Non-invasive Brain Stimulation Effects on the Perceptual and Cognitive Processes Underlying Decision-making: a Mini Review

Abstract

Non-invasive brain stimulation (NIBS) includes transcranial magnetic (TMS), focused ultrasound (tFUS), and electrical (tES) stimulation, each of which modulates the activity of cortical neurons with the intent of modifying functional connectivity and neuroplasticity in the brain. Often employed as a tool to identify causal links between brain regions, cognitive processes, and behavioral outcomes, NIBS is also gaining popularity as a tool for enhancing decision-making under conditions of uncertainty. A literature search revealed 42 published reports conforming to our search criteria, employing diverse NIBS techniques including TMS, repetitive TMS (rTMS), and transcranial direct, alternating, and random noise stimulation (tDCS, tACS, tRNS). Identified studies also employed a range of outcome tasks including recognition memory, non-veridical, moral, economic, perceptual, and risky decision-making. Further categorization was performed to isolate six decision subprocesses, including gathering information, evaluating probabilities, weighting dimensions, integrating and assigning value, creating a strategy, and executing a decision. Most studies targeted the right or left dorsolateral prefrontal cortex (DLPFC), demonstrating critical involvement of this region in all six examined decision subprocesses. Several additional brain regions were targeted, with outcomes demonstrating disruption or facilitation of specific decision outcomes. Results are summarized for each decision subprocess, focusing on converging evidence across NIBS techniques and decision tasks. Several important directions are outlined for future research, to fill knowledge gaps, advance causal and mechanistic understandings of NIBS effects on decisions, and potentially enhance decision-making in real-world settings.