Decision-Making Tasks for Short-Term Memory

Overseen By Salman E Qasim, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Rutgers, The State University of New Jersey

Disqualifiers: Psychosis, Suicidal ideation, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

50 Participants Needed

Trial Summary

What is the purpose of this trial?

Learning to make good decisions in the present, and accurately recalling events and information from the past, are critical aspects of human cognition that are often impaired in many psychiatric disorders. This project aims to identify the how the choices individuals make influence what, and how, people remember by combining disparate techniques in computational modeling and direct brain recordings in human subjects. The researcher developed a dual-task paradigm, probing how decisions in one task affect immediate recognition memory. To examine the neural mechanisms underlying model-free RL's influence on memory, the researcher will record local field potential (LFP) and single neuron activity in various brain regions as epilepsy patients perform the proposed task. The results of this project will identify specific neurocomputational mechanisms unifying decision-making and memory processes.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, since the trial involves epilepsy patients who have not responded to standard treatments, it seems likely that you may continue your current epilepsy medications.

What data supports the effectiveness of the treatment Value-manipulation for short-term memory decision-making tasks?

The research on decision-making nudges suggests that using communication techniques to guide patients' choices can help them make complex decisions more effectively. This implies that value-manipulation, which may involve similar techniques, could potentially improve decision-making in short-term memory tasks by helping individuals focus on important information. ^{1 2 3 4 5}

How does this treatment for short-term memory differ from other treatments?

This treatment is unique because it focuses on decision-making tasks that involve the brain's ability to update and hold value information over time, using a combination of stable and dynamic neural representations. Unlike traditional treatments that may not address the cognitive processes involved in decision-making, this approach leverages the brain's natural mechanisms for flexible cognitive abilities. ^{6 7 8 9 10}

Research Team

Salman E Qasim, PhD

Principal Investigator

Icahn School of Medicine at Mt. Sinai

Eligibility Criteria

This trial is for individuals with medication-resistant epilepsy who are already set to receive brain monitoring via intracranial EEG or neurostimulation. Participants must be able to follow the study's procedures, provide consent, and speak English or Spanish. Excluded are those with cognitive impairments, unwillingness to undergo electrode implantation, medical risks for surgery/MRI scans, pregnancy, history of psychosis, recent suicide risk, or other significant brain disorders.

Inclusion Criteria

You are proficient in either English or Spanish.

My seizures do not improve with standard medications, as confirmed by my neurologist.

I can sign and understand the consent form.

Exclusion Criteria

I am not willing or able to have an electrode implantation procedure.

I cannot have neurosurgery, general anesthesia, or an MRI due to medical reasons.

I have not had thoughts of harming myself or attempted suicide in the last six months.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Task Participation

Participants perform decision-making and memory tasks while neural activity is recorded

2 weeks

During hospital stay

Follow-up

Participants are monitored for safety and effectiveness after task participation

4 weeks

Treatment Details

Interventions

• Value-manipulation

Trial Overview The study investigates how decision-making affects memory by using computational modeling and direct brain recordings during a dual-task paradigm. Patients undergoing treatment for epilepsy will have their brain activity monitored while they perform tasks designed to probe the interaction between decision-making and memory recall.

Participant Groups

Group I: Value-manipulation Experimental Treatment 1 Intervention

Participants with epilepsy will complete a behavioral task in which they use a laptop computer to do a decision-making and memory task.

Who Is Running the Clinical Trial?

Rutgers, The State University of New Jersey

Lead Sponsor

Trials

471

Recruited

81,700+

Icahn School of Medicine at Mount Sinai

Lead Sponsor

Trials

933

Recruited

579,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

In a pilot study with 213 primary care patients, providing quantitative information about colorectal cancer screening significantly increased the likelihood of patients getting screened compared to those who did not receive this information.

While a nudge towards stool testing (FIT) increased perceived risk of colorectal cancer, it did not lead to a higher screening uptake, suggesting that simply nudging patients may not be as effective as providing clear quantitative data.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial. Schwartz, PH., Perkins, SM., Schmidt, KK., et al.[2018]

A study of 18 pregnant women revealed that their preferences regarding pain management during childbirth changed significantly over time, indicating that immediate preferences may not reflect long-term values.

The findings suggest that measuring patient values at different times can lead to inconsistent decision-making, as preferences during active labor differed from those expressed before labor and postpartum, highlighting the need for careful consideration of timing in patient assessments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Discount functions and the measurement of patients' values. Women's decisions during childbirth. Christensen-Szalanski, JJ.[2017]

A study involving 53 kidney transplant professionals showed that using predictive analytics for future organ offers and patient mortality significantly improved decision-making consensus and confidence among surgeons.

