Humans are inherently social creatures. Social behav-
iours emerge in the early stages of infancy
1
and remain
critical throughout the lifespan
2,3
. Much of our everyday
behaviour is motivated by social and emotional goals;
indeed, the disproportionately large size of the human
brain might be the result of evolutionary pressures to
negotiate complex social systems
4
. For this reason, social
cognition — the means by which we perceive, process
and interpret social information — is a fundamental
neurocognitive capacity. A critical role for social cog-
nition in functional disability is now well established:
social cognitive impairment has been linked to poor
quality of life, mental health problems, unemployment
and loneliness
5–7
.
Nearly all neurological disorders that affect the
brain have the potential to disrupt social cognitive
function. Social cognitive impairment can be a prom-
inent clinical symptom after acute brain damage, such
as traumatic brain injury or stroke, and can be a core
feature of the early stages of some chronic neurological
disorders, such as behavioural-variant frontotemporal
dementia (bvFTD)
8
. However, in the early stages of
many neurological disorders, such as Alzheimer disease
(AD), Parkinson disease and multiple sclerosis, social
cognitive disturbances might be relatively subtle and
harder to detect informally. Structured social cogni-
tive assessment is, therefore, useful in a wide range of
neurological conditions. In patients with acute brain
trauma, or if a patient’s history or diagnosis could indi-
cate social cognitive dysfunction, social cognitive assess-
ment should be part of the initial standard neurological
examination. Even if no impairment is identified, such
assessment should be included in routine follow-up in
neurological disorders that are associated with social
cognitive impairment.
Failures of social cognition most often present clin-
ically in one or more of four ways: impaired theory of
mind (ToM), reduced emotional empathy, poor social
perception, and abnormal social behaviour. ToM refers
to our ability to understand the mental states of others,
and to appreciate that these mental states might differ
from our own. Affective ToM requires an understand-
ing of others’ emotions, affective states or feelings (and
overlaps with the construct of cognitive empathy),
1
School of Psychology,
University of Queensland,
St Lucia, Queensland 4072,
Australia.
2
School of Psychological
Sciences and Monash
Institute of Cognitive
& Clinical Neurosciences,
Monash University,
Melbourne, Victoria 3800,
Australia.
3
Centre for Healthy Brain
Ageing, School of Psychiatry,
University of New South
Wales, Prince of Wales
Hospital, Randwick, New
South Wales 2031, Australia.
Correspondence to J.D.H.
julie.henry@uq.edu.au
doi:10.1038/nrneurol.2015.229
Published online 16 Dec 2015
Clinical assessment of social cognitive
function in neurological disorders
Julie D. Henry
1
, William von Hippel
1
, Pascal Molenberghs
2
, Teresa Lee
3
and Perminder S. Sachdev
3
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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