The Edinburgh Social Cognition Test (ESCoT): Examining the effects of age on a new measure of theory of mind and social norm understanding

The 36-Item Yoni Task: Normative Data for the Clinical Assessment of Theory of Mind

Background: The evaluation of Theory of Mind (ToM) in the clinical setting remains limited due to the lack of valid instruments for a quick and reliable assessment. In this study, the psychometric properties of the Yoni-36 task were tested, and correction grids, equivalence scores, and normative data were computed. Methods: In total, 318 healthy subjects (169 females; mean age = 42.22 ± 18.11 years; mean education = 15.01 ± 3.43 years) were enrolled and administered the Yoni-36 task. Results: Statistical analysis showed good-to-high internal consistency, split-half reliability, and discrimination ability (especially for the second-order items) of the Yoni-36 task. Regression models highlighted the predictive role of age and education on second-order, affective, cognitive accuracy, and response time scores. Education influenced the first-order ToM response time score as well. Based on β values of the regressions, raw scores of the Yoni task were adjusted for sex, age, and education, and correction grids were computed. The equivalent scores indicated an accuracy index score < 0.69 and a response time index score < 0.83 as cut-off points for ToM competence. Normative data reported a mean accuracy and response time index score of 0.90 ± 0.11 and 0.91 ± 0.05 in the Italian population, respectively. Conclusions: The Yoni-36 proved to be a valid instrument for a quick and reliable ToM assessment, suitable to be included in neuropsychological batteries and to be used in routine clinical practice.

A further study of the psychometric qualities of the Strange Stories-Revised across the three stages of aging

INTRODUCTION

Happé's Strange Stories task was developed in 1994 to assess theory of mind, the ability to infer mental states in oneself and others. Since then, it has undergone revisions, translations, and adaptations. A modified version of the task, the Strange Stories-Revised (SS-R), previously showed satisfactory qualities in a study aiming at identifying psychometrically acceptable social cognitive measures.

OBJECTIVE

The current study expands upon the psychometric evaluation study by examining the qualities of a short version of the SS-R in a sample of healthy adult subjects.

METHODS

One hundred and eighteen healthy adults completed the task along with neurocognitive measures. Mean scores of the long and short versions were compared. Associations between ToM as measured by performance on this abbreviated version of the SS-R, and potential confounders were explored. Internal consistency, dimensionality of the short version, and performance comparisons across three stages of aging (18-34; 35-59; 60-85 years old) were investigated, and standard measurement error was calculated to improve precision and data interpretation.

RESULTS

Reliability coefficients were comparable in the short and long versions. Principal component analysis showed that a one-factor structure best fits the data. Significant differences were observed in ToM performance across the three age groups, indicating a decline with time that was also captured by the long version, starting during midlife and increasing in significance with age.

CONCLUSION

The short version of the SS-R is a promising measure that can be profitably used in time-limited settings to assess theory of mind.

Human reasoning on social interactions in ecological contexts: insights from the theory of mind brain circuits

Introduction

The relationship between neural social cognition patterns and performance on social cognition tasks in daily life is a topic of debate, with key consideration given to the extent to which theory of mind (ToM) brain circuits share properties reflecting everyday social functioning. To test the efficacy of ecological stimuli in eliciting brain activation within the ToM brain circuits, we adapted the Edinburgh Social Cognition test social scenarios, consisting of dynamic ecological contextually embedded social stimuli, to a fMRI paradigm.

Methods

Forty-two adults (21 men, mean age ± SD = 34.19 years ±12.57) were enrolled and underwent an fMRI assessment which consisted of a ToM task using the Edinburgh Social Cognition test scenarios. We used the same stimuli to prompt implicit (movie viewing) and explicit (silent and two-choice answers) reasoning on cognitive and affective mental states. The fMRI analysis was based on the classical random effect analysis. Group inferences were complemented with supplemental analyses using overlap maps to assess inter-subject variability.

Results

We found that explicit mentalizing reasoning yielded wide neural activations when two-choice answers were used. We also observed that the nature of ToM reasoning, that is, affective or cognitive, played a significant role in activating different neural circuits.

Discussion

The ESCoT stimuli were particularly effective in evoking ToM core neural underpinnings and elicited executive frontal loops. Future work may employ the task in a clinical setting to investigate ToM network reorganization and plasticity.

The Social and Cognitive Online Training (SCOT) project: A digital randomized controlled trial to promote socio-cognitive well-being in older adults

OBJECTIVES

Effective prevention programs targeting risk factors for cognitive decline in the elderly are recommended given the progressive increase in the aging of the general population. The Social and Cognitive Online Training (SCOT) project is a randomized, controlled, parallel clinical trial designed to prevent the age-related decline in executive and social functions.

METHODS

The study included 60 cognitively healthy older adults (age = 71.8±5.3, education = 12.3±3.7, MoCA = 25.1±2.4). Participants underwent a baseline clinical and neuropsychological assessment and were then assigned to either an experimental group (SCOT) or a non-specific cognitive training group (CON). Both 8-week digital interventions included two individual cognitive training sessions and one group meeting per week. Post-intervention assessment evaluated the efficacy of the training on specific outcome measures: the Tower of London for executive functioning, the Ekman-60 Faces test, and the Mini-Social cognition & Emotional Assessment battery for social cognition. A measure of loneliness was included as an exploratory outcome.

RESULTS

Baseline demographic and neuropsychological characteristics were balanced between SCOT (n = 29) and CON (n = 28) groups. Pre-post-intervention analyses showed improvements in executive functioning and social cognition in both groups, without significant interaction effects. Exploratory post-hoc analyses stratifying the SCOT group by training performance showed significant post-training improvements in executive functioning, emotion recognition, and cognitive theory of mind for high-performing participants.

DISCUSSION

Results provide preliminary evidence for the beneficial effects of SCOT training, particularly for those who performed best during the training. The SCOT training could represent a new intervention to promote socio-cognitive well-being in the context of active ageing and dementia prevention.

