Behavioural Brain Research 221 (2011) 587–593 Contents lists available at ScienceDirect Behavioural Brain Research journal homepage: www.elsevier.com/locate/bbr Research report Contributions of subregions of the prefrontal cortex to the theory of mind and decision making Chunhua Xi a,b , Youling Zhu a , Chaoshi Niu c , Chunyan Zhu b , Tatia M.C. Lee d , Yanghua Tian b , Kai Wang b,∗ a Department of Neurology, the Third Affiliated Hospital of Anhui Medical University, Huaihe Road 390, Hefei 230061, Anhui Province, China b Neuropsychology Laboratory, Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Jixi Road, Hefei 230022, Anhui Province, China c Department of Neurosurgery, Anhui Province Hospital, Lujiang Road, Hefei 230001, Anhui Province, China d Neuropsychology Laboratory, The University of Hong Kong, Pokfulam Road, Hong Kong, China article info Article history: Received 23 March 2010 Received in revised form 21 July 2010 Accepted 24 September 2010 Available online 8 October 2010 Keywords: Prefrontal cortex Cognition Theory of mind Decision making abstract Recent works have suggested an association between the ventromedial prefrontal cortex (VMPC) and social cognition or decision making. The aim of this study is to investigate the theory of mind and decision making in patients with VMPC lesions and in those with dorsolateral prefrontal cortex (DLPC) lesions. Patients with VMPC lesions (n = 16) and those with DLPC lesions (n = 14) were compared with healthy controls (HC) on faux pas recognition and 2 decision-making tasks. Consistent with previous data, patients with VMPC lesions performed worse on the theory of mind and decision making. Patients with DLPC lesions showed impairments of the theory of mind but performed at control levels on the 2 decision- making tasks. The results supported the view that a separation of function of 2 distinct subregions of the prefrontal cortex is important to the theory of mind and decision making. © 2010 Elsevier B.V. All rights reserved. 1. Introduction Impairment in social cognition or decision making has long been recognized as a commonly observed effect of prefrontal cortex damage. Many studies have shown that patients with both- sided lesions of the ventromedial prefrontal cortex (VMPC) develop severe impairment in the theory of mind (ToM), social behaviors, or decision making [1–3]. However, most of these patients retain normal intellect and memory [4–6]. The study of social cognition and decision making has attracted much attention [7–10]. A core component of social cognition is the capacity to attribute independent mental states to others or to pre- dict other people’s behavior based on their mental states, a capacity known as ToM [11]. A growing body of evidence from both neu- roimaging [12–14] and lesion studies [15–18] has shown that the prefrontal cortex plays an important role in ToM. The medial pre- frontal cortex (the paracingulate cortex) was activated by tasks on the ToM in normal adult volunteers, but was not activated above baseline in comparison stories or cartoons [12]. Baron-Cohen et al. found that the performance of ToM tasks increased cerebral blood flow in the right orbitofrontal cortex [19]. Many previous functional neuroimaging studies have reported that other areas, including the anterior cingulated cortex, posterior superior temporal sulcus, tem- ∗ Corresponding author. Tel.: +86 0551 2923704; fax: +86 0551 2923704. E-mail address: wangkai1964@yahoo.com (K. Wang). poral pole, and amygdala, are also involved in the neural basis of ToM [14,20–22]. Although evidence from neuroimaging studies had implied that VMPC is involved in ToM, results from lesion studies thus far have not provided any conclusive evidence for the neural basis of ToM. A few studies on primary lesions reported that patients with damage to VMPC typically manifested a severe deficit in social functioning [23–25]. Patients with VMPC lesions were able to correctly analyze abstract social situations, but behaved inappropriately when they responded to real-life situations [26]. For instance, such patients typically do not respond to signals of whether the other person is interested in what they are saying or whether they are on the right topic during a social conversation. Stone et al. found that patients with VMPC lesions performed well on first-order and second-order false-belief tasks, but poorly on faux pas tasks, which required more subtle social reasoning [17]. Baron-Cohen and Ring deduced that VMPC is a part of the neural circuit for mind reading, and the social impairment of patients with VMPC lesions is due to a deficit in the ToM module [19]. However, a previous lesion study showed that a patient with extensive medial frontal lobe damage did not have any significant impairment on ToM tasks [27]. Only a few patients with the damage in the dorsolateral pre- frontal cortex (DLPC) have been directly tested on ToM tasks. Price et al. reported that 2 patients with both-sided DLPC lesions had dif- ficulties in expressing empathy and failed in a perspective-taking task [28]. However, the results of Stone et al.’s study showed that no specific deficit in first or second false belief was evident in patients 0166-4328/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.bbr.2010.09.031