Zeitschrift für
Epileptologie
Original Contribution
Z. Epileptol.
https://doi.org/10.1007/s10309-019-0260-z
© Springer Medizin Verlag GmbH, ein Teil von
Springer Nature 2019
Julia Bauer · Lorena C. Kegel · Bettina K. Steiger · Hennric Jokeit
Swiss Epilepsy Centre, Zurich, Switzerland
Assessment tools for social
cognition in epilepsy
Social cognition describes the processing
of social information relevant to under-
standing and interpreting the intentions,
dispositions, and behavior of those one is
interacting with and adapting one’s own
behavior to them [1]. Tus, socio-cog-
nitive deficits may hinder smooth so-
cial interactions and consequently inter-
fere with social integration and reduce
quality of life [2]. Increasing evidence
suggests that socio-cognitive abilities are
impaired in people with focal and id-
iopathic epilepsies [3]. Socio-cognitive
functions are typically assessed on the
basis of emotion recognition (ER) and
theory of mind (ToM). Emotion recog-
nition describes the ability to recognize
and label emotions typically from facial
and verbal expressions, but also in mu-
sic [4], whereas ToM is the ability to
represent and infer one’s own and oth-
ers’ mental states such as beliefs, desires,
and intentions [1].
Te most common approach to test ER
is to present photographs of static facial
expressions and request the participant
to name the emotion shown. However,
tasks with static photographs are artifi-
cial, since they do not correspond with
visual–spatial and temporal information
in faces processed during everyday so-
cial interactions [5]. Furthermore, such
tasks do not reflect the multimodality of
information processing one experiences
in everyday life [6].
Teory of mind functions are com-
monly examined with text-based tasks
such as the Faux Pas Test [7], in which
the participant has to infer the mental
state of others by reading a short story
about a social situation (for details, see
section on Faux Pas Test). Te gener-
alizability of such tests is questionable,
as short stories lack the wealth of social
situations in which contextual informa-
tion may help or interfere with drawing
conclusions about other people’s state of
mind [8].
In light of this discrepancy with every-
day life, socio-cognitive deficits of people
with epilepsy, as they have generally been
assessed to date, may be over- or under-
estimated. Tis highlights the need for
a new approach that uses multimodal
tasks based on dynamic and highly eco-
logical stimulus material [9]. For this
reason, we developed a novel test bat-
tery that aims at a comprehensive and
detailed understanding of social cogni-
tion: the NEmo (Networks of Emotion
Processing) test battery.
NEmo test battery
Te NEmo test battery consists of five
new computer-based, standardized tasks
and two established tasks. Each task
can be used independently of the oth-
ers. Te tasks were developed to cover
a broad spectrum of socio-cognitive
sub-processes and contain validated
open source stimulus material with
European-looking adults. Te tasks pre-
dominantly rely on dynamic stimulus
material. One task, however, includes
static stimuli to provide a better link
to existing research and to ensure that
those individuals with reduced atten-
tional resources or low processing speed
can be assessed. Te NEmo test battery
is recommended for German-speaking
adults aged 18–65 years with an IQ above
75. Te complete test battery can be per-
formed in approximately 3h. Te time
required for each individual task ranges
between 5 and 40min. More detailed
information on the NEmo test battery is
presented here. For an overview of the
features of the test battery, see . Table 1.
Static facial emotion recognition
Te Static Facial Emotion Recognition
Task is used to assess ER in static facial
expressions. In this task, participants
are required to identify an emotion from
portrait photographs by choosing one of
the emotion labels listed underneath the
photograph. Te photographs and the
response options are presented simulta-
neously without time restriction. An-
swers and reaction times of every trial
are recorded. Te photographs, from
the Radboud Face Database [10], con-
tain gray-scale photographs of female and
male faces displaying the six basic emo-
tions of fear, anger, disgust, surprise, sad-
ness, and joy [11] as well as neutral facial
expressions. For each expression, the task
contains eight photographs of faces, out
of which four are with direct gaze and
four with 45° averted gaze (two to the
lef, two to the right).
Dynamic facial emotion
recognition
Te Dynamic Facial Emotion Recog-
nition Task is used to examine the
recognition of emotions in briefly pre-
sented dynamic facial expressions. Afer
the brief video presentation, participants
must choose the corresponding emotion
out of a list of the six basic emotions as
quickly as possible. Answers and reac-
tion times are recorded for each trial.
Te stimulus material, from the STOIC
Dynamic Facial Emotional Expressions
Database [12], consists of short videos
of gray-scale faces that depict dynamic
expressions of the six basic emotions.
Zeitschrift für Epileptologie