A Modified Reading the Mind in the Eyes Test Predicts Behavioral Variant Frontotemporal Dementia Better Than Executive Function Tests

Abstract

Behavioral variant frontotemporal dementia (bvFTD) is characterized by deep alterations in behavior and personality. Although revised diagnostic criteria agree for executive dysfunction as most characteristic, impairments in social cognition are also suggested. The study aimed at identifying those neuropsychological and behavioral parameters best discriminating between bvFTD and healthy controls. Eighty six patients were diagnosed with possible or probable bvFTD according to Rascovsky et al. (2011) and compared with 43 healthy age-matched controls. Neuropsychological performance was assessed with a modified Reading the Mind in the Eyes Test (RMET), Stroop task, Trail Making Test (TMT), Hamasch-Five-Point Test (H5PT), and semantic and phonemic verbal fluency tasks. Behavior was assessed with the Apathy Evaluation Scale, Frontal Systems Behavioral Scale, and Bayer Activities of Daily Living Scale. Each test’s discriminatory power was investigated by Receiver Operating Characteristic curves calculating the area under the curve (AUC). bvFTD patients performed significantly worse than healthy controls in all neuropsychological tests. Discriminatory power (AUC) was highest in behavioral questionnaires, high in verbal fluency tasks and the RMET, and lower in executive function tests such as the Stroop task, TMT and H5PT. As fluency tasks depend on several cognitive functions, not only executive functions, results suggest that the RMET discriminated better between bvFTD and control subjects than other executive tests. Social cognition should be incorporated into diagnostic criteria for bvFTD in the future, such as in the International Classification of Diseases (ICD)-11, as already suggested in the Diagnostic and Statistical Manual for Mental Disorders (DSM)-5.

Social Cognition Dysfunctions in Neurodegenerative Diseases: Neuroanatomical Correlates and Clinical Implications

“…Furthermore, the bvFTD patients may present disturbances in the more reflexive social cognitive processes including reduced theory of mind abilities [ 43 ], mentalizing deficits [ 80 ], diminished prosocial sentiments [ 81 ], and reduced long-term cooperative behaviors [ 70 , 82 , 83 ]. Recently, impaired performances at RMET have been revealed to better discriminate bvFTD patients from healthy subjects or Alzheimer's disease patients than altered performances in executive tests, thereby underlining the relevance of social cognition abnormalities in bvFTD diagnosis [ 84 - 89 ]. In particular, executive function tests, such as Stroop task and Trail Making Test, have been shown to be less disease specific than social cognition tests, such as the RMET, for the differential diagnosis across different forms of dementia [ 85 - 89 ].…”

“…In support of this, recent meta-analyses confirmed the central role of ToM in bvFTD diagnosis by showing significantly higher and domain-specific impairments of ToM (and emotion recognition) in bvFTD in comparison to control subjects and Alzheimer's disease [ 90 ] or other clinical conditions including multiple psychiatric, neurological, and developmental disorders [ 91 ]. However, questionnaires that also account for behavioral disorders, such as apathy evaluation scale (AES) [ 92 ] and FrSBe scale, especially in the informant-report version, have been shown to significantly differentiate bvFTD patients from healthy controls [ 84 ]. Of note, some of the most frequent behavioral symptoms in bvFTD, including apathy, impulsivity, and disinhibition, have been associated to implicit difficulties in social interaction and alterations in the processing of social cues, suggesting a tight interplay between social cognition and neuropsychiatric symptoms in this condition [ 68 , 93 ].…”

Development of a short‐form version of the Reading the Mind in the Eyes Test for assessing theory of mind in older adults

“…13 The RMET was shown to be highly discriminative in classifying participants with behavioral variant frontotemporal dementia from controls. 14 People with Alzheimer's disease have also been shown to be impaired on the RMET relative to neurotypical controls. 8 Compared to other "higher level" ToM tasks, such as the False Belief Task and the Faux-Pas Test, the RMET assesses ToM on a more basic level, such that it requires inferences to be made based on observable physical cues (in this case, the eyes).…”

Mirror neurons and their relationship with neurodegenerative disorders

“…Impaired performance at a test which is considered a measure of empathic abilities showed to better discriminate behavioral variant of frontotemporal dementia (bvFTD) patients from normal controls or AD patients than altered performance in executive tests. This result highlights the importance of social cognition abnormalities in bvFTD diagnosis (Schroeter et al, ). Interestingly, loss of empathy (Girardi, MacPherson, & Abrahams, ) and altered emotional empathy attribution (Cerami et al, ) have also been described in ALS patients without dementia.…”