Mini-SEA: Validity and Normative Data for the French-Quebec Population Aged 50 Years and Above

OBJECTIVE

The mini Social cognition & Emotional Assessment (mini-SEA) is a social cognition battery which assesses theory of mind and emotion recognition. Currently, no psychometrically validated measure of social cognition with adapted normative data exists for the middle-aged and elderly French-Quebec population. This project aims to determine the known-group discriminant validity of a cultural and linguistic adaptation of the mini-SEA between cognitively healthy people, those with mild cognitive impairment (MCI) or living with Alzheimer's Disease (AD). This study also aims to examine the stability of mini-SEA's performance over a 3-4-month time period, as well as to produce normative data for French-Quebec people aged 50 years. Normative data are derived for the full and an abbreviated version of the Faux Pas subtest.

METHOD

The sample included 211 French-speaking participants from Quebec (Canada) aged 50 to 89 years. Mini-SEA's performance between a sub-sample of cognitively healthy people (n = 20), those with MCI (n = 20) or with AD (n = 20) was compared. A sub-sample of cognitively healthy people (n = 30) performed the task twice to estimate test-retest reliability. Socio-demographic variables' effects on scores were examined to produce normative data in the form of regression equations or percentile ranks.

RESULTS

Significant differences emerged between cognitively healthy people and those with MCI or AD. Moreover, scores were relatively stable over a period of 3 to 4 months. Finally, for the normative data, age, gender, and education were associated with performance on the mini-SEA or its subtests.

CONCLUSIONS

This study improves and standardizes social cognition's assessment among French-Quebec individuals, which will help characterize their cognitive profile.

Multidimensional neural representations of social features during movie viewing

The social world is dynamic and contextually embedded. Yet, most studies utilize simple stimuli that do not capture the complexity of everyday social episodes. To address this, we implemented a movie viewing paradigm and investigated how everyday social episodes are processed in the brain. Participants watched one of two movies during an MRI scan. Neural patterns from brain regions involved in social perception, mentalization, action observation and sensory processing were extracted. Representational similarity analysis results revealed that several labeled social features (including social interaction, mentalization, the actions of others, characters talking about themselves, talking about others and talking about objects) were represented in the superior temporal gyrus (STG) and middle temporal gyrus (MTG). The mentalization feature was also represented throughout the theory of mind network, and characters talking about others engaged the temporoparietal junction (TPJ), suggesting that listeners may spontaneously infer the mental state of those being talked about. In contrast, we did not observe the action representations in the frontoparietal regions of the action observation network. The current findings indicate that STG and MTG serve as key regions for social processing, and that listening to characters talk about others elicits spontaneous mental state inference in TPJ during natural movie viewing.

Dynamic and/or multimodal assessments for social cognition in neuropsychology: Results from a systematic literature review

Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.

Normative values and diagnostic optimisation of three social cognition measures for autism and schizophrenia diagnosis in a healthy adolescent and adult sample

Awareness of the importance of assessing social cognition skills under conditions showing atypical social behaviours has increased over the years. However, the evaluation of the psychometric properties of the measures and the availability of normative values for the clinical context are still limited. This study aims to revise, provide normative values, and evaluate the clinical validity of the Italian version of three social cognition measures: Advanced Theory of Mind (A-ToM) task, the Emotion Attribution Task (EAT), and the Social Situation Task (SST). Measures were administered to 580 adolescents and adult healthy controls (age range 14-50). We performed differential item functioning and Rasch analysis to revise each task, so normative data of the revised measures were calculated. Moreover, the revised measures were administered to 38 individuals with autism spectrum disorder (ASD) and 35 individuals with schizophrenia spectrum disorders (SSD): ASD and SSD were matched by age, gender, and IQ with a control sample to evaluate clinical validity. ROC analysis showed that the SST is the best measure differentiating between healthy and clinical groups, compared to the A-ToM (AUCASD = 0.70; AUCSSD = 0.65) and EAT (AUCASD = 0.67; AUCSSD = 0.50), which showed poorer performance. For SSD diagnosis, two SST subscales (Violation and Gravity score) indicated the best accuracy (AUCs of 0.88 and 0.84, respectively); for the ASD diagnosis, we propose a combined score between the SST subscale and A-ToM (AUC = 0.86). The results suggest that the proposed measures can be used to support the diagnostic process and clinical practice.

Measures of individual differences in adult theory of mind: A systematic review

Theory of mind (ToM), the ability to understand and reason about mental states, has been extensively studied in young children and clinical populations. A growing interest in examining ToM in adults has emerged over the past two decades, but the extent to which existing measures are suitable for studying adults, especially in detecting individual differences, remains understudied. In this systematic review of 273 studies, 75 measures used to investigate individual differences in adults' ToM were identified. Their sensitivity to individual differences, reliability, and validity were examined. Results suggest that ceiling effects were prevalent, and there was limited evidence to establish the reliability or validity of these measures due to the lack of reports of psychometric properties. Interrelations among measures were inconsistent. These findings highlight the need for future empirical and theoretical work to broaden the evidence base regarding psychometric properties of measures, to develop new measures, and to lay out more specific hypotheses about the relevance of ToM for different social outcomes.

Beyond memory: exploring the value of social cognition for older adults with neurocognitive disorders

Neurocognitive disorders involves progressive decline in cognition, function, behavior and needs. Recent developments have identified the need to characterize social cognition in individuals with neurocognitive impairments to support uncertainty in clinical decision making, treatment plans and monitoring individual change. Routine social cognition assessments have thus been more recently used and adopted in persons with dementia or mild cognitive impairment. This work serves to summarize current assessments and provide a discourse on the practicality of available social cognition tools, its implication in clinical practice and key future directions. We highlight advantages in establishing validated, multicomponent measures of social cognition for people with neurocognitive disorders.

Social cognition in cervical dystonia

Background

Whilst traditionally considered a movement disorder, it is now generally accepted that cervical dystonia (CD) presents with additional non-motor symptoms which significantly impact quality of life. Our study primarily aimed to explore social cognition and levels of psychological distress in individuals with CD, in comparison to age- and sex-matched healthy controls.

Methods

20 participants with CD attending a specialist movement disorders clinic were recruited. 20 age and sex matched neurologically healthy controls were recruited in parallel. Participants completed the Hospital Anxiety and Depression Scale, and two novel social cognition tasks: The Cambridge Mindreading Face-Voice Battery (CAFMB) and the Edinburgh Social Cognition Test (ESCoT).

