Deciding how long to keep waiting for uncertain future rewards is a complex problem. Previous research has shown that choosing to stop waiting results from an evaluative process that weighs the subjective value of the awaited reward against the opportunity cost of waiting. Activity in ventromedial prefrontal cortex (vmPFC) tracks the dynamics of this evaluation, while activation in the dorsomedial prefrontal cortex (dmPFC) and anterior insula (AI) ramps up before a decision to quit is made. Here, we provide causal evidence of the necessity of these brain regions for successful performance in a willingness-to-wait task. 28 participants (20 female and 8 male) with lesions to different regions of the frontal lobe were tested on their ability to adaptively calibrate how long they waited for monetary rewards. We found that participants with lesions to the vmPFC waited less overall, while participants with lesions to the dmPFC and anterior insula were specifically impaired at calibrating their level of persistence to the environment. These behavioral effects were accounted for by systematic differences in parameter estimates from a computational model of task performance.Significance Statement Achieving positive outcomes in education, health or personal finance often involves pursuing larger future rewards at the cost of smaller, more immediate ones. Most neuroscience research on future reward pursuit has focused on the initial discrete choice between a smaller reward that will arrive quickly or a larger reward that will arrive later. However, once the choice has been made, persisting in the initial choice of the later reward through the waiting period is perhaps even more critical to success. Here, we identify specific and dissociable causal roles for different regions of prefrontal cortex in determining people's ability to adaptively persist. This finding extends our understanding of how the brain supports subjective value maximization in the context of delayed rewards.
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