Journal Article

Clinical assessment of social cognitive function in neurological disorders

Molenberghs, Pascal, von Hippel, William, Lee, Teresa, Sachdev, Perminder S., Henry, Julie D.

2016

Overview

Key Points Social cognitive deficits are prominent in many conditions and are critical predictors of functional outcomes because they affect the ability to form and sustain interpersonal relationships Assessments of social cognitive impairments typically focus on theory of mind, affective empathy, social perception and social behaviour, four domains that all influence the management of a patient Many social cognitive assessment measures that are appropriate for clinical use are now available and should form part of a broader neurocognitive battery Common disorders that manifest with prominent social cognitive deficits include schizophrenia, autism spectrum disorders, Alzheimer disease, and behavioural-variant frontotemporal dementia A range of effective treatment strategies are currently available, so the nature, magnitude and specificity of social cognitive impairments each have important implications for therapeutic decision-making Many neurological disorders, from traumatic brain injury to Alzheimer disease, affect social cognition, yet deficits in social cognition can be difficult to detect and diagnose effectively. In this Review, Henry and colleagues provide an overview of the clinical contexts in which social cognitive dysfunction arises and consider how tests can be used to detect it. Through examples of four conditions in which social cognitive dysfunction arises, they demonstrate the appropriate tests to use, and consider their clinical application beyond these disorders. Social cognition broadly refers to the processing of social information in the brain that underlies abilities such as the detection of others' emotions and responding appropriately to these emotions. Social cognitive skills are critical for successful communication and, consequently, mental health and wellbeing. Disturbances of social cognition are early and salient features of many neuropsychiatric, neurodevelopmental and neurodegenerative disorders, and often occur after acute brain injury. Its assessment in the clinic is, therefore, of paramount importance. Indeed, the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduced social cognition as one of six core components of neurocognitive function, alongside memory and executive control. Failures of social cognition most often present as poor theory of mind, reduced affective empathy, impaired social perception or abnormal social behaviour. Standard neuropsychological assessments lack the precision and sensitivity needed to adequately inform treatment of these failures. In this Review, we present appropriate methods of assessment for each of the four domains, using an example disorder to illustrate the value of these approaches. We discuss the clinical applications of testing for social cognitive function, and finally suggest a five-step algorithm for the evaluation and treatment of impairments, providing quantitative evidence to guide the selection of social cognitive measures in clinical practice.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 631/378/2645 / 631/378/2649 / 692/617/375 / 692/700/139 / Algorithms / Alzheimer Disease - diagnosis / Alzheimer Disease - psychology / Alzheimer Disease - therapy / Analysis / Brain - physiopathology / Brain Injuries - diagnosis / Brain Injuries - physiopathology / Brain Injuries - psychology / Brain Injuries - therapy / Brain Mapping / Care and treatment / Cognition / Complications and side effects / Diagnosis / Diagnostic and Statistical Manual of Mental Disorders / Emotional Intelligence / Emotions - physiology / Empathy - physiology / Executive Function - physiology / Humans / Interpersonal Relations / Medicine & Public Health / Mental illness / Mental Recall - physiology / Nervous system diseases / Neurocognitive Disorders - diagnosis / Neurocognitive Disorders - physiopathology / Neurocognitive Disorders - psychology / Neurocognitive Disorders - therapy / Neurodegenerative Diseases - diagnosis / Neurodegenerative Diseases - physiopathology / Neurodegenerative Diseases - psychology / Neurodegenerative Diseases - therapy / Neurological disorders / Neurology / Neuropsychological Tests / Neurotransmitter Agents - physiology / review-article / Risk factors / Schizophrenia - diagnosis / Schizophrenia - physiopathology / Schizophrenia - therapy / Schizophrenic Psychology / Social Behavior Disorders - diagnosis / Social Behavior Disorders - physiopathology / Social Behavior Disorders - psychology / Social Behavior Disorders - therapy / Social Communication Disorder - diagnosis / Social Communication Disorder - physiopathology / Social Communication Disorder - psychology / Social Communication Disorder - therapy / Theory of Mind