Cognitive and emotional theory of mind in dementia. Impact on real life behaviors

Abstract Background Theory of mind (ToM) is a core cognitive process that allows regular socioemotional interaction in everyday life. ToM deficits may explain some essential behavior alterations in dementia, particularly in Alzheimer’s disease (AD) and frontotemporal dementia (FTD). This study aimed to (1) identify ToM differences across dementia syndromes and (2) determine if ToM scores predict neuropsychiatric function. Method We evaluated 304 participants (age 64.07±9.2) divided into six groups (healthy control, NC = 41; AD = 34; behavioral variant FTD = 96; semantic aphasia; svPPA = 38, nonfluent aphasia; nfvPPA = 47, and progressive supranuclear palsy; PSP = 48) using the UCSF Emotional and Cognitive ToM Test on the TabCAT platform and comprehensive neuropsychological and neuropsychiatric testing. Pa Patients were early in their disease (Clinical Dementia Rating: 0.80±0.53). We compared ToM between groups and used regression models controlling by age and sex to determine if ToM predicted neuropsychiatric symptoms. Result Cognitive ToM was impaired in AD, bvFTD, svPPA, and PSP (p<0.0001), and all groups had impaired emotional ToM (p<0.0001). Both cToM and eToM performance predicted a real‐life neuropsychiatric behavior syndrome, including anxiety, apathy, disinhibition, and aberrant motor subscales scores on the Neuropsychiatric Inventory questionnaire, even after controlling for the influence of bvFTD diagnosis. Conclusion Cognitive and Emotional ToM are affected early in diverse dementia syndromes, and impaired ToM test performance can predict a real‐life neuropsychiatric behavior. Assessment of ToM and other aspects of social cognition can be beneficial for the early identification of behavioral alterations in dementia cases.