Abstract
Impairment of social cognition (SC) skills such as recognition and attribution of intentions and affective states of others (Theory of Mind, ToM) has been evidenced in Alzheimer’s Disease (AD). This study investigated the neuropsychological, neuroanatomical and brain-functional underpinnings of SC processing to obtain an understanding of the social neurophenotype in early probable AD. Forty-six patients with mild cognitive impairment and mild probable AD underwent SC assessment including emotion recognition (Ekman-60-faces task) and cognitive and affective ToM (Reading-the-Mind-in-the-Eyes test and Story-based Empathy task). Linear models tested the association between SC scores and neuropsychological measures, grey matter maps and large-scale functional networks activity. The executive domain had the most predominant association with SC scores in the cognitive profile. Grey matter volume of the anterior cingulate, orbitofrontal, temporoparietal junction (TPJ), superior temporal, and cerebellar cortices were associated with ToM. Social cognition scores were associated with lower connectivity of the default-mode network with the prefrontal cortex. The right fronto-parietal network displayed higher inter-network connectivity in the right TPJ and insula while the salience network showed lower inter-network connectivity with the left TPJ and insula. Connectivity coupling alterations of executive-attentional networks may support default mode social-cognitive-associated decline through the recruitment of frontal executive mechanisms.
Highlights
Theory of Mind (ToM) is defined as self-originating inferences about other people’s intentions, beliefs and emotions that guide decision making and modulate behaviour in accordance with established social standards (Baron-Cohen et al, 1985)
Based on the present cognitive and neuroimaging data, we suggest that patients in the prodromal to mild stages of probable Alzheimer’s disease (AD) rely significantly on executive resources to sustain affective recognition and processing as a possible adaptive effect to support behavioural performance in response to neurodegeneration
Brain executive networks, which are expressed in neural territories relatively spared by AD pathology in the early disease phases, may compensate for network dysfunction affecting those systems sustaining mentalisation, i.e., inherent default-mode network (DMN) breakdown, providing the necessary attentional/executive support to sustain the attribution of self-other representations
Summary
Theory of Mind (ToM) is defined as self-originating inferences about other people’s intentions, beliefs and emotions that guide decision making and modulate behaviour in accordance with established social standards (Baron-Cohen et al, 1985). Impairment of ToM has been evidenced in Alzheimer’s disease (AD) (Freedman et al, 2013; Moreau et al, 2016; Chainay and Gaubert, 2020; Kessels et al, 2021), and may occur early, even at the prodromal stage of disease (Bora and Yener, 2017; Yildirim et al, 2020). This deterioration is not as severe as that observed in other neurocognitive domains such as for example in memory (Dodich et al, 2016). Social cognition abilities have been proposed as useful cognitive markers for discriminating among different forms of dementia (Bertoux et al, 2016; Dodich et al, 2018)
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