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Abstract
This study aims to explore the potential impairment of Theory of Mind (ToM; i.e., the ability to represent cognitive and affective mental states to both self and others) and the clinical, neuropsychological and Quality of Life (QoL) correlates of these cognitive abnormalities in the early stages of amyotrophic lateral sclerosis (ALS), a multisystem neurodegenerative disease recently recognized as a part of the same clinical and pathological spectrum of frontotemporal lobar degeneration. Twenty-two consecutive, cognitively intact ALS patients, and 15 healthy controls, underwent assessment of executive, verbal comprehension, visuospatial, behavioral, and QoL measures, as well as of the ToM abilities by Emotion Attribution Task (EAT), Advanced Test of ToM (ATT), and Eyes Task (ET). ALS patients obtained significantly lower scores than controls on EAT and ET. No significant difference was found between the two groups on ATT. As regard to type of ALS onset, patients with bulbar onset performed worse than those with spinal onset on ET. Correlation analysis revealed that EAT and ET were positively correlated with education, memory prose, visuo-spatial performances, and “Mental Health” scores among QoL items. Our results suggest that not only “cognitive” but also “affective” subcomponents of ToM may be impaired in the early stages of ALS, with significant linkage to disease onset and dysfunctions of less executively demanding conditions, causing potential impact on patients’ “Mental Health.”
Highlights
Theory of Mind (ToM), regarded as an essential prerequisite for successful human social interaction (Adolphs, 2003), is the ability to infer and predict intentions, thoughts, desires and behavioral reactions to oneself and others, through an awareness that others have a mind with “affective” and “cognitive” mental states that may differ from one’s own (Frith and Frith, 1999)
Several lesion studies have provided evidence that ToM could be considered a multidimensional construct (Shamay-Tsoory et al, 2005, 2006; Gupta et al, 2012; Sebastian et al, 2012) and the different ToM subcomponents have been explored in vivo by several cognitive and affective ToM tasks, such as the false-beliefs tasks (Wimmer and Perner, 1983; Baron-Cohen et al, 1985) and the Reading the Mind in the Eyes or Eyes Task (ET; Baron-Cohen et al, 1997, 2001), the former prototypical for the assessment of cognitive ToM, the latter for the assessment of the affective ToM
Clinical parameters were measured in all amyotrophic lateral sclerosis (ALS) patients using the ALSFRS-R score, an ALS-specific measure of functional ability (Cedarbaum et al, 1999), and the upper motor neuron (UMN) score, a measure of pyramidal dysfunction through the evaluation of the number of pathological reflexes elicited from 15 body sites (Turner et al, 2004)
Summary
Theory of Mind (ToM), regarded as an essential prerequisite for successful human social interaction (Adolphs, 2003), is the ability to infer and predict intentions, thoughts, desires and behavioral reactions to oneself and others, through an awareness that others have a mind with “affective” and “cognitive” mental states that may differ from one’s own (Frith and Frith, 1999). The “cognitive” ToM network primarily engages the dorsomedial prefrontal cortex, the dorsal anterior cingulate cortex and the dorsal striatum, while the “affective” ToM network engages the ventromedial and orbitofrontal cortices, the ventral anterior cingulate cortex, the amygdala and the ventral striatum (Poletti et al, 2012) In this regard, several lesion studies have provided evidence that ToM could be considered a multidimensional construct (Shamay-Tsoory et al, 2005, 2006; Gupta et al, 2012; Sebastian et al, 2012) and the different ToM subcomponents have been explored in vivo by several cognitive and affective ToM tasks, such as the false-beliefs tasks (Wimmer and Perner, 1983; Baron-Cohen et al, 1985) and the Reading the Mind in the Eyes or Eyes Task (ET; Baron-Cohen et al, 1997, 2001), the former prototypical for the assessment of cognitive ToM, the latter for the assessment of the affective ToM. There is a body of literature criticizing how ToM is used and investigated (Frith and Happé, 1994a; Bloom and German, 2000)
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