Results

Participants with CD exhibited poorer complex emotion recognition abilities for visual and auditory stimuli, compared to controls on the CAFMB task. Participants with CD did not differ significantly from controls on performance on cognitive or affective Theory of Mind tasks, or interpersonal or intrapersonal understanding of social norms, as measured by the ESCoT. The proportion of depressive symptoms was significantly higher for participants with CD than controls. 40% of participants with CD reported clinically elevated depressive symptoms, and 60% reported clinically elevated anxiety. Poorer understanding of emotional facial expressions was associated with higher levels of depression in the CD group.

Conclusions

Significant between-group differences between participants with CD and controls suggests socio-cognitive dysfunction is an important aspect of the non-motor syndrome of CD. Findings highlight the need for assessment of and intervention for both social cognitive difficulties and psychological distress in individuals with CD.

Metabolic profile in first episode drug naïve patients with psychosis and its relation to cognitive functions and social cognition: a case control study

1st episode drug naïve patients with psychosis might be at higher risk for cardiometabolic disturbances which could affect the different cognitive, and executive functions and domains of social cognition. This study aimed to study the metabolic parameters in 1st episode drug naïve patients with psychosis, to evaluate the relation of these cardiometabolic domains to the cognitive, executive functions, and social cognition. Socio-demographic characteristics of 150 first episode drug naïve patients with psychosis and 120 matched healthy control groups were collected. The current study also assessed the cardiometabolic profile and cognitive functions in both groups. Social cognition was examined by Edinburgh Social Cognition Test. The study revealed a statistically significant difference in parameters of metabolic profile among the studied groups (p < 0.001*), the scores of cognitive and executive tests were statistically significantly different (p < 0.001*). In addition, the patient's group has lowered scores of domains of social cognition (p < 0.001*). Also, the mean affective theory of mind was negatively correlated with the conflict cost of the Flanker test (r = -.185* p value = .023). The total cholesterol level (r = - 0.241**, p value = .003) and level of triglycerides (r = - 0.241**, p value = 0.003) were negatively correlated with the interpersonal domain of social cognition, the total cholesterol level is positively correlated to the total score of social cognition (r = 0.202*, p value = 0.013). Patients with 1st episode drug naïve psychosis showed disturbed cardiometabolic parameters which have deleterious effects on cognitive functions and social cognition.

Word finding, prosody and social cognition in multiple sclerosis

BACKGROUND

Impairments in speech and social cognition have been reported in people with multiple sclerosis (pwMS), although their relationships with neuropsychological outcomes and their clinical utility in MS are unclear.

OBJECTIVES

To evaluate word finding, prosody and social cognition in pwMS relative to healthy controls (HC).

METHODS

We recruited people with relapsing MS (RMS, n = 21), progressive MS (PMS, n = 24) and HC (n = 25) from an outpatient MS clinic. Participants completed a battery of word-finding, social cognitive, neuropsychological and clinical assessments and performed a speech task for prosodic analysis.

RESULTS

Of 45 pwMS, mean (SD) age was 49.4 (9.4) years, and median (range) Expanded Disability Severity Scale score was 3.5 (1.0-6.5). Compared with HC, pwMS were older and had slower information processing speed (measured with the Symbol Digit Modalities Test, SDMT) and higher depression scores. Most speech and social cognitive measures were associated with information processing speed but not with depression. Unlike speech, social cognition consistently correlated with intelligence and memory. Visual naming test mean response time (VNT-MRT) demonstrated worse outcomes in MS versus HC (p = .034, Nagelkerke's R²  = 65.0%), and in PMS versus RMS (p = .009, Nagelkerke's R²  = 50.2%). Rapid automatised object naming demonstrated worse outcomes in MS versus HC (p = .014, Nagelkerke's R²  = 49.1%). These word-finding measures showed larger effect sizes than that of the SDMT (MS vs. HC, p = .010, Nagelkerke's R²  = 40.6%; PMS vs. RMS, p = .023, Nagelkerke's R²  = 43.5%). Prosody and social cognition did not differ between MS and HC.

CONCLUSIONS

Word finding, prosody and social cognition in MS are associated with information processing speed and largely independent of mood. Impairment in visual object meaning perception is potentially a unique MS disease-related deficit that could be further explored and cautiously considered as an adjunct disability metric for MS.

Standardization and normative data of the 48-item Yoni short version for the assessment of theory of mind in typical and atypical conditions

Introduction

The Yoni task is a computerized tool assessing first-and second-order affective and cognitive Theory of Mind (ToM), accounting for the multidimensional and multi-level mentalizing features. The Italian Yoni task has been validated and standardized in its 98-item version, and a 48-item short version has been proposed for a quick digital evaluation of ToM in clinical contexts.

Methods

The present study aimed to test the Yoni-48's convergent validity, correlating the tool score with the Reading the Mind in the Eyes test (ET) and Gender Test (GT), its items discrimination ability through the Classical Test Theory, and Rash model, its reliability by evaluating the internal consistency (McDonald's ω, Cronbach's α, Guttman's λ ², and Guttman's λ ⁶) and Spearman-Brown ϱ_SP split-half analysis, and to provide standardization and normative data in the Italian population.

Results

Results suggested a good convergent validity with a statistically significant association with ET (p < 0.001), while a null correlation was observed with GT (p = 0.947). The Classical Test Theory and Rash model confirmed a good discrimination ability of the Yoni-48's second-order affective and cognitive ToM items, while weaker discrimination capacity was registered for the first-order ToM items. The inter-item reliability was optimal for clinical purposes (ω, α, λ ², λ ⁶ ≥ 0.90). Also, the split-half reliability was high (Spearman-Brown ϱ_SP = 0.90). For standardization, age and education were revealed as significant predictors of Yoni accuracy scores, except for the first-order ToM score. Instead, age was the only predictor of Yoni's response speed score. The Italian normative data showed a high Yoni accuracy in healthy adults (mean accuracy = 0.85) and speed (mean response time = 0.92). Finally, both accuracy and response time level was balanced between the affective and cognitive components of ToM.

