In making decisions, we often choose from among options with multiple value-relevant attributes. Neuroeconomic models propose that the value associated with each attribute is integrated in a global value for each option. However, some evidence from patients with ventromedial frontal lobe (VMF) damage argues against a very general role for this region in value integration, suggesting instead that it contributes critically to a specific value inference or comparison process. Here, we tested value-based decision-making involving artificial multiattribute objects in humans with focal damage to the VMF (N ϭ 12) compared with a healthy group matched for age and education (N ϭ 24) and with a group with frontal lobe damage sparing the VMF (N ϭ 12). In a "configural" condition, overall object value was predicted by the conjunction of two attributes, while in an "elemental" condition, object value could be assessed by combining the independent values of individual attributes. Patients with VMF damage were impaired in making choices when value was uniquely predicted by the configuration of attributes, but intact when choosing based on elemental attribute values. This is evidence that the VMF is critical for inferring the value of whole objects in a multiattribute choice. These findings have implications for models of value-based choice and add to emerging views of how this region may interact with medial temporal lobe systems involved in configural object processing and relational memory. Significance StatementNeuroeconomic models propose that the ventromedial frontal lobe (VMF) supports multiattribute decisions by integrating the values of attributes. However, researchers have been uncertain about the underlying mechanisms for this process. Patients with VMF damage made multiattribute choices under two conditions: in one, attribute values could be summed to guide choice; in the other, value was predicted by the conjunction of attributes. VMF damage impaired only the latter. This argues that the VMF is critical for inferring value from configural information to guide multiattribute object choice. This region may be key for judging the emergent "value of the forest," rather than for integrating the individual "value of each tree."

Cue-approach training (CAT) is a novel paradigm that has been shown to induce preference changes towards items without external reinforcements. In the task, the mere association of a neutral cue and a speeded button response has been shown to induce a behavioral choice preference change lasting for months. This paradigm includes several phases: after the training of individual items, behavior change is manifested in binary choices of items with similar initial values. Neuroimaging data have implicated the ventromedial prefrontal cortex (vmPFC) in the choice phase of this task. However, the neural mechanisms underlying the preference changes induced by training remain unclear. Here, we asked whether the ventromedial frontal lobe (VMF) is critical for the non-reinforced preference change induced by CAT. For this purpose, 11 participants with focal lesions involving the VMF and 30 healthy age-matched controls performed the CAT. The VMF group was similar to the healthy age-matched control group in the ranking and training phases. As a group, the healthy age-matched controls exhibited a training-induced behavior change, while the VMF group did not. However, on an individual level analysis we found that some of the VMF participants showed a significant preference shift. Thus, we find mixed evidence for the role of VMF in this paradigm. This is another step towards defining the mechanisms underlying the novel form of behavioral change that occurs with CAT.

Decision neuroscience research has consistently implicated orbitofrontal and adjacent ventromedial prefrontal cortex in value-based decision-making. These areas are thought to reflect subjective value, a generic indicator of the personal motivational relevance of different options that allows them to be compared on a common scale. There are a number of unanswered questions arising from this model. We review findings from studies in patients with focal damage to the ventral frontal lobe that led us to reconsider how decision options are evaluated, applying perspectives from research on object recognition in the ventral visual stream. While decision-making is often approached from an abstract economic perspective in the lab, most of our everyday decisions, whether about food, goods, or people, are between directly perceived complex objects made up of multiple value-predictive attributes. It is not clear how multiple attributes are integrated to produce a global value estimate. We know the objects themselves are represented in the ventral visual stream at different levels of complexity, ranging from individual features to unique combinations of such features, but what about the values of those objects? Here, we suggest distinctions between configural and elemental evaluation echoing distinctions in visual processing. We discuss evidence that orbitofrontal-ventromedial prefrontal cortex is not required for all value-based decisions, but rather is specifically critical for recognizing value when it is predicted by configural relationships between attributes. We also consider how this perspective connects with emerging views of orbitofrontal cortex as an abstract cognitive map, and the debate on whether subjective value is a neurobiologically meaningful construct.