Loss of empathy is an early central symptom and diagnostic criterion of the behavioral variant frontotemporal dementia (bvFTD). Although changes in empathy are evident and strongly affect the social functioning of bvFTD patients, few studies have directly investigated this issue by means of experimental paradigms. The current study assessed multiple components of empathy (affective, cognitive and moral) in bvFTD patients. We also explored whether the loss of empathy constitutes a primary deficit of bvFTD or whether it is explained by impairments in executive functions (EF) or other social cognition domains. Thirty-seven bvFTD patients with early/mild stages of the disease and 30 healthy control participants were assessed with a task that involves the perception of intentional and accidental harm. Participants were also evaluated on emotion recognition, theory of mind (ToM), social norms knowledge and several EF domains. BvFTD patients presented deficits in affective, cognitive and moral aspects of empathy. However, empathic concern was the only aspect primarily affected in bvFTD that was neither related nor explained by deficits in EF or other social cognition domains. Deficits in the cognitive and moral aspects of empathy seem to depend on EF, emotion recognition and ToM. Our findings highlight the importance of using tasks depicting real-life social scenarios because of their greater sensitivity in the assessment of bvFTD. Moreover, our results contribute to the understanding of primary and intrinsic empathy deficits of bvFTD and have important theoretical and clinical implications.

Deficits in social cognition are an evident clinical feature of the Asperger syndrome (AS). Although many daily life problems of adults with AS are related to social cognition impairments, few studies have conducted comprehensive research in this area. The current study examined multiple domains of social cognition in adults with AS assessing the executive functions (EF) and exploring the intra and inter-individual variability. Fifteen adult's diagnosed with AS and 15 matched healthy controls completed a battery of social cognition tasks. This battery included measures of emotion recognition, theory of mind (ToM), empathy, moral judgment, social norms knowledge, and self-monitoring behavior in social settings. We controlled for the effect of EF and explored the individual variability. The results indicated that adults with AS had a fundamental deficit in several domains of social cognition. We also found high variability in the social cognition tasks. In these tasks, AS participants obtained mostly subnormal performance. EF did not seem to play a major role in the social cognition impairments. Our results suggest that adults with AS present a pattern of social cognition deficits characterized by the decreased ability to implicitly encode and integrate contextual information in order to access to the social meaning. Nevertheless, when social information is explicitly presented or the situation can be navigated with abstract rules, performance is improved. Our findings have implications for the diagnosis and treatment of individuals with AS as well as for the neurocognitive models of this syndrome.

BackgroundThe ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations.Methodology/Principal FindingsThis study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks.Conclusions/SignificanceOverall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.

ore than a century ago, the Phineas Gage case revealed that frontal lobe lesions can cause personality and social cognition impairment. Since its description, clinical observations 1 have highlighted important similarities between the symptoms of patients with prefrontal lesions (PFL) and patients with the behavioral variant of frontotemporal dementia (bvFTD). Both conditions share symptoms such as distractibility, personality changes, social inappropriateness, and markedly impaired moral judgments. 2,3 However, to our knowledge, no studies have compared PFL and bvFTD regarding any social cognition domain. Social cognition tasks are particularly sensitive in detecting impairment in frontal patients. 4 Moral reasoning is a social cognition domain affected in both conditions. 2,3 The brain areas usually affected in bvFTD 5,6 (the ventromedial prefrontal cortex [VMPC], orbitofrontal cortex, anterior temporal lobes, amygdala, and insula) are involved in moral cognition. 7 Moreover, patients with VMPC damage show abnormal moral judgments of harmful intentions in the absence of harmful outcomes. 3 However, to our knowledge, no studies of bvFTD have previously examined the processing of intentions and outcomes in moral judgment. This work compared the moral judgments of patients with bvFTD and patients with PFL by means of a well-characterized task 3 involving scenarios that disentangle the contributions of intentions and outcomes to moral judgment. Methods Participants All participants provided written informed consent in agreement with the Helsinki declaration. The ethics committee of the Institute of Cognitive Neurology approved this study. Eight patients with unilateral chronic cerebrovascular lesions confined to frontal structures were recruited. All patients were assessed at least 6 months after the lesion and none of them had aphasia or motor difficulties. Nineteen patients fulfilled the revised criteria for probable bvFTD. 8 All patients underwent neurological, neuropsychiatric, and neuropsychological examinations and were in the early or mild stages of the disease. Patients with bvFTD and patients with PFL with psychiatric disorders, other neurological diseases, or diffuse brain damage in neuroimaging were excluded. IMPORTANCE Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups. OBSERVATIONS This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the co...

Background: Moral judgment has been proposed to rely on a distributed brain network. This function is impaired in behavioral variant frontotemporal dementia (bvFTD), a condition involving damage to some regions of this network. However, no studies have investigated moral judgment in bvFTD via structural neuroimaging. Methods: We compared the performance of 21 bvFTD patients and 19 controls on a moral judgment task involving scenarios that discriminate between the contributions of intentions and outcomes. Voxel-based morphometry was used to assess (a) the atrophy pattern in bvFTD patients, (b) associations between gray matter (GM) volume and moral judgments, and (c) structural differences between bvFTD subgroups (patients with relatively preserved moral judgment and patients with severer moral judgment impairments). Results: Patients judged attempted harm as more permissible and accidental harm as less permissible than controls. The groups' performance on accidental harm was associated with GM volume in the precuneus. In controls, it was al- so associated with the ventromedial prefrontal cortex (VMPFC). Also, both groups' performance on attempted harm was associated with GM volume in the temporoparietal junction. Patients exhibiting worse performance displayed smaller GM volumes in the precuneus and temporal pole. Conclusions: Results suggest that moral judgment abnormalities in bvFTD are associated with impaired integration of intentions and outcomes, which depends on an extended brain network. In bvFTD, moral judgment seems to critically depend on areas beyond the VMPFC.

This test of free distribution demonstrated a satisfactory validity.

A theoretical framework which considers the verbal functions of the brain under a multivariate and comprehensive cognitive model was statistically analyzed. A confirmatory factor analysis was performed to verify whether some recognized aphasia constructs can be hierarchically integrated as latent factors from a homogenously verbal test. The Brief Aphasia Evaluation was used. A sample of 65 patients with left cerebral lesions, and two supplementary samples comprising 35 patients with right cerebral lesions and 30 healthy participants were studied. A model encompassing an all inclusive verbal organizer and two successive organizers was validated. The two last organizers were: three factors of comprehension, expression and a "complementary" verbal factor which included praxia, attention, and memory; followed by the individual (and correlated) factors of auditory comprehension, repetition, naming, speech, reading, writing, and the "complementary" factor. By following this approach all the patients fall inside the classification system; consequently, theoretical improvement is guaranteed.

The Mini-Mental State Examination (MMSE) is recognized as a valid screening for dementia. It consists of 29 verbal items from a total of 30. The Brief Aphasia Evaluation (BAE) includes 10 aphasia and 12 orientation items, which are similar to most of the MMSE items. It was studied whether those BAE items (MMSE-like): (a) correlate with the rest of the BAE items (BAE-rest), and (b) differentiate patients with left cerebral lesions (LC) from both patients with right cerebral lesions (RC) and healthy participants (HP). A sample of 109 right-handed volunteers (38 HP, 37 LC, and 34 RC) was studied. The three groups were matched according to gender, age, and education. Patients were similar in multiple variables. The correlation between MMSE-like and BAE-rest was .90. MMSE-like showed a sensitivity and specificity of .81 or above to identify the LC from the other two groups. There is a risk for misdiagnosing aphasia as dementia with the MMSE.