Discussion

This study supports the psychometric properties of the Yoni-48 and provides normative data for the Italian population. Further studies are needed to test the suitability of this short version for profiling the social cognition neurocognitive phenotype.

Cognitive empathy across the lifespan

AIM

To describe the development of cognitive empathy across the lifespan from a very large cohort using a standardized measure of cognitive empathy ability.

METHOD

Participants (n=4545, age bands <5y to >75y, 60% female) were a convenience sample recruited voluntarily from visitors to the Glasgow Science Centre in the UK, who completed the Reading the Mind in the Eyes Test.

RESULTS

When compared to preceding age groups, we found significant developmental gains in empathy ability in children aged 6 to 7 years (p=0.048, d=0.45) and again at 10 to 12 years (p=0.042, d=0.23), followed by a slight reduction in ability during adolescence (p=0.087, d=-0.18), and functional maturity in those aged 19 to 25 years (p=0.001, d=0.76). Cognitive empathy abilities remained relatively stable across adulthood but gradually declined in people over 65 years, with notable decline in males over 75 years (p=0.001, d=-0.98). Females performed better than males at all ages.

INTERPRETATION

Understanding developmental issues in cognitive empathy could influence approaches to moral and social education for children, and health and social care support for older people. Standardized cognitive empathy tests could also provide novel approaches in the early detection of developmental vulnerabilities in a range of neurological conditions, and within neuropsychiatric and neurodegenerative disorders in which cognitive empathy is known to be impaired.

WHAT THIS PAPER ADDS

Cognitive empathy is a late-developing ability and changes across the lifespan. Cognitive empathy increases during childhood but with potentially altered abilities during adolescence. Cognitive empathy matures during early adulthood and gradually declines in older age. There is a female advantage in cognitive empathy abilities.

Age differences in social-cognitive abilities across the stages of adulthood and path model investigation of adult social cognition

Accumulating evidence points toward an association between older age and performance decrements in social cognition (SC). We explored age-related variations in four components of SC: emotion recognition, theory of mind, social judgment, and blame attributions. A total of 120 adults divided into three stages (18-34 years, 35-59 years, 60-85 years) completed a battery of SC. Between and within age-group differences in SC were investigated. Path analyses were used to identify relationships among the components. Emotion recognition and theory of mind showed differences beginning either in midlife, or after. Blame attributions and social judgment did not show a significant difference. However, social judgment varied significantly within groups. Path models revealed a relationship between emotion recognition and theory of mind. Findings highlight age-related differences in some components and a link between two components. Strategies promoting social functioning in aging might help to maintain or improve these abilities over time.

An Investigation of the Validity of the Edinburgh Social Cognition Test (ESCoT) in Acquired Brain Injury (ABI)

OBJECTIVES

Social cognition is frequently impaired following an acquired brain injury (ABI) but often overlooked in clinical assessments. There are few validated and appropriate measures of social cognitive abilities for ABI patients. The current study examined the validity of the Edinburgh Social Cognition Test (ESCoT, Baksh et al., ) in measuring social cognition following an ABI.

METHODS

Forty-one patients with ABI were recruited from a rehabilitation service and completed measures of general ability, executive functions and social cognition (Faux Pas; FP, Reading the Mind in the Eyes; RME, Social Norms Questionnaire; SNQ and the ESCoT). Forty-one controls matched on age, sex and years of education also performed the RME, SNQ and ESCoT.

RESULTS

A diagnosis of ABI was significantly associated with poorer performance on all ESCoT measures and RME while adjusting for age, sex and years of education. In ABI patients, the ESCoT showed good internal consistency with its subcomponents and performance correlated with the other measures of social cognition demonstrating convergent validity. Better Trail Making Test performance predicted better ESCoT total, RME and SNQ scores. Higher TOPF IQ was associated with higher RME scores, while higher WAIS-IV working memory predicted better FP performance.

CONCLUSIONS

The ESCoT is a brief, valid and internally consistent assessment tool able to detect social cognition deficits in neurological patients. Given the prevalence of social cognition deficits in ABI and the marked impact these can have on an individual's recovery, this assessment can be a helpful addition to a comprehensive neuropsychological assessment.

Italian adaptation of the Edinburgh Social Cognition Test (ESCoT): A new tool for the assessment of theory of mind and social norm understanding

The relevance of social cognition assessment has been formally described in the Diagnostic and Statistical Manual of Mental Disorders-5. However, social cognition tools evaluating different socio-cognitive components for Italian-speaking populations are lacking. The Edinburgh Social Cognition Test (ESCoT) is a new social cognition measure that uses animations of everyday social interactions to assess (i) cognitive theory of mind, (ii) affective theory of mind, (iii) interpersonal social norm understanding, and (iv) intrapersonal social norm understanding. Previous studies have shown that the ESCoT is a sensitive measure of social cognition in healthy and clinical populations in the United Kingdom. This work aimed to adapt and validate the ESCoT in an Italian population of healthy adults. A translation-back-translation procedure was followed to create and refine the Italian version. Then, 94 healthy adults (47 females, mean age  35 ± 15.9) completed the ESCoT, a battery of conventional social cognition tests (Yoni; Reading the Mind in the Eyes Strange Stories, and Social Norm Questionnaire, SNQ) and measures of intelligence and executive functions. Reliability, convergent validity, and predictors of performance on the ESCoT were examined. Results demonstrated good reliability of the ESCoT and an association between the ESCoT scores and some traditional social cognition tests (Yoni cognitive subscale, SNQ). Hierarchical regression results showed that the ESCoT total score was associated with age. Also, the ESCoT subscore (intrapersonal social norm understanding) was associated with education. These findings support the ESCoT as a valid tool testing social norm understanding, a reliable measure of social cognition for an adult Italian population, and provides further evidence that the ESCoT is sensitive to age- and education-related changes in social cognition, and it is a task not affected by general cognitive functioning.

Social Cognition and Social Functioning in MCI and Dementia in an Epidemiological Sample

OBJECTIVE

Social cognition is impaired in mild cognitive impairment (MCI) and dementia. However, its relationship to social functioning and perceived social support has yet to be explored. Here, we examine how theory of mind (ToM) relates to social functioning in MCI and dementia.

