Ventromedial prefrontal cortex

Brain: Ventromedial prefrontal cortex
Ventromedial prefrontal cortex shown on medial and ventral views of the brain, reflecting approximate location of damage in patients with decision making deficits.
Medial surface of the brain with Brodmann's areas numbered.
Latin	Cortex praefrontalis ventromedialis

The ventromedial prefrontal cortex (vmPFC) is a part of the prefrontal cortex in the mammalian brain. The ventral medial prefrontal is located in the frontal lobe at the bottom of the cerebral hemispheres and is implicated in the processing of risk and fear. It also plays a role in the inhibition of emotional responses, and in the process of decision making.

Anatomy

The ventromedial prefrontal cortex has been described as equivalent to Brodmann area 10. However, not all sources agree on the boundaries of the area.

To get a rough idea of where the ventromedial prefrontal cortex is, recall that the left and right hemispheres of the brain are separated [by the longitudinal cerebral fissure]. Now imagine you could take your hand and starting at the anterior brain (where your forehead is) insert it into this gap until you reached the insula (a structure that is beneath the frontal lobe). Your palm would be touching a part of the prefrontal cortex, which is in the front part of the brain and the lower part of your palm would be touching the ventral medial prefrontal cortex.

The ventromedial prefrontal cortex is connected to and receives input from the ventral tegmental area, amygdala, the temporal lobe, the olfactory system, and the dorsomedial thalamus. It, in turn, sends signals to many different brain regions including; The temporal lobe, amygdala, the lateral hypothalamus, the hippocampal formation, the cingulate cortex, and certain other regions of the prefrontal cortex. This huge network of connections affords the vmPFC the ability to receive and monitor large amounts of sensory data and to affect and influence a plethora of other brain regions, particularly the amygdala.

Note that different researchers use the term 'Ventromedial prefrontal cortex' differently. Sometimes, the term is saved for the area above the medial orbitofrontal cortex, while at other times, 'ventromedial prefrontal cortex' is used to describe a broad area in the lower (ventral) central (medial) region of the prefrontal cortex, of which the medial orbitofrontal cortex constitutes the lowermost part. This latter, broader area, corresponds to the area damaged in patients with decision-making impairments investigated by António Damásio and colleagues (see diagram, and below).

Function

Functional differences between the orbitofrontal and ventromedial areas of the pre-frontal cortex have not yet been clearly established, although the areas of the ventromedial cortex superior to the orbitofrontal cortex are much less associated with social functions and more with pure emotion regulation. Research in developmental neuroscience also suggested that neural networks in the ventromedial prefrontal cortex are rapidly developing during adolescence and young adulthood supporting emotion regulation through the amygdala, being associated with a decrease in cortisol levels. Compared to adults, lesions in the vmPFC of children result in more severe inhibition of social functions and emotional regulation.

Left lateral and medial orbitofrontal cortex areas were also measured to be highly active during guessing tasks. An increase in probabilistic scenario complexity was associated with orbitofrontal cortex activity level increase, therefore suggesting the special role that the ventromedial prefrontal cortex plays in decision making containing uncertainty. A study also indicated that patients with lesions in the ventromedial prefrontal cortex tend to have difficulties reacting to future consequences.

It is also suggested that the ventromedial prefrontal cortex also has a role in decision making in situations containing certainty. This demonstrates a form of myopia for the future because patients with lesions in the vmPFC generally only show concern for immediate prospects, regardless of past consequences or future outcomes. These results suggest that the vmPFC plays a significant role in decision making in general.

The ventromedial prefrontal cortex plays a key role in regulating emotional responses to stressful situations. It allows us to remain calm and suppress emotional urges. Patients with damage to the vmPFC are shown to possess serious impairments in decision and behavior control. These patients tend to exhibit negative personality changes, such as lack of empathy, irresponsibility, aggression, and poor decision making, traits that are also characteristic of psychopathic patients. A recent study on people with vmPFC damage showed a high correlation between emotional dysfunction and impaired competency in real-world activities, while there was no observed relationship between cognitive abilities and competency in real-world activities. This strongly points to the vmPFC's ability to regulate emotions as a key factor in the decision making process.

It is important to note that people with damage to the ventromedial prefrontal cortex still retain the ability to consciously make moral judgments without error, but only in hypothetical situations presented to them. There is a gap in reasoning when applying the same moral principles to similar situations in their own lives. The result is that you see people making decisions that are inconsistent with their self professed moral values.

The right half of the ventromedial prefrontal cortex was associated with regulating the interaction of cognition and affect in the production of empathic responses. Hedonic (pleasure) responses were also associations to orbitofrontal cortex activity level by Morten Kringelbach. This finding contributes findings suggesting ventromedial prefrontal cortex being associated with preference judgement, possibly assigning the ventromedial prefrontal cortex a key role in constructing one's self. Studies with PTSD also supported the idea that the ventromedial prefrontal cortex is an important component for reactivating past emotional associations and events, therefore essentially mediating pathogenesis of PTSD. Treatments geared to the inhibition of the ventromedial prefrontal cortex were therefore suggested for PTSD. The right half of the ventrolateral prefrontal cortex, being active during emotion regulation, was activated when participants were offered an unfair offer in a scenario. Specific deficits in reversal learning and decision-making have led to the hypothesis that the ventromedial prefrontal cortex is a major locus of dysfunction in the mild stages of the behavioural variant of frontotemporal dementia.

One particularly notable theory of vmPFC function is the somatic marker hypothesis, accredited to António Damásio. By this hypothesis, the vmPFC has a central role in adapting somatic markers—emotional associations, or associations between mental objects and visceral (bodily) feedback—for use in natural decision making. This account also gives the vmPFC a role in moderating emotions and emotional reactions because whether the vmPFC decides the markers are positive or negative affects the appropriate response in a particular situation.

