Abstract
Background: In view of the recent literature, the negative impact of traumatic brain injury (TBI) on social cognition remains a debated issue. On one hand, a considerable number of studies reported significant impairments in emotion recognition, empathy, moral reasoning, social problem solving, and mentalizing or theory of mind (ToM) abilities in patients with TBI. On the other hand, the ecological validity of social cognition tasks is still a matter of concern and debate for clinicians and researchers.Objectives: The objectives of the present study were 2-fold: (1) to assess social cognition in TBI with an ecological performance-based test which focuses on ToM ability, and (2) to study the relationship between performances on this task and behavioral disorders. To this end, 47 patients with moderate to severe TBI in the chronic stage were assessed with a ToM task, the Movie for the Assessment of Social Cognition (MASC), a film displaying social interactions in natural settings and asking for an evaluation of the emotions, thoughts, and intentions of the characters. Behavioral disorders were assessed with the Behavioral Dysexecutive Syndrome Inventory (BDSI), a structured interview of an informant in assessing changes compared with previous behavior in 12 domains.Results: Patients were significantly less accurate in mental state attribution than a demographically matched group of 38 healthy control subjects. Significant others of patients also reported more behavioral executive problems than controls' relatives on most of the domains of the BDSI. In addition, social cognition performance in the MASC was significantly correlated with behavioral dysexecutive problems rated by proxies on the BDSI.Conclusions: This study is the first to find association between impairments in mentalizing abilities in the MASC and behavioral impairments in patients with TBI, confirming the added value of this ecological task and that the recognition of social signals is a key element for adequate behavioral functioning.
Highlights
The notion of social cognition embraces several subdomains and refers to all the socio-emotional abilities and experiences regulating the relationships between individuals and allowing the explanation of individual human behaviors or behaviors in a group [1, 2]
Theory of Mind (ToM) is a component of social cognition that is of concern for adults who suffered traumatic brain injury (TBI) as, over the past few decades, a proliferation of research has shown that adults with moderate to severe TBI exhibited significant deficits on ToM tasks [for review, see [6]]
Regarding effect sizes for non-parametric statistics, as their estimates are known to be affected by departures from normality of variances, we followed the recommendations of Ivarsson et al [44] [see [45]]
Summary
The notion of social cognition embraces several subdomains and refers to all the socio-emotional abilities and experiences regulating the relationships between individuals and allowing the explanation of individual human behaviors or behaviors in a group [1, 2]. ToM is a component of social cognition that is of concern for adults who suffered traumatic brain injury (TBI) as, over the past few decades, a proliferation of research has shown that adults with moderate to severe TBI exhibited significant deficits on ToM tasks [for review, see [6]]. These deficits have been observed for both components of ToM, early after injury [7,8,9] and in the chronic stage [10,11,12]. The ecological validity of social cognition tasks is still a matter of concern and debate for clinicians and researchers
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