A 58-year-old man with bilateral ventromedial prefrontal cortex damage makes consistently poor life decisions despite intact IQ, memory, and reasoning on formal testing. He fails to learn from negative outcomes in gambling tasks. This deficit is best explained by which concept?

• A Working memory deficit due to dorsolateral prefrontal damage
• B Failure of long-term potentiation in the hippocampus
• C Impairment of the somatic marker hypothesis-guided decision-making ✓
• D Disruption of the Papez circuit causing emotional blunting

Explanation

The somatic marker hypothesis, proposed by Damasio, states that emotional processes guide (somatic markers) behavior, especially decision-making. Ventromedial prefrontal cortex damage impairs the ability to use emotional signals to anticipate consequences, leading to poor decisions despite preserved intellect. This is classically demonstrated in the Iowa Gambling Task. Working memory deficits relate to dorsolateral prefrontal cortex, not ventromedial.

Reference: Ganong's Review of Medical Physiology, 26th ed.

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