The Relationship Between Social Cognitive Processes and Behavior Changes in People With Amnestic Mild Cognitive Impairment or Dementia Using the Edinburgh Social Cognition Test (ESCoT)

Objective: People with amnestic mild cognitive impairment (aMCI) or dementia often exhibit a decline in their social abilities, but few tests of social cognition exist that are suitable for clinical use. Moreover, the relationship between changes in behavior and impairments in social cognition is poorly understood. We examined the utility of the Edinburgh Social Cognition Test (ESCoT) in people with aMCI/dementia and explored associations between social cognition performance and behavior changes. Method: We administered the ESCoT and two established social cognition tests (the Reading the Mind in the Eyes and the Social Norms Questionnaire) to 28 people with aMCI or dementia and 28 age and sex matched cognitively healthy controls. Behavior change was measured using a semistructured interview which assesses behavioral abnormalities found in frontotemporal dementia. Results: People with aMCI/dementia were impaired on the ESCoT affective theory of mind, ESCoT total score and the Reading the Mind in the Eyes. Behavior changes in the domains of apathy, loss of sympathy/empathy, perseveration, and psychotic symptoms were associated with poorer affective theory of mind scores. Disinhibition, loss of sympathy/empathy and hyperorality or altered food preferences were associated with cognitive theory of mind. All behaviors were significantly associated with poorer performance on ESCoT total score, but were not associated with performance on the Reading the Mind in the Eyes or the Social Norms Questionnaire. Conclusions: The ESCoT was sensitive to social cognition impairments in people with aMCI/dementia and it relates to behavior change in aMCI/dementia unlike established tests. Different subtests of the ESCoT were related to different behavior changes. These findings suggest that the ESCoT may be a clinically valuable tool when examining social cognition. Key Points Question: The aim of this study was to examine whether the Edinburgh Social Cognition Test (ESCoT) was sensitive to social cognitive impairments in people with amnestic mild cognitive impairment (aMCI) and a range of neurodegenerative dementias and to explore associations between social cognition performance and behavior changes. Findings: People with aMCI/dementia were impaired on the ESCoT and an established social cognition test, but only the ESCoT was sensitive to impairments in social abilities in people with aMCI/dementia with behavior change. Importance: The ESCoT is a valid measure of social cog