social cognition in dementia: informing diagnosis ... · • aspects of social cognition are one of...

fiona.kumfor@sydney.edu.au

Social Cognition in Dementia:

Informing Diagnosis, Prognosis

and Management

Dr Fiona Kumfor

University of Sydney

fiona.kumfor@sydney.edu.au

CHANGES IN DEMENTIA

Social cognition

Language

Memory

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ELEMENTS OF SOCIAL COGNITION

Face processingEmotion

perceptionEmpathy

Theory of Mind

(Understanding others)

fiona.kumfor@sydney.edu.au

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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Ehninger, Matnyia & Silva (2005)

HOW DO WE ASSESS SOCIAL COGNITION

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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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TASIT-S

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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

fiona.kumfor@sydney.edu.au

• 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?

fiona.kumfor@sydney.edu.au

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

fiona.kumfor@sydney.edu.au

• 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?

fiona.kumfor@sydney.edu.au

INCREASING SALIENCE

IMPROVING EMOTION RECOGNITION

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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