METHODS

Older adults (cognitively normal = 1272; MCI = 132; dementia = 23) from the PATH Through Life project, a longitudinal, population-based study, were assessed on the Reading the Mind in the Eyes Test (RMET), measures of social functioning, and social well-being. The associations between RMET performance, social functioning, and cognitive status were analysed using generalised linear models, adjusting for demographic variables.

RESULTS

Participants with MCI (b=-.52, 95% CI [-.70, -.33]) and dementia (b=-.78, 95% CI [-1.22, -.34]) showed poorer RMET performance than cognitively normal participants. Participants with MCI and dementia reported reduced social network size (b=-.21, 95% CI [-.40, -.02] and b=-.90, 95% CI [-1.38, -.42], respectively) and participants with dementia reported increased loneliness (b = .36, 95% CI [.06, .67]). In dementia, poorer RMET performance was associated with increased loneliness (b=-.07, 95% CI [-.14, -.00]) and a trend for negative interactions with partners (b=-.37, 95% CI [-.74, .00]), but no significant associations were found in MCI.

CONCLUSIONS

MCI and dementia were associated with poor self-reported social function. ToM deficits were related to poor social function in dementia but not MCI. Findings highlight the importance of interventions to address social cognitive deficits in persons with dementia and education of support networks to facilitate positive interactions and social well-being.

Progression of socio-cognitive impairment from healthy aging to Alzheimer's Dementia: A systematic Review and Meta-Analysis

BACKGROUND

Trajectories of decline across different socio-cognitive domains in healthy older adults and in pathological aging conditions have not been investigated. This was addressed in the present systematic review and meta-analysis.

METHODS

MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched for studies investigating social cognition across four domains (Theory of Mind, ToM; emotion recognition, ER; Social-decision making, SD; visual perspective taking, VPT) in healthy older individuals, individuals with subjective and mild cognitive impairment (SCD, MCI) and Alzheimer's disease (AD). Random-effects meta-analyses were conducted.

RESULTS

Of 8,137 screened studies, 132 studies were included in the review. ToM and ER showed a clear progression of impairment from normal aging to AD. Differential patterns of decline were identified for different types of ToM and ER.

CONCLUSION

This systematic review identified progression of impairment of specific socio-cognitive abilities, which is the necessary pre-requisite for developing targeted interventions. We identified a lack of research on socio-cognitive decline in different populations (e.g., middle age, SCD and MCI-subtypes) and domains (SDM, VPT).

REGISTRATION

CRD42020191607, https://www.crd.york.ac.uk/prospero/.

Measuring cognitive and affective Theory of Mind with the Italian Yoni task: normative data and short versions

Theory of Mind (ToM), a high-order human social cognition skill, is relevant for mental health and wellbeing and frequently impaired in many clinical conditions. To detect ToM difficulties, validated and standardized measures need to be adopted in clinical practice. The Yoni task provides a comprehensive evaluation of first-order, second-order, affective and cognitive mentalistic inferences. However, the Yoni task remains a time-demanding tool without normative data. To fill this gap, we explored the convergent and discriminant validity, the inter-item reliability and provided normative data of the Italian version of the Yoni task (98 items), and developed two short versions (48 and 36 items). For the validation, internal consistency and convergent/discriminant validity have been considered. Then, the effects of demographical variables on 98 item Yoni were explored, and normative data were provided. Our data demonstrated high reliability and a good convergent validity in all the Yoni versions. Then, two composite scores were proposed to obtain: 1) a global ToM level and 2) the balance between affective and cognitive ToM components, whose alteration represents a signature of several clinical conditions. The future standardization of the short versions of Yoni will allow a comprehensive and quick examination of ToM abilities, suitable for both research and clinical settings.

Cognitive and Affective Theory of Mind across Adulthood

BACKGROUND

Theory of mind (ToM) is a fundamental aspect of social cognition. Previous studies on age-related changes in mentalizing processes have provided conflicting results. This study aims to investigate the age-related changes in the cognitive and affective components of ToM throughout adulthood.

METHODS

Two hundred and thirty-eight healthy participants divided into five age groups (18-40 years old; 41-50 years old; 51-60 years old; 61-70 years; 71-80 years old) underwent tasks assessing the cognitive (ToM Picture Sequencing Task, TMPS, and the Advanced Test of ToM, ATT) and affective (Reading the Mind in the Eyes Task, RMET, and the Emotion Attribution Task, EAT) components of ToM, in both verbal and nonverbal modality.

RESULTS

Regarding affective ToM, both the youngest- and middle-old adult groups (61 to 80 years) performed worse than the young and youngest-middle adult groups (18 to 50 years) in the RMET, but no significant differences were found in the EAT. Regarding cognitive ToM, the middle-old adult group (71 to 80 years) performed worse than the young adult group (18 to 40 years) only in the TMPS, but no significant differences were found in the ATT.

CONCLUSION

Rather than a general decline in ToM, our results provide evidence regarding selective changes in ToM in older adults, further confirming the dissociation of cognitive and affective ToM.

Using a Computer-Based Virtual Environment to Assess Social Cognition in Aging: An Exploratory Study of the REALSoCog Task

Although previous studies have suggested that some component processes of social cognition decline in normal aging, several methodological limitations can be pointed out. Traditional sociocognitive tasks assess processes separately and lack ecological validity. In the present study, the main aim was to propose an integrative social cognition assessment in normal aging using an original computer-based task developed in non-immersive virtual reality. Forty-five young adults (YA) and 50 older adults (OA) were asked to navigate in a simulated city environment and to judge several situations that they encountered. These situations investigated social norms by displaying control or (conventional/moral) transgressions. Following each situation, the participants were asked several questions in order to assess their ability to make moral judgments, affective and cognitive theory of mind, emotional reactivity and empathy, and the propensity to act in a socially appropriate or inappropriate way. The main results showed (i) a preserved ability to detect moral and conventional transgressions with advancing age; (ii) participants' preserved cognitive ToM abilities; (iii) an age-related decline in affective ToM, that disappeared when the victim was a senior; (iv) preserved emotional reactivity and emotional empathy in normal aging; (v) an increase in inappropriate behavioral intentions in normal aging. Offering more naturalistic conditions, this new task is an interesting integrative measure of sociocognitive functioning to better reflect social behavior in daily living.

