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

2. Disclosures
Melanie Cohn
None!

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

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

5. 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

6. 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

7. 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

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

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

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

11. TOM in other epilepsies
Stewart, Catroppa & Lah, 2016

12. 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

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

14. 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

15. 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…

16. 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!