Social cognition: An under-assessed area in epilepsy Melanie Cohn, Ph.D., C.Psych melanie.cohn@uhn.ca CLAE Meeting – Quebec City, October 15, 2016

Disclosures Melanie Cohn None!

Neuropsychological assessment in epilepsy: should we assess social cognition? Executive function Attention Language Visuo-spatial Social cognition? Memory IQ

Outline What is social cognition? Social cognition deficits in epilepsy Clinical implications Available tests

What is social cognition (inference)? Attribution of the mental state of others (beliefs, thoughts, emotions, intentions), based on the interpretation and integration of various cues (e.g., discourse content, intonation, facial expression, eye gaze, gestures, context, norms). Range of paradigms/tasks: Basic: (e.g., facial expression, prosody) Complex (theory-of-mind): (Faux-pas, false-belief, sarcasm, interactions) Ekman, 1976 Abell, 2000

Neural substrate (imaging & patients) Impaired in various groups (lesions, autism, TBI, schizophrenia, FTD, PD and epilepsy) Beauchamp 2010 Zaki & Oschner 2008 Regions overlap with alterations seen in epilepsy & surgery (TLE here): (A) superior temporal sulcus; (B) fusiform gyrus; (C) temporal pole; (D) medial prefrontal cortex and frontal pole; (E) cingulate cortex; (F) orbitofrontal cortex; (G) amygdala; (H) temporoparietal junction; (I) inferior parietal cortex; (J) inferior frontal cortex; insula (not shown). TLE/ATL Poor facial emotion recognition – does not always generalize to other material (e.g. prosody) Poor complex social inference but evidence is sparse (3 TLE; 2 TLE/ATL), mostly faux-pas task, ceiling, small n (Broicher, 2012, Giovagnoli, 2011, Li, 2013, Schacher, 2006, Shaw, 2009) Lin et al. (2006) Spencer, 2012

Epilepsy (TLE) and social cognition Geschwind syndrome (1974)- includes viscosity (sticking to topics, interpersonal adhesiveness) which Rae (1992) hypothesized to be caused by a deficit in the ability to perceive social cues in conversation. Emotional face perception in TLE (most studied) Meta-analysis (Bora & Meletti, 2016) Ekman, 1976

Emotional face perception in TLE Cohn et al., 2015 Bora & Meletti, 2016

Complex theory-of-mind (TOM) in TLE Bora & Meletti, 2016

TOM in TLE (sincere, deceit, sarcasm) Cohn et al., 2015

TOM in other epilepsies Stewart, Catroppa & Lah, 2016

Interim conclusions Perception of emotional face expressions (any types) and TOM are impaired in TLE TOM is also impaired in other epilepsies including frontal lobe and idiopathic generalized, but not in extra- TL or extra-FL epilepsy Suggests stigma or reduced socialization opportunities are not solely to blame Suggests frontal and temporal dysfunction are key factors

Neural substrate of social cognition deficits in TLE Cohn et al., 2015

Other associated risk factors (worse social cognition) Consistent finding: Early age of onset (deficit if disruption during critical period of acquisition, but less so after) Mixed findings Long duration of epilepsy MTL structural abnormality (MTS, amygdala, surgery) Laterality Executive dysfunction & IQ No relationship Number of AEDS Seizure frequency

Clinical Implications (psycho-behavioural) Lack of social support is correlated with (but not predictive of) impaired TOM (Hennion et al., 2014) TOM relates to self-appraisal, coping and overall quality of life in TLE and FLE (Giovagnoli et al, 2013) Identification of social cognition deficits is a first step towards intervention Possible application of training programs developped in autism and schizophrenia…

Available clinical tests of social cognition Few tasks with proper psychometric properties and normative data Non-exhaustive list… (excludes questionnaires) Adults: Advanced Clinical Solutions for the WAIS®-IV and WMS®-IV The Awareness of Social Inference Test (TASIT) Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) Children: NEPSY (2 subtests) Test Of Problem Solving (TOPS) Thanks!