Another role that the vmPFC plays is in the process of extinction, the gradual weakening and eventual cessation of a conditioned response. The specific role played by the vmPFC concerning extinction is not well understood, but it is believed that it plays a necessary role in the recall of extinction learning after a long period of time. Studies show that it aids in the consolidation of extinction learning. A separate study has implicated the correlation between the cortical thickness of the vmPFC and the degree of extinction memory. Patients with larger vmPFCs tended to have lower responses to the extinct conditioned stimulus, therefore suggesting a superior extinction memory.

Ventromedial prefrontal cortex lesions were also associated with a deficit in processing gender specific social cues. One experiment tested the ability of patients with vmPFC lesions to categorize gender-specific names, attributes, and attitudes compared to patients with dorsolateral prefrontal cortex lesions and control subjects. Whereas the patients with dorsolateral prefrontal cortex lesions performed similarly to the control subjects on tests indicating gender stereotypes, patients with ventromedial prefrontal cortex lesions demonstrated impaired stereotypic social knowledge.

External links

• The Brain from Top to Bottom: Brain Abnormalities Associated With Anxiety Disorders
• Bechara A, Tranel D, Damasio H (November 2000). "Characterization of the decision-making deficit of patients with ventromedial prefrontal cortex lesions". Brain 123 (Pt 11): 2189–202. doi:10.1093/brain/123.11.2189. PMID 11050020. 
• Quirk GJ, Russo GK, Barron JL, Lebron K (August 2000). "The role of ventromedial prefrontal cortex in the recovery of extinguished fear". J. Neurosci. 20 (16): 6225–31. PMID 10934272. 
• "Scientists Draw Link Between Morality And Brain's Wiring". Wall Street Journal. 2007-05-11. 
• Carey, Benedict (2007-03-22). "Brain Injury Said to Affect Moral Choices". New York Times. 
• Shamay-Tsoory, S. G.; Tomer, R.; Berger, B. D.; Aharon-Peretz, J. (2003). "Characterization of Empathy Deficits following Prefrontal Brain Damage: The Role of the Right Ventromedial Prefrontal Cortex". Journal of Cognitive Neuroscience 15 (3): 324–37. doi:10.1162/089892903321593063. PMID 12729486. 
• Hooper CJ, Luciana M, Conklin HM, Yarger RS (November 2004). "Adolescents' performance on the Iowa Gambling Task: implications for the development of decision making and ventromedial prefrontal cortex". Dev Psychol 40 (6): 1148–58. doi:10.1037/0012-1649.40.6.1148. PMID 15535763. 
• Elliott R, Rees G, Dolan RJ (April 1999). "Ventromedial prefrontal cortex mediates guessing". Neuropsychologia 37 (4): 403–11. doi:10.1016/S0028-3932(98)00107-9. PMID 10215087. 
• Rahman, S.; Sahakian, B.J.; Hodges, J.R.; Rogers, R.D.; Robbins, T.W. (1999). "Specific cognitive deficits in mild frontal variant frontotemporal dementia". Brain 122 (8): 1469–93. doi:10.1093/brain/122.8.1469. 
• Jacques Mehler; Susana Franck (1995). Cognition on cognition. MIT Press. pp. 3–. ISBN 978-0-262-63167-9. "Intensity to Future Consequences Following Damage to Human Prefrontal Cortex" 
• Urry HL, van Reekum CM, Johnstone T, et al. (April 2006). "Amygdala and ventromedial prefrontal cortex are inversely coupled during regulation of negative affect and predict the diurnal pattern of cortisol secretion among older adults". J. Neurosci. 26 (16): 4415–25. doi:10.1523/JNEUROSCI.3215-05.2006. PMID 16624961. 
• Paulus MP, Frank LR (July 2003). "Ventromedial prefrontal cortex activation is critical for preference judgments". NeuroReport 14 (10): 1311–5. doi:10.1097/01.wnr.0000078543.07662.02. PMID 12876463. 
• Zald DH, Mattson DL, Pardo JV (February 2002). "Brain activity in ventromedial prefrontal cortex correlates with individual differences in negative affect". Proc. Natl. Acad. Sci. U.S.A. 99 (4): 2450–4. doi:10.1073/pnas.042457199. PMC 122385. PMID 11842195. 
• Tabibnia G, Satpute AB, Lieberman MD (April 2008). "The sunny side of fairness: preference for fairness activates reward circuitry (and disregarding unfairness activates self-control circuitry)". Psychol Sci 19 (4): 339–47. doi:10.1111/j.1467-9280.2008.02091.x. PMID 18399886. 
• The Orbitofrontal Cortex: Linking Reward to Hedonic Experience
• Milne E, Grafman J (June 2001). "Ventromedial prefrontal cortex lesions in humans eliminate implicit gender stereotyping". J. Neurosci. 21 (12): RC150. PMID 11404442. 
• Koenigs M, Huey ED, Raymont V, et al. (February 2008). "Focal brain damage protects against post-traumatic stress disorder in combat veterans". Nat. Neurosci. 11 (2): 232–7. doi:10.1038/nn2032. PMC 2693133. PMID 18157125. 
• Sanchez-Navarro, Juan P.; Driscoll, David; Buchanan, Tony W.; Bechara, Antoine; Anderson, Steven W.; Tranel, Daniel (September 2011). "Ventromedial prefrontal cortex regulation of prepulse inhibition and emotional modulation of the startle reflex: effect of lesion onset". Front. Hum. Neurosci. Conference Abstract: XI International Conference on Cognitive Neuroscience (ICON XI). doi: 10.3389/conf.fnhum.2011.207.00165