Theory of mind and empathy in preclinical and clinical Huntington’s disease

Abstract

We investigated cognitive and affective Theory of Mind (ToM) and empathy in patients with premanifest and manifest Huntington's disease (HD). The relationship between ToM performance and executive skills was also examined. Sixteen preclinical and 23 clinical HD patients, and 39 healthy subjects divided into 2 control groups were given a French adaptation of the Yoni test (Shamay-Tsoory, S.G., Aharon-Peretz, J. (2007). Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study. Neuropsychologia, 45(3), 3054-67) that examines first- and second-order cognitive and affective ToM processing in separate conditions with a physical control condition. Participants were also given questionnaires of empathy and cognitive tests which mainly assessed executive functions (inhibition and mental flexibility). Clinical HD patients made significantly more errors than their controls in the first- and second-order cognitive and affective ToM conditions of the Yoni task, but exhibited no empathy deficits. However, there was no evidence that ToM impairment was related to cognitive deficits in these patients. Preclinical HD patients were unimpaired in ToM tasks and empathy measures compared with their controls. Our results are consistent with the idea that impaired affective and cognitive mentalizing emerges with the clinical manifestation of HD, but is not necessarily part of the preclinical stage. Furthermore, these impairments appear independent of executive dysfunction and empathy.

Huntington's Disease: Premotor Phase

“…Although the authors found significant differences in performance on almost all of the tests between manifest HD gene expansion carriers and healthy controls, no difference on any measure was found in premotor-HD patients relative to the healthy controls, suggesting that these are not early changes in the natural history of HD [38]. Similar studies corroborate these findings, stating that there are no differences between pre-HD patients and controls in terms of ToM [39] or emotion recognition [40]. …”

Through your eyes or mine? The neural correlates of mental state recognition in Huntington's disease

“…Premanifest patients can also exhibit deficits on social cognitive tasks, including those involving theory of mind: the ability to reason about mental states (Eddy and Rickards, ), which can be associated with functional capacity in terms of capability in areas of daily life including self‐care, employment, and so on (Eddy, Sira Mahalingappa, & Rickards, ; Ille et al, ). However, deficits in theory of mind have not been found in all previous studies of premanifest HD (Adjeroud et al, ), suggesting that certain tasks may be more sensitive to impairment or that selective aspects of social cognition may be compromised at an earlier stage. Impairments in reasoning about peoples’ mental states may contribute to interpersonal difficulties (Snowden et al, ) and aggressive or inflexible behavior in HD (Eddy, Parkinson, & Rickards, ).…”

<p>Neurocognitive mechanisms of theory of mind impairment in neurodegeneration: a transdiagnostic approach</p>

“…Taken together, these findings suggest that the pervasive ToM impairments in HD are largely attributable to executive dysfunction, and as such, domain-general in nature. One anomaly is the Judgment of Preference task, which does not correlate with executive function in HD 29,116. Performance on this measure is not consistently impaired in HD,29 suggesting that it may capture slightly different aspects of ToM vs other tasks.…”

“…Deficits in ToM have also been documented prior to motor symptom onset in premanifest HD (ie, individuals carrying the CAG-repeat expansion in the Huntingtin gene), specifically on tests of faux pas detection117 and mental state attribution (Frith–Happé task) 117. Other tasks, including Judgment of Preference116 and RMET,118 while intact at the whole-group level in premanifest HD, are positively associated with time to symptom onset, suggesting that alterations in ToM ability may be an early feature of the disease.…”