery: a systematic review and meta-analysis.J Neurosurg. 2012; 116: 1042-1048
- Neuropsychological consequences of epilepsy surgery in frontal lobe epilepsy.Neuropsychologia. 1998; 36: 681-689
- Cognitive outcome two years after frontal lobe resection for epilepsy - a prospective longitudinal study.Seizure. 2015; 30: 50-56
- Neuropsychological outcome following frontal lobectomy for pharmacoresistant epilepsy in adults.Neurology. 2017; 88: 692-700
- Executive functioning and depressed mood before and after unilateral frontal lobe resection for intractable epilepsy.Neuropsychologia. 2013; 51: 1370-1376
- Pre- and postoperative verbal memory and executive functioning in frontal versus temporal lobe epilepsy.Epilepsy Behav. 2019; 101106538
- Predictors of decline in verbal fluency after frontal lobe epilepsy surgery.Epilepsy Behav. 2013; 27: 326-329
- Cognitive outcomes in patients with frontal lobe epilepsy.Epilepsia. 2006; 2: 87-89
- Longitudinal trajectory of quality of life and psychological outcomes following epilepsy surgery.Epilepsy Behav. 2020; 111107283
- Psychosocial outcome in epilepsy after extratemporal surgery.Epilepsy Behav. 2018; 81: 94-100
- Reduction in apathy following epilepsy surgery.Neuropsychiatr Dis Treat. 2019; 15: 1679-1684
- Experiences of emotional and psychosocial functioning after frontal lobe resection for epilepsy.Epilepsy Behav. 2021; 121108077
- Risky decision-making in older adults without cognitive deficits: an fMRI study of VMPFC using the Iowa Gambling Task.Soc Neurosci. 2012; 7: 178-190
- Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex.PNAS. 2012; 109: 14681-14686
Bechara A. Iowa Gambling Task. Professional Manual. In. Lutz: PAR; 2007.
Wechsler D. Wechsler Adult Intelligence Scale - Fourth Edition. In: Pearson Assessments. USA; 2008.
Delis DC, Kaplan E, Kramer JH. Delis Kaplan Executive Function System (D-KEFS). In. San Antonio: The Psychological Corporation; 2001.
- Reliability and validity of the Delis-Kaplan Executive Function System: an update.J Int Neuropsychol Soc. 2004; 10: 301-303
- On the control of automatic processes: a parallel distributed processing account of the Stroop effect.Psychol Rev. 1990; 97: 332-361
Wechsler D. Technical Manual for the Wechsler Adult Intelligence Scale - Third Edition. San Antonio: The Psychological Corporation; 1997.
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- Mental fatigue–subjective problem possible to assess. New Swedish self-assessment scale tested in different patient groups.Lakartidningen. 2010; 107: 2964-2967
- Assessing frontal lobe behavioral syndromes with the frontal lobe personality scale.Assessment. 1999; 6: 269-284
- Emotion and decision-making: affect-driven belief systems in anxiety and depression.Trends Cogn Sci. 2012; 16: 476-483
- Relationship between poor decision-making process and fatigue perception in Parkinson's disease patients.J Neurol Sci. 2014; 337: 167-172
- Screening for depression in people with epilepsy: comparative study among neurological disorders depression inventory for epilepsy (NDDI-E), hospital anxiety and depression scale depression subscale (HADS-D), and Beck depression inventory (BDI).Epilepsy Behav. 2014; 34: 50-54
- Using Hospital Anxiety and Depression Scale (HADS) on patients with epilepsy: Confirmatory factor analysis and Rasch models.Seizure. 2017; 45: 42-46
- A self-assessment questionnaire for mental fatigue and related symptoms after neurological disorders and injuries.Brain Inj. 2010; 24: 2-12
- Factor analysis of the frontal systems behavior scale (FrSBe).Assessment. 2003; 10: 79-85
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
- The somatic marker hypothesis: a critical evaluation.Neurosci Biobehav Rev. 2006; 30: 239-271
- 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. 2007; 29: 86-99
- Deciding advantageously before knowing the advantageous strategy.Science. 1997; 275: 1293-1295
- Social-economical decision making in current and remitted major depression.Psychol Med. 2015; 45: 1301-1313
- Decision-making executive function profile and performance in older adults with major depression: a case-control study.Aging Ment Health. 2021; : 1-7
- The Iowa Gambling Task in depression - what have we learned about sub-optimal decision-making strategies?.Front Psychol. 2013; 4: 732
Article info
Publication history
Published online: April 17, 2023
Accepted:
April 4,
2023
Received in revised form:
April 2,
2023
Received:
November 28,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
