The role of executive functions and cognitive estimation in decision-making: a study with patients with prefrontal cortex damage.

Evidence remained conflicting regarding how the prefrontal cortex supported decision-making abilities, particularly in patients with focal prefrontal cortex lesions. While damage to this region was known to impair executive functioning, the precise contribution of such deficits to decision-making performance - especially under varying levels of uncertainty - remained debated. Moreover, cognitive estimation processes, which were associated with logical reasoning and prefrontal involvement, had rarely been examined in relation to decision-making tasks. To clarify these associations, we administered a cognitive estimation task and the Iowa Gambling Task (IGT), alongside a battery of executive function tests, to 30 patients with focal prefrontal damage and 30 matched control subjects. Our results indicated that patients showed consistent impairment across executive functions, cognitive estimation, and decision-making under risk. Furthermore, correlation and regression analyses revealed that performance on executive tasks and cognitive estimation predicted IGT outcomes, particularly under risk conditions. Finally, voxel-based lesion-symptom mapping identified a bilateral prefrontal network - spanning ventromedial, dorsomedial, and dorsolateral regions - associated with impaired IGT performance. These findings suggested that the multidimensional nature of the IGT was associated with complex executive and inferential reasoning demands and implicated diverse patterns of frontal dysfunction beyond the ventromedial prefrontal cortex.

• Publication year

  2026

• Venue

  Social Neuroscience

• Publication date

  2026-02-05

• Fields of study

  Medicine, Psychology

• Identifiers
  DOI 10.1080/17470919.2026.2614481PMID 41640360
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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

  2025cited by this paper
• Relationship Between Cognitive Estimation, Executive Functions, and Theory of Mind in Patients With Prefrontal Cortex Damage.

  2024cited by this paper
• The role of cognitive estimation in understanding the mental states of others

  2023cited by this paper
• Risk Decision Making and Executive Function among Adolescents and Young Adults

  2023cited by this paper
• Decision-making under ambiguity and risk and executive functions in Parkinson’s disease patients: A scoping review of the studies investigating the Iowa Gambling Task and the Game of Dice

  2023cited by this paper
• Executive Functions in Decision Making under Ambiguity and Risk in Healthy Adults: A Scoping Review Adopting the Hot and Cold Executive Functions Perspective

  2022cited by this paper
• Decision-making ability, psychopathology, and brain connectivity

  2021cited by this paper
• What determines cognitive estimation ability? Changing contributions of semantic and executive domains as a function of age

  2021cited by this paper
• Neural Activation in Risky Decision-Making Tasks in Healthy Older Adults: A Meta-Analysis of fMRI Data

  2021cited by this paper
• The role of PFC networks in cognitive control and executive function

  2021cited by this paper
• Neural Correlates of Verb Fluency Performance in Cognitively Healthy Older Adults and Individuals With Dementia: A Pilot fMRI Study

  2020cited by this paper
• The value of decision-making power in social decisions

  2020cited by this paper
• Relationships between executive function, working memory, and decision-making on the Iowa Gambling Task: Evidence from ventromedial patients, dorsolateral patients, and normal subjects.

  2019cited by this paper
• The comparison of risky and ambiguity decision making and cool executive functions between patients with obsessive compulsive disorder and healthy controls

  2018cited by this paper
• Contributions of medial prefrontal cortex to decision making involving risk of punishment

  2018cited by this paper
• Learning, Reward, and Decision Making

  2017cited by this paper
• Design fluency subsequent to onset of aphasia: a distinct pattern of executive function difficulties?

  2017cited by this paper
• Cognitive estimation: Performance of patients with focal frontal and posterior lesions

  2017cited by this paper
• Contribution of different regions of the prefrontal cortex and lesion laterality to deficit of decision‐making on the Iowa Gambling Task

  2017cited by this paper
• Assessing Cognitive Estimation and Its Effects on Community Integration in People with Acquired Brain Injury Undergoing Rehabilitation

  2017cited by this paper
• Strategic Decision-Making and Social Skills: Integrating Behavioral Economics and Social Cognition Research

  2016cited by this paper
• Semantic memory organization on verbal fluency test "Human Body Parts" in patients with chronic schizophrenia diagnosis and healthy controls

  2016cited by this paper
• Disentangling the relationship between cognitive estimation abilities and executive functions: a study on patients with Parkinson’s disease

  2015cited by this paper
• How many segments are there in an orange: normative data for the new Cognitive Estimation Task in an Italian population

  2015cited by this paper
• Mental simulation and meaning in life.

