title: Canceled connections: Lesion-derived network mapping helps explain differences in performance on a complex decision-making task.
abstract: Studies of patients with brain damage have highlighted a broad neural network of limbic and prefrontal areas as important for adaptive decision-making. However, some patients with damage outside these regions have impaired decision-making behavior, and the behavioral impairments observed in these cases are often attributed to the general variability in behavior following brain damage, rather than a deficit in a specific brain-behavior relationship. A novel approach, lesion-derived network mapping, uses healthy subject resting-state functional connectivity (RSFC) data to infer the areas that would be connected with each patient's lesion area in healthy adults. Here, we used this approach to investigate whether there was a systematic pattern of connectivity associated with decision-making performance in patients with focal damage in areas not classically associated with decision-making. These patients were categorized a priori into "impaired" or "unimpaired" groups based on their performance on the Iowa Gambling Task (IGT). Lesion-derived network maps based on the impaired patients showed overlap in somatosensory, motor and insula cortices, to a greater extent than patients who showed unimpaired IGT performance. Akin to the classic concept of "diaschisis" (von Monakow, 1914), this focus on the remote effects that focal damage can have on large-scale distributed brain networks has the potential to inform not only differences in decision-making behavior, but also other cognitive functions or neurological syndromes where a distinct phenotype has eluded neuroanatomical classification and brain-behavior relationships appear highly heterogeneous.
authors.affiliation: Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. Electronic address: matthew-sutterer@uiowa.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Sutterer
authors.affiliation: Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Bruss
authors.affiliation: Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Boes
authors.affiliation: Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
authors.forename: Michelle W
authors.initials: MW
authors.lastname: Voss
authors.affiliation: Department of Psychology, University of Southern California, Los Angeles, CA, USA.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bechara
authors.affiliation: Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tranel
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology*; D001930:Brain Injuries / Q000503:physiopathology*; D001931:Brain Mapping; D003071:Cognition / Q000502:physiology*; D003657:Decision Making / Q000502:physiology*; D005260:Female; D005715:Gambling / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013647:Task Performance and Analysis
keywords: Decision-making; Functional connectivity; Lesion-derived network mapping