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  • Review Article
  • Published:

Clinical assessment of social cognitive function in neurological disorders

Nature Reviews Neurology volume 12, pages 28–39 (2016)Cite this article

Subjects

Key Points

  • Social cognitive deficits are prominent in many conditions and are critical predictors of functional outcomes because they affect the ability to form and sustain interpersonal relationships

  • Assessments of social cognitive impairments typically focus on theory of mind, affective empathy, social perception and social behaviour, four domains that all influence the management of a patient

  • Many social cognitive assessment measures that are appropriate for clinical use are now available and should form part of a broader neurocognitive battery

  • Common disorders that manifest with prominent social cognitive deficits include schizophrenia, autism spectrum disorders, Alzheimer disease, and behavioural-variant frontotemporal dementia

  • A range of effective treatment strategies are currently available, so the nature, magnitude and specificity of social cognitive impairments each have important implications for therapeutic decision-making

Abstract

Social cognition broadly refers to the processing of social information in the brain that underlies abilities such as the detection of others' emotions and responding appropriately to these emotions. Social cognitive skills are critical for successful communication and, consequently, mental health and wellbeing. Disturbances of social cognition are early and salient features of many neuropsychiatric, neurodevelopmental and neurodegenerative disorders, and often occur after acute brain injury. Its assessment in the clinic is, therefore, of paramount importance. Indeed, the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduced social cognition as one of six core components of neurocognitive function, alongside memory and executive control. Failures of social cognition most often present as poor theory of mind, reduced affective empathy, impaired social perception or abnormal social behaviour. Standard neuropsychological assessments lack the precision and sensitivity needed to adequately inform treatment of these failures. In this Review, we present appropriate methods of assessment for each of the four domains, using an example disorder to illustrate the value of these approaches. We discuss the clinical applications of testing for social cognitive function, and finally suggest a five-step algorithm for the evaluation and treatment of impairments, providing quantitative evidence to guide the selection of social cognitive measures in clinical practice.

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Figure 1: Brain regions that are consistently involved in the four social cognition networks.
Figure 2: Algorithm for the evaluation and treatment of social cognitive impairments.

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Acknowledgements

J.D.H. was supported by two Discovery Project grants (DP1093234 and DP150100302) from the Australian Research Council. W.v.H. was supported by a Discovery Project grant (DP1093234) from the Australian Research Council. P.M. was supported by an ARC Discovery Early Career Research Award (DE130100120) and a Heart Foundation Future Leader Fellowship (1000458).

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Authors and Affiliations

  1. School of Psychology, University of Queensland, St Lucia, 4072, Queensland, Australia

    Julie D. Henry & William von Hippel

  2. School of Psychological Sciences and Monash Institute of Cognitive & Clinical Neurosciences, Monash University, Melbourne, 3800, Victoria, Australia

    Pascal Molenberghs

  3. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Prince of Wales Hospital, Randwick, 2031, New South Wales, Australia

    Teresa Lee & Perminder S. Sachdev

Authors
  1. Julie D. Henry
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  2. William von Hippel
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  3. Pascal Molenberghs
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  4. Teresa Lee
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  5. Perminder S. Sachdev
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Contributions

J.D.H. researched data for the article and wrote the article. J.D.H., W.v.H., P.M. and P.S.S. made substantial contributions to discussion of the content. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Julie D. Henry.

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Supplementary information

Supplementary Table 1

Reliability, clinical validity and norms for theory of mind measures (DOCX 32 kb)

Supplementary Table 2

Reliability, clinical validity and norms for measures of affective empathy (DOCX 32 kb)

Supplementary Table 3

Reliability, clinical validity and norms for social perception measures (DOCX 34 kb)

Supplementary Table 4

Reliability, clinical validity and norms for measures of social behaviour (DOCX 27 kb)

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Henry, J., von Hippel, W., Molenberghs, P. et al. Clinical assessment of social cognitive function in neurological disorders. Nat Rev Neurol 12, 28–39 (2016). https://doi.org/10.1038/nrneurol.2015.229

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