Changes in Social Cognition in Dementia

Introduction

The prevalence of older adults with cognitive impairment is increasing globally, and this fact has been associated with rising healthcare costs and loss of independence (Prince et al., 2013; Jutkowitz et al., 2017). The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, APA, 2022) includes dementia syndromes belonging to the group of “Major Neurocognitive Disorders (MND)”. It considers that they can occur due to multiple etiologies. In this chapter, we will use the term “dementia” to refer to the group of neurodegenerative disorders that commonly affect older adults.

Dementia is a clinical syndrome characterized by an inexorably progressive deterioration in cognitive domains, associated with several impairments in capacity for independent living. Although young-onset cases are increasingly recognized, dementia typically affects older people (Sousa et al., 2010). Alzheimer’s Disease (AD), vascular disease (VD), Lewy Body Disease (DLB), and Frontotemporal Dementia (FTD) are the most prevalent dementia syndromes. The current classification criteria for the dementia subtypes considers which cognitive domains are impaired. Attention, executive functions, learning and memory, language, perceptual-motor abilities, and social cognition are considered by DSM-5-TR as the key domains that may be affected. However, although the pattern of cognitive disturbances helps define the etiological classification, declines in some of these domains can be shared by more than one type of dementia.

Social cognitive deficits were kept in DSM-5-TR as one of the core domains of impaired neurocognitive function (Sachdev et al., 2014). Although the early decline in social cognition is a core feature of FTD, changes in social conduct have been recognized as a significant cognitive and clinical marker for AD and LBD (Gregory et al., 2002; Cosentino et al., 2014; Henry et al., 2016). Considering that comprehending impaired cognitive domains in this population can help promote cognition rehabilitation and healthy aging, this chapter aims to discuss current scientific evidence on social cognition in the main subtypes of dementia. For this, initially, we will give a conceptual definition of social cognition and what science tells us about this cognitive domain in normal aging. Then, a more specific discussion of changes in social cognition in AD and FTD will be presented.