Social cognition is impaired years after stroke (Research Summary)

What do we already know?

Social Cognition = the capacity to process social information

• The ability to understand the behaviour of others and to react appropriately in social situations
• Impaired social cognition may be associated with decreased social participation and decreased quality of life

Social cognition is consists of four processes:

(1) Emotion recognition – i.e., identify and discriminate (tell the difference between) the emotional states of others

(2) Theory of Mind (ToM) – i.e., infer/predict the beliefs/intentions of others and understand that others have beliefs, intentions, and perspectives that are different from one’s own

(3) Empathy – i.e., recognize that other people’s emotions are linked to one’s own emotional experience

(4) Behaviour regulation & inhibition – i.e., monitoring, controlling, and inhibition of your behaviours, emotions, or thoughts in order to adapt to a situation

Past research on social cognition:

• People with damage to the right side of the brain tend to have greater impairments in social cognition
• Past research is limited: Used small sample sizes and only looked at social cognition right after stroke (not in the long-term)

What did they want to know?

Main research question: To what degree is social cognition impaired in stroke patients in the long-term?

Secondary research questions:

• How is social cognition related to general cognition?
• What factors predict social cognition performance?

What did they do?

Recruited 148 stroke patients from 6 hospitals in the Netherlands

• Mean age was 67.7 years
• Mean time since stroke was 3.7 years
• 81.7% had a minor stroke

Also recruited a similar-aged group of healthy people without stroke (compare stroke group to healthy control group to make comparisons)

Assessment 1 (4-days post-stroke): Demographic information, stroke-related factors (side of brain affected, severity of stroke)

Assessment 2 (3-4 years after stroke): Neuropsychological assessment

• General Cognition assessed with a series of cognitive tests
• Emotion Recognition assessed with the Ekman 60-Faces test
• Theory of Mind assessed with the Cartoon test
• Empathy assessed with the Faux Pas test and Balanced Emotional Empathy Scale
• Behaviour Regulation and Inhibition assessed with the Hayling Sentence Completion test

What did they find?

Social Cognition Impairments

• People with stroke had lower scores on tests of emotion recognition, Theory of Mind, and behaviour regulation & inhibition
• No difference between stroke group and healthy control group on empathy tests

Relationship Between Social Cognition and General Cognition

• Lower scores on social cognition tests were associated with lower scores on tests of visual perception and language

Influence of Demographic and Stroke-Related Factors on Social Cognition

• No differences in social cognition for left vs. right-sided brain injury
• Impairments in social cognition were more severe in people with less education and older age

What does this mean?

Overall, social cognition is impaired in the long-term after stroke

• Specifically, emotion recognition, Theory of Mind, and behaviour regulation & inhibition were impaired
• Participants in this study mostly had mild stroke and were assessed 3-4 years after their injury -individuals with more severe stroke or in the acute phase may have greater impairments in social cognition

Effect sizes in this study were small: This means the stroke group had slightly lower scores on the tests of social cognition compared to the healthy control group

• But, even small impairments in social cognition can have big impacts on day-to-day activities and social participation

Future research should explore…

• Whether empathy and other aspects of social cognition are affected in people with damage to the prefrontal cortex
• Whether factors like depression, pain, and fatigue influence social cognition

We know that many people with stroke continue to receive supports in the community once discharged from the hospital and may deal with persisting symptoms for years

• Community-based rehabilitation and supports should target social cognition and promote prosocial behaviour, communication skills, and social participation

Source:

Nijsse, B., Spikman, J. M., Visser-Meily, J. M., de Kort, P. L., & van Heugten, C. M. (2019). Social cognition impairments in the long term post stroke. Archives of Physical Medicine and Rehabilitation, 100(7), 1300-1307.

https://doi.org/10.1016/j.apmr.2019.01.023

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