from his mistakes. His decisions repeatedly lead to negative consequences. In striking contrast to this real-life decision-making impairment, E.Y.R.'s general intellect and problem-solving abilities in a laboratory setting remain intact. For instance, he produces perfect scores on the Wisconsin Card Sorting Test (Milner, 1963), his performances in paradigms requiring self-ordering (Petrides & Milner, 1982), cognitive estimations (Shallice & Evans, 1978), and judgements of recency and frequency (Milner, Petrides, & Smith, 1985) are flawless; he is not presevera-tive, nor is he impulsive; his knowledge base is intact and so is his short-term and working memory as tested to date; his solution of verbally posed social problems and ethical dilemmas comparable to that of controls (Saver & Damasio, 1991). The condition has posed a double challenge, since there has been neither a satisfactory account of its physiopathology, rior a laboratory probe to detect and measure an impairment that is so obvious in its ecological niche. Here we describe an experimental neuropsychological task which simulates, real time, personal real-life decision-making relative to the way it factors uncertainty of premises and outcomes, as well as reward and punishment. We show that, unlike controls, patients with prefrontal damage perform defectively and are seemingly insensitive to the future. The subjects sit in front of four decks of cards equal in appearance and size, and are given a $2000 loan of play money (a set of facsimile US bills). The subjects are told that the game requires a long series of card selections, one card at a time, from any of the four decks. until they are told to stop. After turning card, the subjects receive some money (the amount is only announced after the turning, and varies with the deck). After turning some cards, the subjects are given money and asked to pay a penalty (again the amount is only announced after the card is turned and varies with the deck and the position in the deck according to a schedule unknown to the subjects). The subjects are told that (1) the goal of the task is to maximize profit on the loan of play money, (2) they are free to switch from any deck to another, at any time, and as often as wished, but (3) they are not told ahead of time how many card selections must be made (the task is stopped after a series of 100 card selections). The pre-programmed schedules of reward and punishment are shown on the score cards (Fig. 1). Turning any card from deck A or deck B yields $100; turning any card from deck C or deck D yields $50. However, the ultimate future yield of each deck varies because the penalty amounts are higher in the high-paying decks (A and B), and lower in the low-paying decks (C and D). For example, after turning cards from deck A, the subjects have earned $1000, but they have also encountered 5 unpredicted punishments bringing their total cost to $1250, thus

DOI link for from his mistakes. His decisions repeatedly lead to negative consequences. In striking contrast to this real-life decision-making impairment, E.Y.R.'s general intellect and problem-solving abilities in a laboratory setting remain intact. For instance, he produces perfect scores on the Wisconsin Card Sorting Test (Milner, 1963), his performances in paradigms requiring self-ordering (Petrides & Milner, 1982), cognitive estimations (Shallice & Evans, 1978), and judgements of recency and frequency (Milner, Petrides, & Smith, 1985) are flawless; he is not presevera-tive, nor is he impulsive; his knowledge base is intact and so is his short-term and working memory as tested to date; his solution of verbally posed social problems and ethical dilemmas comparable to that of controls (Saver & Damasio, 1991). The condition has posed a double challenge, since there has been neither a satisfactory account of its physiopathology, rior a laboratory probe to detect and measure an impairment that is so obvious in its ecological niche. Here we describe an experimental neuropsychological task which simulates, real time, personal real-life decision-making relative to the way it factors uncertainty of premises and outcomes, as well as reward and punishment. We show that, unlike controls, patients with prefrontal damage perform defectively and are seemingly insensitive to the future. The subjects sit in front of four decks of cards equal in appearance and size, and are given a $2000 loan of play money (a set of facsimile US bills). The subjects are told that the game requires a long series of card selections, one card at a time, from any of the four decks. until they are told to stop. After turning card, the subjects receive some money (the amount is only announced after the turning, and varies with the deck). After turning some cards, the subjects are given money and asked to pay a penalty (again the amount is only announced after the card is turned and varies with the deck and the position in the deck according to a schedule unknown to the subjects). The subjects are told that (1) the goal of the task is to maximize profit on the loan of play money, (2) they are free to switch from any deck to another, at any time, and as often as wished, but (3) they are not told ahead of time how many card selections must be made (the task is stopped after a series of 100 card selections). The pre-programmed schedules of reward and punishment are shown on the score cards (Fig. 1). Turning any card from deck A or deck B yields $100; turning any card from deck C or deck D yields $50. However, the ultimate future yield of each deck varies because the penalty amounts are higher in the high-paying decks (A and B), and lower in the low-paying decks (C and D). For example, after turning cards from deck A, the subjects have earned $1000, but they have also encountered 5 unpredicted punishments bringing their total cost to $1250, thus

from his mistakes. His decisions repeatedly lead to negative consequences. In striking contrast to this real-life decision-making impairment, E.Y.R.'s general intellect and problem-solving abilities in a laboratory setting remain intact. For instance, he produces perfect scores on the Wisconsin Card Sorting Test (Milner, 1963), his performances in paradigms requiring self-ordering (Petrides & Milner, 1982), cognitive estimations (Shallice & Evans, 1978), and judgements of recency and frequency (Milner, Petrides, & Smith, 1985) are flawless; he is not presevera-tive, nor is he impulsive; his knowledge base is intact and so is his short-term and working memory as tested to date; his solution of verbally posed social problems and ethical dilemmas comparable to that of controls (Saver & Damasio, 1991). The condition has posed a double challenge, since there has been neither a satisfactory account of its physiopathology, rior a laboratory probe to detect and measure an impairment that is so obvious in its ecological niche. Here we describe an experimental neuropsychological task which simulates, real time, personal real-life decision-making relative to the way it factors uncertainty of premises and outcomes, as well as reward and punishment. We show that, unlike controls, patients with prefrontal damage perform defectively and are seemingly insensitive to the future. The subjects sit in front of four decks of cards equal in appearance and size, and are given a $2000 loan of play money (a set of facsimile US bills). The subjects are told that the game requires a long series of card selections, one card at a time, from any of the four decks. until they are told to stop. After turning card, the subjects receive some money (the amount is only announced after the turning, and varies with the deck). After turning some cards, the subjects are given money and asked to pay a penalty (again the amount is only announced after the card is turned and varies with the deck and the position in the deck according to a schedule unknown to the subjects). The subjects are told that (1) the goal of the task is to maximize profit on the loan of play money, (2) they are free to switch from any deck to another, at any time, and as often as wished, but (3) they are not told ahead of time how many card selections must be made (the task is stopped after a series of 100 card selections). The pre-programmed schedules of reward and punishment are shown on the score cards (Fig. 1). Turning any card from deck A or deck B yields $100; turning any card from deck C or deck D yields $50. However, the ultimate future yield of each deck varies because the penalty amounts are higher in the high-paying decks (A and B), and lower in the low-paying decks (C and D). For example, after turning cards from deck A, the subjects have earned $1000, but they have also encountered 5 unpredicted punishments bringing their total cost to $1250, thus