social cognition in dementia: informing diagnosis ... fiona kumfor.pdf• aspects of social...
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Social Cognition in Dementia:
Informing Diagnosis, Prognosis
and Management
Dr Fiona Kumfor
University of Sydney
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ELEMENTS OF SOCIAL COGNITION
Face processingEmotion
perceptionEmpathy
Theory of Mind
(Understanding others)
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Social cognition
Recognise intentions of others
Foster appropriate responses
Establish relationships
Develop emotional reciprocity
SOCIAL DYSFUNCTION
Carer burden
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Ehninger, Matnyia & Silva (2005)
Behavioural-variant frontotemporal
dementia (bvFTD)
• Executive dysfunction
• Change in personality and
behaviour
• Marked frontal lobe atrophy
Alzheimer’s disease (AD)
• Memory disturbance
• orientation, visuospatial
• Medial temporal lobe atrophy
Executive dysfunction
Memorydisturbance
DEMENTIA SYNDROMES
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SOCIAL/BEHAVIOURAL CHANGES
• In frontotemporal dementia changes in social cognition are profound
– Apathy/ loss of motivation
– Loss of empathy
– Inappropriate behavior in social situations
– Reduced engagement in social settings
– Altered personality
• In Alzheimer’s disease changes in emotion and behaviour are mild
– Difficulty recognising friends/family
– Agitation
– Apathy
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Motivation
Emotion
Behavioural regulation
Memory
• Brain regions involved in social cognition affected to different degrees in bvFTD and AD
SOCIAL COGNITION IN DEMENTIA
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• Is this dementia?
• Differentiating between dementia types (frontotemporal dementia vs. Alzheimer’s)
Diagnosis
• Tracking how the disease progresses
• Understanding how and which symptoms change over time
Prognosis
• How can we improve patient quality of life?
• How can we reduce carer burden?Management
WHY IS SOCIAL COGNITION IMPORTANT?
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Ehninger, Matnyia & Silva (2005)
• bvFTD impaired on sarcasm detection
• AD perform within normal limits
DIAGNOSIS OF FTD
Kumfor et al, (under review) Cortex
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• Is this dementia?
• Differentiating between dementia types (frontotemporal dementia vs. Alzheimer’s)
Diagnosis
• Tracking how the disease progresses
• Understanding how and which symptoms change over time
Prognosis
• How can we improve patient quality of life?
• How can we reduce carer burden?Management
WHY IS SOCIAL COGNITION IMPORTANT?
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Sarcasm – TASIT BCognition – ACE-R
General cognition ability is similar in bvFTD and AD
Sarcasm detection is affected early in bvFTD and continues to decline
UNDERSTANDING PROGNOSIS
Cognition - ACE-R
%
0 200 400 600 80040
50
60
70
80
90
100
Sarcasm - Tasit B
0 200 400 600 80040
50
60
70
80
90
100
Days
%
bvFTD-certain
AD
bvFTD-uncertain
Kumfor et al, (2014) JNNP
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• Is this dementia?
• Differentiating between dementia types (frontotemporal dementia vs. Alzheimer’s)
Diagnosis
• Tracking how the disease progresses
• Understanding how and which symptoms change over time
Prognosis
• How can we improve patient quality of life?
• How can we reduce carer burden?Management
WHY IS SOCIAL COGNITION IMPORTANT?
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*
*
Kumfor et al (2011) Social Neuroscience; Kumfor et al (2013) PLOS One
• Emotion recognition impaired in bvFTD and SD• Increasing salience improves performance in bvFTD but not SD
behavioural-variant
semantic dementiaprogressive nonfluent
aphasia
healthy controls
Anger
+15% +30% +50% +75%20
40
60
80
100
Pe
rce
nt C
orr
ect
IMPROVING EMOTION RECOGNITION
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Frontotemporal dementia
• Aspects of social cognition are one of the primary and earliest symptoms
• With disease progression, these skills continue to decline
• Interventions need to target social cognition
• Carer burden is high
Alzheimer’s disease
• Typically, early symptoms are dominated by memory impairment
• Despite general cognitive decline, social skills can remain relatively intact
• May be able to harness these skills to improve quality of life
SUMMARY OF FINDINGS
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• Important to be aware of non-cognitive symptoms of dementia
• Helpful to assess social cognition in dementia
• These symptoms are due to brain changes
• Need to develop ways to improve social interactions
TAKE HOME MESSAGES
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Patients & families
FRONTIER group
A/Prof Olivier Piguet
Prof John R. Hodges
Dr Agustin Ibanez (INECO)
Rosi Hutchings
Jess Hazelton
ACKNOWLEDGEMENTS