Social Cognition in Dementia:
Informing Diagnosis, Prognosis
and Management
Dr Fiona Kumfor
University of Sydney
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CHANGES IN DEMENTIA
Memory
Language
Social
cognition
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ELEMENTS OF SOCIAL COGNITION
Face processing
Emotion
perception
Theory of Mind
Empathy
(Understanding
others)
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SOCIAL DYSFUNCTION
Foster appropriate
responses
Establish relationships
Carer burden
Social cognition
Recognise intentions of
others
Develop emotional
reciprocity
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DEMENTIA SYNDROMES
Memory
disturbance
Behavioural-variant
frontotemporal
dementia (bvFTD)
Alzheimer’s disease (AD)
Executive
dysfunction
Ehninger, Matnyia & Silva (2005)
• Executive dysfunction
• Change in personality and
behaviour
• Marked frontal lobe atrophy
• Memory disturbance
•  orientation, visuospatial
• Medial temporal lobe atrophy
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SOCIAL/BEHAVIOURAL CHANGES
•
In frontotemporal dementia changes in social cognition are profound
– Apathy/ loss of motivation
– Loss of empathy
– Inappropriate behavior in social situations
– Reduced engagement in social settings
– Altered personality
•
In Alzheimer’s disease changes in emotion and behaviour are mild
– Difficulty recognising friends/family
– Agitation
– Apathy
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SOCIAL COGNITION IN DEMENTIA
• Brain regions involved in social cognition affected to
different degrees in bvFTD and AD
Motivation
Memory
Emotion
Behavioural
regulation
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HOW DO WE ASSESS SOCIAL COGNITION
Ehninger, Matnyia & Silva (2005)
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WHY IS SOCIAL COGNITION IMPORTANT?
Diagnosis
• Is this dementia?
• Differentiating between dementia types
(frontotemporal dementia vs. Alzheimer’s)
Prognosis
• Tracking how the disease progresses
• Understanding how and which symptoms
change over time
Management
• How can we improve patient quality of life?
• How can we reduce carer burden?
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TASIT-S
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DIAGNOSIS OF FTD
• bvFTD impaired on sarcasm detection
• AD perform within normal limits
Ehninger, Matnyia & Silva (2005)
Kumfor et al, (under review) Cortex
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WHY IS SOCIAL COGNITION IMPORTANT?
Diagnosis
• Is this dementia?
• Differentiating between dementia types
(frontotemporal dementia vs. Alzheimer’s)
Prognosis
• Tracking how the disease progresses
• Understanding how and which symptoms
change over time
Management
• How can we improve patient quality of life?
• How can we reduce carer burden?
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UNDERSTANDING PROGNOSIS
Sarcasm – TASIT B
Cognition – ACE-R
100
100
90
90
Sarcasm detection is
affected early in
bvFTD and continues
to decline
80
%
80
%
General cognition
ability is similar in
bvFTD and AD
Sarcasm - Tasit B
Cognition - ACE-R
70
70
60
60
50
50
40
bvFTD-uncertain
bvFTD-certain
AD
0
200
400
600
800
40
0
200
400
600
800
Days
Kumfor et al, (2014) JNNP
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WHY IS SOCIAL COGNITION IMPORTANT?
Diagnosis
• Is this dementia?
• Differentiating between dementia types
(frontotemporal dementia vs. Alzheimer’s)
Prognosis
• Tracking how the disease progresses
• Understanding how and which symptoms
change over time
Management
• How can we improve patient quality of life?
• How can we reduce carer burden?
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IMPROVING EMOTION RECOGNITION
INCREASING SALIENCE
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IMPROVING EMOTION RECOGNITION
Anger
*
*
Percent Correct
100
80
60
40
20
+15%
+30%
+50%
+75%
healthy controls
behavioural-variant
semantic dementia
progressive nonfluent
aphasia
• Emotion recognition impaired in bvFTD and SD
• Increasing salience improves performance in bvFTD but not SD
Kumfor et al (2011) Social Neuroscience; Kumfor et al (2013) PLOS One
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SUMMARY OF FINDINGS
Frontotemporal dementia
• Aspects of social cognition
are one of the primary and
earliest symptoms
• With disease progression,
these skills continue to
decline
• Interventions need to
target social cognition
• Carer burden is high
Alzheimer’s disease
• Typically, early symptoms
are dominated by memory
impairment
• Despite general cognitive
decline, social skills can
remain relatively intact
• May be able to harness
these skills to improve
quality of life
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TAKE HOME MESSAGES
• Important to be aware of noncognitive symptoms of dementia
• Helpful to assess social cognition
in dementia
• These symptoms are due to brain
changes
• Need to develop ways to improve
social interactions
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ACKNOWLEDGEMENTS
Patients & families
FRONTIER group
A/Prof Olivier Piguet
Prof John R. Hodges
Dr Agustin Ibanez (INECO)
Rosi Hutchings
Jess Hazelton
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