Source: Laboratories of Jonas T. Kaplan and Sarah I. Gimbel—University of Southern California

Decision-making is an important component of human executive function, in which a choice about a course of action or cognition is made from many possibilities. Damage to the inferior parts of the frontal lobes can affect a person's ability to make good decisions. However, while decision-making deficits can have a large impact on one's life, these deficits can be difficult to quantify in the laboratory. In the mid-1990s, a task was designed to mimic real life decision-making in the laboratory. This task, known as the Iowa Gambling Task (IGT), is a cognitively complex task used widely in research and clinical studies as a highly sensitive measure of decision-making ability.^1-3

In the IGT, a participant is shown four decks of cards and chooses to reveal a card from one deck on each turn. When a card is turned over, the participant will receive some money, but sometimes will also be required to pay a penalty. Two of the decks have higher payoffs, but also have high penalties such that choosing from these decks leads to a net loss in the long term. The other two decks have lower payoffs, but also present smaller penalties, so that choosing from these decks leads to a net gain. Thus, to make an advantageous choice, participants must integrate information about losses and gains over time.

This video demonstrates how to administer the IGT to compare the performance of patients with damage to the ventromedial prefrontal cortex to a group of matched control subjects, revealing the unique contribution of this brain region to decision-making.

1. Participant recruitment

1. Patient recruitment
   1. Recruit 10 patients with damage to the ventromedial sector of the prefrontal cortices.
   2. Damage to this region is confirmed by neuroimaging with MRI. The ventromedial prefrontal cortex is located at the most anterior medial wall of the cerebral cortex, on the ventral surface. Damage can be unilateral or bilateral, but should not extend beyond the ventromedial prefrontal cortex. An example of the brain of such a patient is shown in Fig

In 100-card draws from four decks, normal controls made more selections from the good decks (C and D), and avoided the bad decks (A and B). In contrast, patients with ventromedial prefrontal cortex (VMPFC) damage made more selections from the bad decks (A and B), and avoided the good decks (C and D; Figure 3). The number of cards selected by controls from decks A and B were significantly less than the number of cards selected from those decks by the patients. In contrast,

This task can serve to assess decision-making deficits in a variety of populations. For example, in addition to patients with damage to the VMPFC, patients with bilateral amygdala damage also show severe decision-making impairments that can be measured by the IGT. Additionally, disadvantageous decision-making characterizes various psychopathological conditions, including substance addiction, pathological gambling, schizophrenia, obsessive-compulsive disorder, anorexia nervosa, attention deficit/hyperactivity disorder, ps

1. 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).
2. Bechara, A., Damasio, H., Tranel, D. & Damasio, A.R. Deciding advantageously before knowing the advantageous strategy. Science 275, 1293-1295 (1997).
3. Li, X., Lu, Z.L., D'Argembeau, A., Ng, M. & Bechara, A. The Iowa Gambling Task in fMRI images. Hum Brain Mapp 31, 410-423 (2010).
4. Shurman, B., Horan, W.P. & Nuechterlein, K.H. Schizophrenia patients demonstrate a distinctive pattern of decision-making impairment on the Iowa Gambling Task. Schizophr Res 72, 215-224 (2005).