The ageing of the social mind: replicating the preservation of socio-affective and the decline of socio-cognitive processes in old age

Anticipating population ageing to reach a historically unprecedented level in this century and considering the public goal of promoting well-being until old age, research in many fields has started to focus on processes and factors that contribute to healthy ageing. Since human interactions have a tremendous impact on our mental and physical well-being, scientists are increasingly investigating the basic processes that enable successful social interactions such as social affect (empathy, compassion) and social cognition (Theory of Mind). However, regarding the replication crisis in psychological science it is crucial to probe the reproducibility of findings revealed by each specific method. To this end, we aimed to replicate the effect of age on empathy, compassion and Theory of Mind observed in Reiter and colleagues' study (Reiter et al. 2017 Sci. Rep. 7, 11046 (doi:10.1038/s41598-017-10669-4)) by using the same ecologically valid paradigm in an independent sample with similar age ranges. We were able to replicate the previously observed results of a preservation or even enhancement in socio-affective processes, but a decline in socio-cognitive processes for older adults. Our findings add to the understanding of how social affect and cognition change across the adult lifespan and may suggest targets for intervention studies aiming to foster successful social interactions and well-being until advanced old age.

Measurement Properties of Social Communication Assessments for Transition-Age Adolescents: A Systematic Review

Purpose An important role of social communication assessment is to support intervention planning as adolescents with disabilities transition to workplaces and other adult settings. Adoption of evidence-based assessment practices would align professionals with legal and ethical mandates for schools and other settings. There is, however, limited adoption of evidence-based assessment selection. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) provide a structured approach to identifying assessments with sufficient validity and reliability backed by strong evidence. The purpose of this review was to identify directly administered social communication assessments for adolescents and to apply the COSMIN framework to evaluate their measurement properties. Method A systematic search identified 13 assessments designed for 14- to 21-year-olds with developmental disabilities putting them at risk for social communication deficits. Measurement properties were extracted from included studies and rated for sufficiency. The quality of evidence supporting the findings was graded using COSMIN guidelines. Results Five social communication assessments were recommended as having sufficient evidence of content validity and internal consistency. Remaining assessments could be recommended as gaps in the evidence for their measurement properties are filled. Conclusions The application of the COSMIN standards has the potential to advance evidence-based assessment for social communication. There were important gaps in the independent replication of measurement properties and methodological shortcomings in the evaluation of reliability, measurement error, and structural validity.

A revised instrument for the assessment of empathy and Theory of Mind in adolescents: Introducing the EmpaToM-Y

Empathy and Theory of Mind (ToM) are two core components of social understanding. The EmpaToM is a validated social video task that allows for independent manipulation and assessment of the two capacities. First applications revealed that empathy and ToM are dissociable constructs on a neuronal as well as on a behavioral level. As the EmpaToM has been designed for the assessment of social understanding in adults, it has a high degree of complexity and comprises topics that are inadequate for minors. For this reason, we designed a new version of the EmpaToM that is especially suited to measure empathy and ToM in youths. In experiment 1, we successfully validated the EmpaToM-Y on the original EmpaToM in an adult sample (N = 61), revealing a similar pattern of results across tasks and strong correlations of all constructs. As intended, the performance measure for ToM and the control condition of the EmpaToM-Y showed reduced difficulty. In experiment 2, we tested the feasibility of the EmpaToM-Y in a group of teenagers (N = 36). Results indicate a reliable empathy induction and higher demands of ToM questions for adolescents. We provide a promising task for future research targeting inter-individual variability of socio-cognitive and socio-affective capacities as well as their precursors and outcomes in healthy minors and clinical populations.

A Taxonomy of Social Errors in Human-Robot Interaction

Robotic applications have entered various aspects of our lives, such as health care and educational services. In such Human-robot Interaction (HRI), trust and mutual adaption are established and maintained through a positive social relationship between a user and a robot. This social relationship relies on the perceived competence of a robot on the social-emotional dimension. However, because of technical limitations and user heterogeneity, current HRI is far from error-free, especially when a system leaves controlled lab environments and is applied to in-the-wild conditions. Errors in HRI may either degrade a user’s perception of a robot’s capability in achieving a task (defined as performance errors in this work) or degrade a user’s perception of a robot’s socio-affective competence (defined as social errors in this work). The impact of these errors and effective strategies to handle such an impact remains an open question. We focus on social errors in HRI in this work. In particular, we identify the major attributes of perceived socio-affective competence by reviewing human social interaction studies and HRI error studies. This motivates us to propose a taxonomy of social errors in HRI. We then discuss the impact of social errors situated in three representative HRI scenarios. This article provides foundations for a systematic analysis of the social-emotional dimension of HRI. The proposed taxonomy of social errors encourages the development of user-centered HRI systems, designed to offer positive and adaptive interaction experiences and improved interaction outcomes.

Impaired Knowledge of Social Norms in Dementia and Psychiatric Disorders: Validation of the Social Norms Questionnaire-Dutch Version (SNQ-NL)

The Social Norms Questionnaire–Dutch version (SNQ-NL) measures the ability to understand and identify social boundaries. We examined the psychometric characteristics of the SNQ-NL and its ability to differentiate between patients with behavioral variant frontotemporal dementia (bvFTD; n = 23), Alzheimer’s dementia (AD; n = 26), chronic psychiatric disorders (n = 27), and control participants (n = 92). Between-group differences in the Total score, Break errors, and Overadhere errors were examined and associations with demographic variables and other cognitive functions were explored. Results showed that the SNQ-NL Total Score and Break errors differed between patients with AD and bvFTD, but not between patients with bvFTD and psychiatric disorders. Modest correlations with age, sex, and education were observed. The SNQ-NL Total score and Break errors correlated significantly with emotion recognition and verbal fluency but not with processing speed or mental flexibility. In conclusion, the SNQ-NL has sufficient construct validity and can be used to investigate knowledge of social norms in clinical populations.

