Social Cognition in Community Dwelling Persons With Dementia; Is Facial Emotion Recognition Related to Proxy Rated Empathy and Aggression?

OBJECTIVES: Aggressive behaviour and decreased empathy occur in many dementia syndromes. This may be related to lowered overall cognitive functioning which is a common feature of dementia. However, to date, the role of social cognitive impairments such as facial emotion recognition (FER) deficits in dementias other than behavioural variant frontotemporal dementia (bvFTD) remains largely elusive. This study focusses on people who were recently diagnosed with dementia in the memory clinic of a regional hospital, excluding bvFTD. The first question was whether FER was impaired in this group. Next the relation between FER, cognitive functioning and proxy-rated levels of empathic and aggressive behaviour was examined. METHODS: 80 persons with non-bvFTD dementia were included. FER, overall cognitive functioning, mental speed and executive functioning (mental flexibility, working memory), were measured with respectively The Ekman 60 faces Test, the Mini Mental State Examination (MMSE), the Oral version of the Letter Digit Substitution Test, the Controlled Word Association Test, and the Digit Span test. Empathic and aggressive behaviour were measured using proxy ratings on the Empathic Concern scale of the Interpersonal Reactivity Index, and the Aggression Questionnaire, respectively. RESULTS: Persons with non-bvFTD dementia were significantly impaired in FER compared to healthy controls, but impaired FER was not significantly related to proxy ratings of aggressive or unempathic behaviour. Neither were cognitive impairments in mental speed and executive functions significantly related to these behaviours. However, we did find a significant association between lower MMSE-scores with higher proxy ratings of unempathic behaviour. CONCLUSIONS: Levels of emphatic behaviour in persons with non-bvFTD dementia as indicated by proxies might be primarily related to disease severity and not directly to impairments in FER as a measure of social cognition.