Neural mechanisms underlying metacognitive processes in sequential decision-making

Self-monitoring in decision-making is a hallmark of self-improvement in cognitive processes. To enhance outcomes in future decisions, individuals must accurately assess the correctness of prior choices and apply the information to control subsequent decisions. Although metacognition encompasses monitoring and control functions, the neural mechanisms underlying these processes and their relationships remain unclear. Furthermore, while the prefrontal cortex (PFC) is implicated in both functions, their distinct neural substrates and interrelations require further elucidation. In this study, we employed a sequential perceptual decision-making task with confidence ratings to examine how initial confidence influences subsequent decisions while recording neural activity using functional magnetic resonance imaging (fMRI). Subjects (female and male) performed a visual discrimination of two different-sized stimuli and subsequently rated their decision confidence. Behavioral results showed that subjects were more likely to change their choices between initial and subsequent decisions according to confidence levels. A signature of confidence (confidence magnitude) in initial decisions was observed primarily in the anterior medial PFC (amPFC). In contrast, the dorsal anterior cingulate cortex (dACC) exhibited higher neural activity related to changes of their initial choice at subsequent decisions. Furthermore, the pregenual ACC (pgACC) was associated with both processes, and it exhibited effective connectivity with the amPFC and dACC. These findings suggest that the medial PFC plays a role in integrating metacognitive monitoring and subsequent control in the sequential decision-making processes.Significance Statement Metacognition, encompassing monitoring and control, is fundamental to self-regulation and sequential decision-making. Despite their distinct roles, the neural mechanisms of how monitoring connects to subsequent control remain unclear. Using functional magnetic resonance imaging (fMRI), we reveal distinct yet interconnected medial prefrontal regions that support metacognitive processes. Specifically, the anterior medial prefrontal cortex encodes confidence in initial decisions, while the dorsal anterior cingulate cortex supports changes of mind. Effective connectivity analysis indicates that the pregenual anterior cingulate cortex integrates these processes. These findings advance our understanding of medial prefrontal mechanisms underlying adaptive self-regulation, with implications for addressing disorders characterized by impaired behavioral control.