A Comprehensive Assessment of Poststroke Social Cognitive Function

Objective: Stroke-related social cognitive impairment is now well established, but studies vary considerably in the nature and magnitude of the deficits reported, as well as whether there are potential areas of preservation. Because these discrepancies may reflect clinical heterogeneity between the contributing research participants, this study provides the first concurrent assessment of all four core social cognitive domains (theory of mind, emotion perception, social behavior, and affective empathy) in the same stroke cohort. A secondary goal was to test whether the degree of social cognitive impairment varied as a function of the tasks' ecological validity, on the basis that tasks with greater realism may provide a better indication of the implications of any stroke-related difficulties for everyday social interactions. Method: Participants included 35 people with first-time, ischemic or hemorrhagic stroke (as confirmed via MRI or CT) aged between 29 and 87 years (M = 64.69; SD = 12.92), and 35 controls matched for age, sex, and years of education. All participants completed a comprehensive social cognitive test battery as well as measures to broadly characterize neurocognitive function and well-being. Results: Relative to controls, affective empathy was selectively preserved (d = 0.02), but stroke-related deficits were identified for theory of mind (d = -0.42), emotion perception (d = -0.48), and social behavior (d = -0.59). The degree of social cognitive impairment did not vary as a function of the tasks' ecological validity. Conclusions: These data enhance understanding of stroke-related social cognitive impairment and inform the development of tailored, evidence-based rehabilitation efforts. Key Points Question: The primary aim of the present study was to investigate the sensitivity of four core domains of social cognitive function (theory of mind, emotion perception, social behavior, and affective empathy) to stroke. Findings: People with stroke exhibited significant difficulties with theory of mind, emotion perception, and social behavior but the capacity for affective empathy was intact. Importance: Given the critical role that social cognitive function plays in social functioning and broader well-being, these results reinforce the importance of assessing social cognition in survivors of stroke to guide rehabilitative efforts. Next Steps: Future work should examine the nature and real-world implications of social behavioral impairment in stroke s