Visualizing patient mortality risks helped speed up decision-making processes, suggesting that incorporating patient-specific predictions could enhance the quality of transplant decisions and potentially improve patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An experiment on the impact of predictive analytics on kidney offers acceptance decisions. McCulloh, I., Stewart, D., Kiernan, K., et al.[2023]

Medical inpatients of all ages often misunderstand verbal descriptions of probability related to treatment risks and benefits, which raises concerns about their ability to give informed consent.

In contrast, pictorial representations of probability were much better understood by patients, indicating that using visual aids could improve patient comprehension and support better decision-making in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How informed is consent? Understanding of pictorial and verbal probability information by medical inpatients. Fuller, R., Dudley, N., Blacktop, J.[2019]

A study involving 89 resident-physicians and 336 non-clinicians found that both groups generally viewed the use of 'nudges'—communication techniques that guide patient choices—as ethical and appropriate in medical decision-making, especially in complex situations like choosing between chemotherapy and hospice care.

Physicians preferred nudges that supported hospice care, while non-clinicians favored nudges that promoted chemotherapy, highlighting differing perceptions of nudges between medical professionals and the general public, which could impact their application in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perspectives on using decision-making nudges in physician-patient communications. Fridman, I., Hart, JL., Yadav, KN., et al.[2019]

The proposed neural network model explains human decision-making through a structured interaction between brain regions, using a proposer-predictor-actor-critic framework that adapts animal action-selection theories for human complexity.

This model suggests that decision-making involves fast, parallel computations for proposing plans, followed by slower, predictive evaluations of outcomes, with the basal ganglia acting as a reward-based critic to refine choices based on past experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neural Mechanisms of Human Decision-Making. Herd, S., Krueger, K., Nair, A., et al.[2021]

Neuronal activity in the orbitofrontal and anterior cingulate cortex of monkeys shows that working memory for value involves a combination of persistent and transient activity, indicating a complex mechanism for decision-making.

This hybrid coding allows for both stable and dynamic representations of value, which is essential for maintaining accurate stimulus-value associations over time.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stable and dynamic representations of value in the prefrontal cortex. Enel, P., Wallis, JD., Rich, EL.[2021]

The paper highlights the importance of the hippocampus in value-based decision-making, suggesting that it plays a crucial role in processing past information to influence current choices, beyond the traditional focus on the striatum and prefrontal regions.

It proposes the successor representation (SR) as a mechanism for encoding state representations in the hippocampus, which enhances the performance of reinforcement learning agents by allowing them to process information over multiple timescales, thus improving decision-making in real-world contexts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Accounting for multiscale processing in adaptive real-world decision-making via the hippocampus. Mehrotra, D., Dubé, L.[2023]

Monkeys were studied in a dynamic foraging environment to understand how their choices and reward histories influence their internal representation of action value, revealing insights into decision-making processes.

The research demonstrated that a simple model based on reward history could replicate the monkeys' foraging behavior, and that neurons in the parietal cortex are involved in representing the relative value of competing actions, highlighting a neural basis for value assessment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Matching behavior and the representation of value in the parietal cortex. Sugrue, LP., Corrado, GS., Newsome, WT.[2022]

A new spiking neural network model effectively solves the complex problem of online value estimation for goal-directed decision making, achieving near-optimal performance in tasks ranging from simple choices to more complex sequential decisions.

The model's predictions align closely with behavioral data and neural responses recorded in the frontal cortices, providing a biologically realistic framework for understanding the neural mechanisms behind goal-directed actions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Goal-Directed Decision Making with Spiking Neurons. Friedrich, J., Lengyel, M.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial. [2018]

2. United States pubmed.ncbi.nlm.nih.gov

Discount functions and the measurement of patients' values. Women's decisions during childbirth. [2017]

3. United States pubmed.ncbi.nlm.nih.gov

An experiment on the impact of predictive analytics on kidney offers acceptance decisions. [2023]

4. England pubmed.ncbi.nlm.nih.gov

How informed is consent? Understanding of pictorial and verbal probability information by medical inpatients. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Perspectives on using decision-making nudges in physician-patient communications. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Neural Mechanisms of Human Decision-Making. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Stable and dynamic representations of value in the prefrontal cortex. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Accounting for multiscale processing in adaptive real-world decision-making via the hippocampus. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Matching behavior and the representation of value in the parietal cortex. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Goal-Directed Decision Making with Spiking Neurons. [2022]