Following damage to the ventromedial prefrontal cortex, humans develop
a defect in real-life decision-making, which contrasts with otherwise
normal intellectual functions. Currently, there is no neuropsychologi
cal probe to detect in the laboratory, and the cognitive and neural me
chanisms responsible for this defect have resisted explanation. Here,
using a novel task which simulates real-life decision-making in the wa
y it factors uncertainty of premises and outcomes, as well as reward a
nd punishment, we find that prefrontal patients, unlike controls, are
oblivious to the future consequences of their actions, and seem to be
guided by immediate prospects only. This finding offers, for the first
time, the possibility of detecting these patients' elusive impairment
in the laboratory, measuring it, and investigating its possible cause
s.