The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, proposed 6 domains of cognitive function:complex attention, executive function, learning and memory, language, perceptual-motor and social cognition. Social cognition is the ability “to understand others and yourself”, including theory of mind (ToM) and self-insights.
A recent meta-analysis showed a decline in ToM in Alzheimer’s disease (AD) as well as in frontotemporal dementia (FTD), but whether ToM deficits are independent of cognitive functioning, or the deficits are related to those of executive and/or memory functioning is controversial. ToM deficits could lead to poor social integration, social difficulties and social miscommunication. The pragmatic language disorder and decline of non-verbal communication functioning could also be related to social miscommunication in AD. We have reported declines in communicative competence for metaphor and sarcasm (irony) understanding in AD. We also reported declines in comprehension for facial expression. We compared the sensitivity of 6 basic facial expressions (happiness, sadness, surprise, fear, disgust, and anger) among the mild AD group, aged normal controls, and young normal controls. The AD group was less sensitive than aged normal controls in recognition of 5 expressions other than happiness. Within the AD group, happiness offered significantly higher sensitivity than the other five expressions. Such positivity bias needs to be confirmed in further studies.
Regarding self-insights, anosognosia, a deficit of insight into disease, has been discussed in FTD and AD. With disease progression, patients with FTD and AD tend to overestimate their own functions and abilities. Anosognosia in MCI is controversial and the functioning of self-insights could be highly individual. It is suggested that patients who retain insights tend to be depressive and anxious, whereas insight deficits may be associated with more severe caregiver burden.
Perspective-taking is a common factor in ToM and self-insights;ToM is the ability to evaluate others from a third-person perspective, whereas self-insight is the ability to evaluate the self from a third-person perspective. Studies to delineate the relationship between those two functions therefore represent important research for social cognition in dementia.
The deficits of social cognition in dementia can lead to poor social integration, and support for better social participation is desired. For better support, evaluation of social cognition is informative to understanding the social difficulties of each individual with dementia.
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