Alzheimer's disease disrupts a lot of social-cognitive skills—but empathy stays strong according to new research

Despite the decline in several social-cognitive skills, the ability to feel other people's emotions is preserved in advanced dementia. People with Alzheimer's may even feel more empathy than those with mild cognitive impairment.This is a surprising finding from a group of researchers in the United Kingdom who investigated the role of declining social cognition in the progression of dementia. Every year, 10% to 15% of people with mild cognitive impairment will develop Alzheimer's disease. Mild cognitive impairment (MCI) with amnesia is known to be more likely to lead to Alzheimer's disease, but it is not known whether other symptoms can predict disease progression.Social cognitionBased on a meta-analysis of 28 studies involving 2,400 participants with dementia or mild cognitive impairment, the researchers analyzed changes in three aspects of social cognition: emotion recognition, theory of mind (i.e., the ability to understand another's perspective) and emotional and cognitive empathy. When it came to emotion recognition, people with amnesic mild cognitive impairment performed better than those with dementia in identifying emotions on faces presented to them or from sound clips. The gap was even greater in individuals with frontotemporal degeneration (FTD), confirming that this neurodegenerative disease interferes more with social cognition. A decline in social cognition is considered one of the earliest clinical symptoms of this disease.As for theory of mind, once again, people with mild cognitive impairment fared better. They demonstrated a greater ability to understand the intentions, beliefs and behaviours of the characters in the scenarios presented to them, even if they differed from their own.Empathy preservedThe biggest surprise came when we assessed empathy. This time, it was people with Alzheimer's disease who showed the greatest ability to sense the emotions of others. Faced with different scenarios, they felt more compassion and concern for another person's distress, as well as discomfort when confronted with another person's negative emotions.The capacity for empathy would not only be preserved but potentially increased in later stages of dementia. “Higher emotional empathy reflects greater emotional reactivity and distress in the face of negative emotions, which may partly explain the emotional dysregulation seen in Alzheimer's disease,” argue the authors of the study, published in the journal Alzheimer's & Dementia.This serendipitous finding represents a potential window of opportunity, “to exploit these empathic skills in psychological support for people with Alzheimer's disease to help them build and maintain social bonds,” they add. The results also suggest a progressive decline in certain aspects of social cognition, including emotion recognition and theory of mind. Thus, social-cognitive deficits at an early stage of the disease would increase the risk of progressing to a more advanced form of dementia, compared with those whose social cognition remained stable. The decline would be even more abrupt in FTD.Longitudinal cohort studies will be needed, however, to confirm the predictive role of the observed differences in social cognition.

Alzheimer's disease disrupts a lot of social-cognitive skills—but empathy stays strong according to new research

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