Emotional empathy in amyotrophic lateral sclerosis: a behavioural and voxel-based morphometry study

Abstract

Amyotrophic lateral sclerosis (ALS) is a multisystem condition, in which executive and/or behavioural symptoms can occur. Deficits of social cognition, including defective cognitive and emotional empathy, have been recently reported in ALS subjects. The neurostructural correlates of these disorders in ALS are still unknown. The aims of this study were to evaluate two components of empathy in non-demented ALS subjects, and to associate performance with regional grey-matter density using voxel-based morphometry (VBM). Twenty non-demented sporadic probable or definite ALS patients and 56 matched healthy controls (HC) participated in a non-verbal task requiring the attribution of emotional versus cognitive states to identify the correct ending of comic strips, compared with a control condition requiring identifying causal relationships devoid of social components. A subgroup of 14 ALS and 20 HC joined the VBM study. Results demonstrated that, compared with controls, ALS patients showed defective emotional empathy attribution, related with reduced grey-matter density in the anterior cingulate cortex and right inferior frontal gyrus. Our study provided evidence of a specific impairment of emotional empathy in ALS patients, reflecting neural damage in a limbic prefrontal network involved in emotional processing. Social cognition disorders may represent a marker of cognitive dysfunction in ALS.

Challenges in the Understanding and Treatment of Amyotrophic Lateral Sclerosis/Motor Neuron Disease

“…The dysexecutive syndrome of ALS seems to best correlate with deficits in theory of mind, reflecting the capacity to appreciate other's intentions and beliefs, and to extend this into predicting other's behavior by attributing an independent mental state to them. Such deficits are reflective of orbitofrontal and anterior cingulate pathology and can be observed in upwards of 50 % of patients with ALS who have no evidence otherwise of dementia [68,69]. When impairment in social cognition is considered along with ALSci, ALSbi, and ALS-FTD, a more robust picture of the prevalence of frontotemporal dysfunction in ALS is attained in which executive dysfunction is second to only ALSci as being the most common manifestation.…”

Does dysfunction of the mirror neuron system contribute to symptoms in amyotrophic lateral sclerosis?

“…The deficits in anterior cingulate/vMPFC associated with loss of empathy in bvFTD are of particular interest for ALS, where patients show consistently changes in anterior cingulate regions as well (Lillo et al , 2012, Filippi et al , 2013. Indeed, recent studies suggest that impairments of emotional decision-making, and impaired empathy might be also more due to anterior cingulate and insula atrophy changes than ventral motor cortex atrophy in ALS (Girardi et al , 2011, Cerami et al , 2014. If so, this would suggest that empathy impairments in ALS might be also more due to perspective taking deficits than pure action observation deficits similar to bvFTD.…”

Executive dysfunction predicts social cognition impairment in amyotrophic lateral sclerosis

“…The investigation of ToM in ALS has relied exclusively on cartoons and written or video vignettes [see [17] for review]. Relative to healthy controls, people with ALS have shown difficulty with describing the intentions and feelings of characters [15,18,19], identifying and explaining social faux pas [20] and estimating characters' preferences for objects based on their eye gaze direction [13,21].…”