# Value-Based Decision-Making Following Medial Temporal Lobe Lesions

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2021 · —

## Abstract

Making optimal decisions depends on appreciation of the value of choices. An important source of information
about the value of choices is prior experience: Positive experiences are more likely than negative ones to be
selected again. Such value-based learning has long been considered the domain of trial-and-error incremental
learning mediated by a cortico-striatal system. Recent evidence, however, suggests that in some conditions
the medial temporal lobe (MTL), which mediates episodic memory, may also contribute to value-based learning.
However, when and how the MTL contributes is poorly understood.
In this proposal we put forth a novel way to conceptualize the role of the MTL in decision-making that exploits
the known computational characteristics of that system. Specifically, MTL-mediated episodic memory
representations are flexible and serve not only memory but also the representation of possible novel scenarios.
We postulate that the representational flexibility afforded by the MTL is important for decision-making
whenever value information needs to be integrated across distinct experiences. Such is the case when 1)
value information needs to be updated as a result of shifting reward contingencies; 2) when value information
is not directly available but is generalized across experiences; and 3) when value representations need to be
constructed de novo. We systematically examine the performance of patients with MTL lesions in these three
paradigmatic cases and test specific predictions about the conditions in which value-based learning and
decision-making will be impaired.
The studies comprising this proposal have the potential to deepen our understanding of the role of the MTL in
higher-level cognition and to break down the stark boundaries commonly assumed between processes
involved in episodic memory and decision-making. Further, it is anticipated that these studies will have
important clinical implications for a range of neurological and psychiatric populations with MTL pathology.
Understanding the scope and nature of MTL involvement in decision-making not only will shed light on the
nature of decisional impairments in these populations but also will guide clinical assessment and theoretically
informed interventions.

## Key facts

- **NIH application ID:** 9856883
- **Project number:** 5I01CX001748-02
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** MIEKE H. VERFAELLIE
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9856883

## Citation

> US National Institutes of Health, RePORTER application 9856883, Value-Based Decision-Making Following Medial Temporal Lobe Lesions (5I01CX001748-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9856883. Licensed CC0.

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