  2015cited by this paper
• Among three different executive functions, general executive control ability is a key predictor of decision making under objective risk

  2014cited by this paper
• Know the risk, take the win: How executive functions and probability processing influence advantageous decision making under risk conditions

  2014cited by this paper
• Bringing the Cognitive Estimation Task into the 21st Century: Normative Data on Two New Parallel Forms

  2014cited by this paper
• Validating the PVL-Delta model for the Iowa gambling task

  2013cited by this paper
• A Comparison of Reinforcement Learning Models for the Iowa Gambling Task Using Parameter Space Partitioning

  2013cited by this paper
• Investigating higher-order cognitive functions in temporal lobe epilepsy: cognitive estimation.

  2013cited by this paper
• Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex

  2012cited by this paper
• Cognitive estimation abilities in healthy and clinical populations: the use of the Cognitive Estimation Test

  2011cited by this paper
• Executive functions, categorization of probabilities, and learning from feedback: What does really matter for decision making under explicit risk conditions?

  2011cited by this paper
• Contributions of subregions of the prefrontal cortex to the theory of mind and decision making.

  2011cited by this paper
• Contributions of the nucleus accumbens and its subregions to different aspects of risk-based decision making

  2011cited by this paper
• Cognitive estimation in aged patients with major depressive disorder.

  2010cited by this paper
• Decision-making and cognitive abilities: A review of associations between Iowa Gambling Task performance, executive functions, and intelligence.

  2010cited by this paper
• Decreased activation of lateral orbitofrontal cortex during risky choices under uncertainty is associated with disadvantageous decision-making and suicidal behavior

  2010cited by this paper
• Frontotemporal dementia presenting as pathological gambling

  2010cited by this paper
• Brain regions involved in the learning and application of reward rules in a two-deck gambling task.

  2010cited by this paper
• Impaired decision making in schizophrenia and orbitofrontal cortex lesion patients.

  2010cited by this paper
• A neuropsychological battery to detect specific executive and social cognitive impairments in early frontotemporal dementia.

  2009cited by this paper
• The Cognitive Estimation Test (CET): Psychometric limitations in neurorehabilitation populations

  2009cited by this paper
• Distinct roles of prefrontal cortical subregions in the Iowa Gambling Task.

  2009cited by this paper
• Iowa Gambling Task Impairment Is Not Specific To Ventromedial Prefrontal Lesions

  2009cited by this paper
• Decision making in patients with temporal lobe epilepsy.

  2009cited by this paper
• Determining a role for ventromedial prefrontal cortex in encoding action-based value signals during reward-related decision making.

  2009cited by this paper
• Impact of ambiguity and risk on decision making in mild Alzheimer's disease.

  2008cited by this paper
• Assessment of executive functions: review of instruments and identification of critical issues.

  2008cited by this paper
• Impulsivity and risk-taking behavior in focal frontal lobe lesions.

  2008cited by this paper
• Explicit neural signals reflecting reward uncertainty

  2008cited by this paper
• Power in Voxel-based Lesion-Symptom Mapping

  2007cited by this paper
• The Neural Basis of Loss Aversion in Decision-Making Under Risk

  2007cited by this paper
• Improving Lesion-Symptom Mapping

  2007cited by this paper
• Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study.

  2007cited by this paper
• Orbitofrontal volume deficit in schizophrenia and thought disorder.

  2007cited by this paper
• Segregation of function in the lateral prefrontal cortex during visual object working memory.

  2007cited by this paper
• Decisions under ambiguity and decisions under risk: Correlations with executive functions and comparisons of two different gambling tasks with implicit and explicit rules

  2007cited by this paper
• Response inhibition deficit is involved in poor decision making under risk in nonamnesic individuals with alcoholism.