Face perception across the adult lifespan: evidence for age-related changes independent of general intelligence

It is well-documented that face perception - including facial expression and identity recognition ability - declines with age. To date, however, it is not yet well understood whether this age-related decline reflects face-specific effects, or instead can be accounted for by well-known declines in general intelligence. We examined this issue using a relatively large, healthy, age-diverse (18-88 years) sample (N = 595) who were assessed on well-established measures of face perception and general intelligence. Replicating previous work, we observed that facial expression recognition, facial identity recognition, and general intelligence all showed declines with age. Of importance, the age-related decline of expression and identity recognition was present even when the effects of general intelligence were statistically controlled. Moreover, facial expression and identity ability each showed significant unique associations with age. These results indicate that face perception ability becomes poorer as we age, and that this decline is to some extent relatively focal in nature. Results are in line with a hierarchical structure of face perception ability, and suggest that age appears to have independent effects on the general and specific face processing levels within this structure.

Social Cognition in Autism Spectrum Disorder Across the Adult Lifespan: Influence of Age and Sex on Reading the Mind in the Eyes Task in a Cross-sectional Sample

Background: Approximately 50,000 U.S. teens with autism spectrum disorder (ASD) become adults every year, however little is known regarding how age influences social cognition and if men and women with ASD are differentially impacted across the adult lifespan. Social cognition declines non-linearly with age in neurotypical (NT) adults. Moreover, sex differences have been observed on RME tasks in NT adults but not adults with ASD, although aging effects have been largely ignored.

Objective: This cross-sectional study examined the influence of age and sex on social cognition in adults with ASD compared to NT adults.

Methods: The Reading the Mind in the Eyes (RME) task was administered to evaluate the theory of mind abilities in 95 adults with ASD and 82 NT adults ages 18–71 years. The main effects of diagnosis, age, and sex, as well as two-way and three-way interaction were modeled using linear and quadratic aging terms in a multiple regression analysis.

Results: A main effect of diagnosis was observed, indicating poorer performance in adults with ASD relative to NT adults. Age and sex interactions were nonsignificant.

Discussion: We replicated previous findings of reduced theory of mind (ToM) abilities in adults with ASD, compared to NT adults. While interactions were nonsignificant, visual inspection of quadratic age curves indicated the possibility of unique ToM trajectories in men and women with and without ASD that should be investigated in larger longitudinal studies.

Cognitive and Affective Theory of Mind in Healthy Aging

BACKGROUND

Previous studies on the effect of healthy aging on Theory of Mind (ToM) have produced mixed results. A possible explanation may be that different ToM components and types of inference have not systematically been considered. This study examined the effect of aging on ToM by assessing both first and second order cognitive and affective components within a single task.

METHODS

We compared performance of young (M = 18.3y) and older adults (M = 61.0y) on the Yoni task. This task allows for a within-subject assessment of both first and second order cognitive and affective ToM.

RESULTS

We observed that older adults had longer reaction times than young adults across cognitive and affective first order items. For second order items, this age difference was larger for affective than cognitive items. Results showed no indications that these findings could be explained by age differences in speed/accuracy trade-offs.

CONCLUSION

Our findings suggest that decision processes underlying ToM are slower in older adults on both first and second order inferences, but that age differences in these processes between cognitive and affective ToM are selective to second order inferences. We propose that the observed age differences may be associated with cortical and mental changes that occur with aging.

Executive Functions do not Underlie Performance on the Edinburgh Social Cognition Test (ESCoT) in Healthy Younger and Older Adults

OBJECTIVE

Current measures of social cognition have shown inconsistent findings regarding the effects of executive function (EF) abilities on social cognitive performance in older adults. The psychometric properties of the different social cognition tests may underlie the disproportional overlap with EF abilities. Our aim was to examine the relationship between social cognition and EF abilities using the Edinburgh Social Cognition Test (ESCoT; Baksh, R.A., Abrahams, S., Auyeung, B., & MacPherson, S.E. (2018). The Edinburgh Social Cognition Test (ESCoT): Examining the effects of age on a new measure of theory of mind and social norm understanding. PloS One, 13(4), e0195818.), a test assessing four different aspects of social cognition: cognitive theory of mind (ToM), affective ToM, interpersonal understanding of social norms, and intrapersonal understanding of social norms.

METHOD

We administered the ESCoT, EF measures of inhibition, set shifting, updating, and a measure of processing speed to 30 younger and 31 older adults. We also administered the Visual Perspective Taking task (VPT) as a ToM test thought to be reliant on EF abilities.

RESULTS

Better performance on cognitive ToM was significantly associated with younger age and slower processing speed. Better performance on affective ToM and ESCoT total score was associated with being younger and female. Better performance on interpersonal understanding of social norms was associated with being younger. EF abilities did not predict performance on any subtest of the ESCoT. In contrast, on the VPT, the relationship between age group and performance was fully or partially mediated by processing speed and updating.

CONCLUSIONS

These findings show that the ESCoT is a valuable measure of different aspects of social cognition and, unlike many established tests of social cognition, performance is not predicted by EF abilities.

The Lens Shapes the View: on Task Dependency in ToM Research

Purpose of Review

This article provides an overview of current findings on Theory of Mind (ToM) in human children and adults and highlights the relationship between task specifications and their outcome in socio-cognitive research.

Recent Findings

ToM, the capacity to reason about and infer others’ mental states, develops progressively throughout childhood—the exact time course is still a matter of debate. Neuroimaging studies indicate the involvement of a widespread neuronal network during mentalizing, suggesting that ToM is a multifaceted process. Accordingly, the tasks and trainings that currently exist to investigate and enhance ToM are heterogeneous, and the outcomes largely depend on the paradigm that was used.

Summary

We argue for the implementation of multiple-task batteries in the assessment of socio-cognitive abilities. Decisions for a particular paradigm need to be carefully considered and justified. We want to emphasize the importance of targeted research on the relationship between task specifications and outcomes.

