The Functional Neuroanatomy of Decision-Making

The process of decision-making is a complex executive function involving cognitive and emotional integration of experience. fMRI and focal lesion studies have implicated the orbitofrontal, anterior cingulate, and dorsolateral prefrontal cortex as areas that, in their connections with the limbic system, basal ganglia, and cerebellum, form a novel, integrated neuroanatomical model. This integrated circuitry may be damaged by the processes of frontotemporal dementia, traumatic brain injury, or possible structural/functional deficits that result in sociopathy.

Decision-making is a complex executive function that draws on past experience, present goals, and anticipation of outcome, and which is influenced by prevailing and predicted emotional tone and cultural context. Functional imaging investigations and focal lesion studies identify the orbitofrontal, anterior cingulate, and dorsolateral prefrontal cortices as critical to decision-making. The authors review the connections of these prefrontal regions with the neocortex, limbic system, basal ganglia, and cerebellum, highlight current ideas regarding the cognitive processes of decision-making that these networks subserve, and present a novel integrated neuroanatomical model for decision-making. Finally, clinical relevance of this circuitry is illustrated through a discussion of frontotemporal dementia, traumatic brain injury, and sociopathy.