Social Cognition Impairments in the Long Term Post Stroke

Abstract

Objective: To examine the presence of social cognition deficits and the relationship between social and general cognition (eg, attention, mental speed, verbal, visual, or memory abilities) in a large sample of chronic stroke patients and to identify stroke-related factors associated with social cognitive performance. Design: Inception cohort study in which social cognition was assessed at 3-4 years post stroke. Setting: Stroke units in 6 general hospitals. Participants: The data of 148 patients were available. Fifty controls without stroke (consisting of partners of patients and acquaintances of researchers) were recruited (NZ198). Interventions: Not applicable. Main Outcome Measures: Patients underwent neuropsychological assessment by means of tests for social cognition (emotion recognition, theory of mind [ToM], empathy, and behavior regulation) and general cognition. Subgroup analysis was performed to compare right hemisphere stroke patients with left hemisphere stroke patients. Correlations between general and social cognition tests were assessed. Multiple regression analyses were performed to identify demographic and stroke-related predictors of social cognitive performance. Results: Patients performed significantly worse on emotion recognition (assessed with the Ekman 60-Faces test on total score as well as on the emotion anger), ToM (assessed with the Cartoon test), and behavior regulation (assessed with the Hayling test). Subgroup analysis revealed no differences between right and left hemisphere patients. Social cognition tests showed significant correlations with each other and with tests for visual perception, language, mental speed, cognitive flexibility, and memory. Older age, low level of education (and for ToM, also female sex) were predictors of worse performance on social cognition tests. Conclusion: Social cognition impairments are present in the long term post stroke, even in a group of mildly affected stroke patients, which may contribute to their long-term problems. Severity of impairments is determined mainly by demographic factors.

The relationship between social cognition and participation in the long term after stroke

“…USER-P restriction scores were indeed higher in a sample with greater stroke severity (Groeneveld et al, 2019). Social cognitive deficits were mild as well; even though patients scored significantly lower compared to controls on emotion recognition, ToM and behavioural control, effect sizes were only small (Nijsse et al, 2019b) and a maximum of only 4.2% of the patients were impaired to a degree of two standard deviations or more below control mean. Support for the role of stroke severity in the relationship of social cognition and participation is found in the fact that social cognition does not predict community participation in healthy controls (Pijnenborg et al, 2009) and that studies reporting a relationship in TBI patients involved participants with moderate to severe TBI (Knox & Douglas, 2009;May et al, 2017;Struchen et al, 2008;Ubukata et al, 2014;Westerhof-Evers et al, 2018).…”

“…The mean scores on social cognitive tasks and the comparison with the performance of healthy controls have been described elsewhere (see Nijsse et al, 2019b). Briefly, differences between patients and healthy controls were small but significant for the FEEST, Cartoon Test and Hayling test.…”

“…In stroke patients, impairments in social cognition have been reported with regard to the ability to recognize emotions in others (Abbott, Wijeratne, Hughes, Perre, & Lindell, 2014;Leite, Guerreiro, Almeida, & Peixoto, 2017;Nijsse, Spikman, Visser-Meily, de Kort, & van Heugten, 2019b;Yuvaraj et al, 2013) and the ability to reason about one's own and others' beliefs, feelings, intentions and knowledge (theory of mind; ToM) (Hamilton, Radlak, Morris, & Phillips, 2017;Martín-Rodríguez & León-Carrión, 2010;Nijsse et al, 2019b;Yeh & Tsai, 2014). Findings are mixed for the domain of empathy, with some (Hillis, 2014;Leigh et al, 2013;Yeh & Tsai, 2014) but not all studies reporting a decrease in sharing of emotions and feeling with another's feelings (Nijsse et al, 2019b). Most research on social cognition after stroke aimed to determine its neural underpinnings, specifically lateralization of impairments (Baldo, Kacinik, Moncrief, Beghin, & Dronkers, 2016;Hamilton et al, 2017;Yeh & Tsai, 2014;Yeh, Lo, Tsai, & Tsai, 2015;Yuvaraj et al, 2013).…”

High occurrence of impaired emotion recognition after ischemic stroke

“…18 Moreover, little is known about the way emotion recognition is related to general cognitive functioning shortly after ischemic stroke. One recent study of social cognition in the long term after ischemic stroke showed only weak associations between other aspects of cognitive functioning and social cognition, 24 but whether these associations are present in the subacute phase is unclear. It is important to study the association between emotion recognition and general cognitive functioning, because impairments of emotion recognition might be explained by general cognitive impairments.…”

Comparing static and dynamic emotion recognition tests: Performance of healthy participants

“…There is no time restriction for answering. Total score ranges from 0 to 60, the separate emotion scores range from 0 to 10The FEEST has shown to have good reliability and validity and has proven to be sensitive in various patient groups, such as acquired brain injury patients [ 10 , 51 ] and patients with FTD [ 14 ].…”