  2007cited by this paper
• Decision-making with explicit and stable rules in mild Alzheimer's disease.

  2007cited by this paper
• Decision-making impairments in adolescents with early-onset schizophrenia.

  2006cited by this paper
• Using fMRI to decompose the neural processes underlying the Wisconsin Card Sorting Test

  2006cited by this paper
• Neuropsychological correlates of decision-making in ambiguous and risky situations

  2006cited by this paper
• The somatic marker hypothesis: a critical evaluation.

  2006cited by this paper
• Executive Function and the Frontal Lobes: A Meta-Analytic Review

  2006cited by this paper
• Decision-making deficits of korsakoff patients in a new gambling task with explicit rules: associations with executive functions.

  2005cited by this paper
• Neural Systems Responding to Degrees of Uncertainty in Human Decision-Making

  2005cited by this paper
• The neuroanatomical basis of understanding sarcasm and its relationship to social cognition.

  2005cited by this paper
• Functional activity related to risk anticipation during performance of the Iowa gambling task

  2005cited by this paper
• Functional connectivity with anterior cingulate and orbitofrontal cortices during decision-making.

  2005cited by this paper
• The somatic marker hypothesis: still many questions but no answers: Response to Bechara et al.

  2005cited by this paper
• The cerebral correlates of different types of perseveration in the Wisconsin Card Sorting Test

  2005cited by this paper
• The ability to decide advantageously declines prematurely in some normal older persons.

  2005cited by this paper
• Artificial time constraints on the Iowa Gambling Task: the effects on behavioural performance and subjective experience.

  2005cited by this paper
• The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage.

  2004cited by this paper
• Different underlying impairments in decision-making following ventromedial and dorsolateral frontal lobe damage in humans.

  2004cited by this paper
• A reexamination of the evidence for the somatic marker hypothesis: what participants really know in the Iowa gambling task.

  2004cited by this paper
• The role of semantic knowledge on the cognitive estimation task

  2004cited by this paper
• Performance on the IOWA card task by adolescents and adults.

  2004cited by this paper
• The Biber Cognitive Estimation Test.

  2004cited by this paper
• Social and Emotional Decision-making Following Frontal Lobe Injury

  2004cited by this paper
• Impaired performance in a test of decision-making by opiate-dependent tobacco smokers.

  2004cited by this paper
• How many camels are there in Italy? Cognitive estimates standardised on the Italian population

  2003cited by this paper
• Ventromedial frontal cortex mediates affective shifting in humans: evidence from a reversal learning paradigm.

  2003cited by this paper
• Cognitve estimation: comparison of two tests in nondemented parkinsonian patients

  2003cited by this paper
• Voxel-based lesion–symptom mapping

  2003cited by this paper
• Automated Anatomical Labeling of Activations in SPM Using a Macroscopic Anatomical Parcellation of the MNI MRI Single-Subject Brain

  2002cited by this paper
• Neural mechanisms of planning: A computational analysis using event-related fMRI

  2002cited by this paper
• Adult clinical neuropsychology: lessons from studies of the frontal lobes.

  2002cited by this paper
• Decision-making processes following damage to the prefrontal cortex.

  2002cited by this paper
• Hemispheric asymmetry in human lateral prefrontal cortex during cognitive set shifting

  2002cited by this paper
• Performance of Older Adults on Tests of Cognitive Estimation

  2002cited by this paper
• Emotion, decision making and the orbitofrontal cortex.

  2000cited by this paper
• Visualizing brain activation during planning: the tower of London test adapted for functional MR imaging.

  2000cited by this paper
• Strategy application disorder: the role of the frontal lobes in human multitasking

  2000cited by this paper
• Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions.

  2000cited by this paper
• Functional magnetic resonance imaging of human brain activity in a verbal fluency task

  1998cited by this paper
• Transient activation of inferior prefrontal cortex during cognitive set shifting

  1998cited by this paper
• Deciding Advantageously Before Knowing the Advantageous Strategy

  1997cited by this paper

• No citing papers are available for this paper.