Stuck in the here and now: Construction of fictitious and future experiences following ventromedial prefrontal damage

There is increasing interest in uncovering the cognitive and neural bases of episodic future thinking (EFT), the ability to imagine events relevant to one's own future. Recent functional neuroimaging evidence shows that the ventromedial prefrontal cortex (vmPFC) is engaged during EFT. However, vmPFC is also activated during imagination of fictitious, atemporal experiences. Therefore, its role in EFT is currently unclear. To test (1) whether vmPFC is critical for EFT, and (2) whether it supports EFT specifically, or, rather, construction of any complex experience, patients with focal lesions to vmPFC (vmPFC patients), control patients with lesions not involving vmPFC, and healthy controls were asked to imagine personal future experiences and fictitious experiences. Compared to the control groups, vmPFC patients were impaired at imagining both future and fictitious experiences, indicating a general deficit in constructing novel experiences. Unlike the control groups, however, vmPFC patients had more difficulties in imagining future compared to fictitious experiences. Exploratory correlation analyses showed that general construction deficits correlated with lesion volume in BA 11, whereas specific EFT deficits correlated with lesion volume in BA 32 and BA 10. Together, these findings indicate that vmPFC is crucial for EFT. We propose, however, that different vmPFC subregions may support different component processes of EFT: the most ventral part, BA 11, may underlie core constructive processes needed to imagine any complex experience (e.g., scene construction), whereas BA 10 and BA 32 may mediate simulation of those specific experiences that likely await us in the future.