Summary
Purpose: Theory of mind (ToM) is an important prerequisite to social behavior. This study evaluated ToM in patients with temporal (TLE) or frontal lobe epilepsy (FLE) aiming to determine the cognitive aspects, severity, and pathophysiologic mechanisms of ToM impairment in focal epilepsy.
Methods: One hundred thirty‐eight patients with TLE (n = 109) or FLE (n = 29) and 69 healthy subjects underwent the Faux Pas task (FPT), which evaluates the recognition and comprehension of others’ mental states, and neuropsychological tests for other cognitive functions.
Key Findings: Factor analysis of all test scores yielded two ToM factors (Recognizing faux pas, FP; Excluding nonexistent FP) distinct from the Control, Language, Matching, and Praxis factors. With respect to healthy subjects, both TLE and FLE patients showed correct exclusion of nonexistent FPs but significantly lower recognition and comprehension of real FPs. FLE patients were also impaired with respect to TLE patients. In the whole patient group, schooling and group membership predicted ToM impairment. In FLE patients, the comprehension of mental states was predicted by disease duration, whereas TLE patients’ comprehension of affects and intentions was associated with early age of seizure onset and medial temporal lobe sclerosis (MTLS).
Significance: Focal epilepsy impairs advanced ToM abilities. FLE may affect online performances owing to long‐lasting dysfunctions of the prefrontal areas. MTLS may provoke selective ToM deficits due to medial temporal damage, prefrontal dysfunctions, or early interference with cognitive development. Future studies are needed to determine the implications of ToM impairment on behavior and quality of life.
The role of the phonological loop in auditory sentence comprehension was examined in a 35-year-old woman with a selective deficit of verbal short-term memory (STM). More specifically, the objective of the experiment was to test whether sentence comprehension is limited by number of propositions, as suggested by Rochon, Waters, and Caplan (2000), or whether it depends on syntactic complexity. In an offline task, severe impairment was present on cleft objects and centre-embedded structures; the deficit on object relatives in right peripheral position was less relevant, and the patient was able to handle sentential coordination easily. In an online task, her processing of centre-embedded structures and object relatives in right peripheral position was significantly slower than that in controls. She was also significantly slower in processing the verb of the object relative in centre-embedded structures. The results obtained do not support the claim that the difficulties encountered by patients with limited working-memory resources are due to the number of propositions in the sentence; they do, however, suggest a direct involvement of the phonological loop in processing syntactically complex sentences.
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