Social cognition in adults with autism spectrum disorders: Validation of the Edinburgh Social Cognition Test (ESCoT)

OBJECTIVE

Many existing tests of social cognition are not appropriate for clinical use, due to their length, complexity or uncertainty in what they are assessing. The Edinburgh Social Cognition Test (ESCoT) is a new test of social cognition that assesses affective and cognitive Theory of Mind as well as inter- and intrapersonal understanding of social norms using animated interactions.

METHOD

To support the development of the ESCoT as a clinical tool, we derived cut-off scores from a neurotypical population (n = 236) and sought to validate the ESCoT in a sample of Autism Spectrum Disorder (ASD; n = 19) adults and neurotypical controls (NC; n = 38) matched on age and education. The ESCoT was administered alongside established tests and questionnaire measures of ASD, empathy, systemizing traits and intelligence.

RESULTS

Performance on the subtests of the ESCoT and ESCoT total scores correlated with performance on traditional tests, demonstrating convergent validity. ASD adults performed poorer on all measures of social cognition. Unlike the ESCoT, performance on the established tests was predicted by verbal comprehension abilities. Using a ROC curve analysis, we showed that the ESCoT was more effective than existing tests at differentiating ASD adults from NC. Furthermore, a total of 42.11% of ASD adults were impaired on the ESCoT compared to 0% of NC adults.

CONCLUSIONS

Overall these results demonstrate that the ESCoT is a useful test for clinical assessment and can aid in the detection of potential difficulties in ToM and social norm understanding.

Theory of mind performance in younger and older adults with elevated autistic traits

Little is known about the impact of aging with Autism Spectrum Disorder on theory of mind (ToM). While ToM difficulties appear to abate with age in older autistic populations, this has yet to be explored in the Broad Autism Phenotype (BAP). The current study examined ToM performance among younger (n = 49, aged 18-46) and older adults (n = 47, aged 60-91) who were classified as on the BAP (younger n = 18; older n = 21) or not (younger n = 31; older n = 26) using the BAP Questionnaire. ToM was assessed using the ecologically valid Strange Stories Film Task (SSFT) and the dynamic Happé-Frith Triangle Animations task (TA). A 2 × 2 analysis of variance examined the effects of autistic traits (BAP vs. non-BAP) and age (young vs. old). For both SSFT and TA, results showed autistic trait main effects on task performance (non-BAP > BAP). Age main effects were observed for some but not all metrics on TA (younger better than older), with no differences in SSFT. An interaction of autistic traits and age was observed in TA Intentionality, with younger non-BAP and younger BAP performing similarly but older non-BAP performing better than older BAP. Results show that younger and older adults with elevated autistic traits show poorer ToM performance. Despite ToM difficulties being common in later life in the general population, this effect was not observed when using a ToM task designed to reflect real-world scenarios. However, results suggest that autistic traits and age could interact to increase risk for poor ToM performance in older adults who endorse elevated autistic traits. Autism Res 2020, 13: 751-762. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The behaviors and characteristics commonly found in autism spectrum disorders have been linked to differences in understanding social situations. Similar difficulties have also been found in older age. We assessed social understanding in younger and older adults from the general population. Both younger and older adults who report more autism-like characteristics experience more difficulties with social understanding. However, few differences were found between younger and older adults.

Psychological and Cognitive Markers of Behavioral Variant Frontotemporal Dementia-A Clinical Neuropsychologist's View on Diagnostic Criteria and Beyond

Behavioral variant frontotemporal dementia (bvFTD) is the second leading cognitive disorder caused by neurodegeneration in patients under 65 years of age. Characterized by frontal, insular, and/or temporal brain atrophy, patients present with heterogeneous constellations of behavioral and psychological symptoms among which progressive changes in social conduct, lack of empathy, apathy, disinhibited behaviors, and cognitive impairments are frequently observed. Since the histopathology of the disease is heterogeneous and identified genetic mutations only account for ~30% of cases, there are no reliable biomarkers for the diagnosis of bvFTD available in clinical routine as yet. Early detection of bvFTD thus relies on correct application of clinical diagnostic criteria. Their evaluation however, requires expertise and in-depth assessments of cognitive functions, history taking, clinical observations as well as caregiver reports on behavioral and psychological symptoms and their respective changes. With this review, we aim for a critical appraisal of common methods to access the behavioral and psychological symptoms as well as the cognitive alterations presented in the diagnostic criteria for bvFTD. We highlight both, practical difficulties as well as current controversies regarding an overlap of symptoms and particularly cognitive impairments with other neurodegenerative and primary psychiatric diseases. We then review more recent developments and evidence on cognitive, behavioral and psychological symptoms of bvFTD beyond the diagnostic criteria which may prospectively enhance the early detection and differential diagnosis in clinical routine. In particular, evidence on specific impairments in social and emotional processing, praxis abilities as well as interoceptive processing in bvFTD is summarized and potential links with behavior and classic cognitive domains are discussed. We finally outline both, future opportunities and major challenges with regard to the role of clinical neuropsychology in detecting bvFTD and related neurocognitive disorders.

Impact of Aging on Empathy: Review of Psychological and Neural Mechanisms

Empathy in aging is a key capacity because it affects the quality of older adults' relationships and reduced levels are associated with greater loneliness. Many older adults also find themselves in the role of a caregiver to a loved one, and thus empathy is critical for the success of the caregiver-patient relationship. Furthermore, older adults are motivated to make strong emotional connections with others, as highlighted in the socioemotional selectivity theory. Consequently, reductions in empathy could negatively impact their goals. However, there is growing evidence that older adults experience at least some changes in empathy, depending on the domain. Specifically, the state of the research is that older adults have lower cognitive empathy (i.e., the ability to understand others' thoughts and feelings) than younger adults, but similar and in some cases even higher levels of emotional empathy (i.e., the ability to feel emotions that are similar to others' or feel compassion for them). A small number of studies have examined the neural mechanisms for age-related differences in empathy and have found reduced activity in a key brain area associated with cognitive empathy. However, more research is needed to further characterize how brain changes impact empathy with age, especially in the emotional domain of empathy. In this review, we discuss the current state of the research on age-related differences in the psychological and neural bases of empathy, with a specific comparison of the cognitive versus emotional components. Finally, we highlight new directions for research in this area and examine the implications of age-related differences in empathy for older adults.