An Evaluation of Cross-Cultural Adaptations of Social Cognition Testing: A Systematic Review.

Social cognition remains one of the most difficult cognitive domains to assess in diverse populations due to a lack of culturally appropriate tools. This study systematically reviewed literature on neuropsychological tests for social cognition that have been translated, adapted, are cross-cultural, or are assembled for diverse, specifically "Global South," populations. The aim was to identify assessments appropriate for diverse populations, outline and evaluate their methodological approaches, and provide procedural recommendations for future research. The PRISMA systematic review search strategy produced 10,957 articles, of which 287 were selected for full-text screening. The study had to include a neuropsychological assessment of social cognition. The full text of the resulting 287 articles was then screened; the study had to include a translated, adapted, cross-cultural test, or an assembled test for Global South populations. Eighty-four articles were included in this study: 24 for emotion recognition, 45 for theory of mind, 9 for moral reasoning, and six for social cognition in general. Overall, there were 31 translations, 27 adaptations, 14 cross-cultural tests, and 12 assembled tests for Global South populations. Regarding quality, 35 were of low quality, 27 were of moderate quality, and 22 were high quality. This study provides an overview of social cognition tests modified or assembled for diverse populations and gives examples of methodological procedures. It highlights the variability in procedure quality and provides possible reasons for this variability. Finally, it suggests a need to report rigorous modification and assembly procedure in order to have modified and assembled social cognition tests appropriate for diverse populations.

Updating the cognitive model of humour perception: a potential implicit processing pathway?

ABSTRACTThe model of humour comprehension-elaboration postulates that the feeling of amusement follows serially upon humour comprehension. Yet, in clinical practice, patients with impaired humour comprehension may show typical happy facial expressions, suggesting a preservation of amusement feeling. The aim of the present study was to test the hypothesis of a potential implicit processing pathway to add to the explicit pathway described in the model. Twenty healthy participants and two patients with cerebral tumour (LM and JM) completed a task of humour judgment during which their face was filmed. Two independent blinded raters quantified the happy facial expressions produced. The accuracy scores for humour judgment reflected humour comprehension while the number of happy facial expressions assessed amusement feeling. Patients' results showed a case contrast. In accordance with the cognitive model of humour comprehension, JM's scores for humour comprehension were not statistically different from those of the control group; however, he presented impaired facial expressions. LM, on the contrary, showed typical happy facial expressions despite humour comprehension deficits. This profile suggests the existence of a potential implicit pathway to feelings of amusement. A revision of the cognitive model is proposed by adding a potential implicit processing pathway to the explicit one already described.

Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities-focused research.

Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.

Is music a memory booster in normal aging? The influence of emotion.

Age-related differences in episodic memory have been explained by a decrement in strategic encoding implementation. It has been shown in clinical populations that music can be used during the encoding stage as a mnemonic strategy to learn verbal information. The effectiveness of this strategy remains equivocal in older adults (OA). Furthermore, the impact of the emotional valence of the music used has never been investigated in this context. Thirty OA and 24 young adults (YA) learned texts that were either set to music that was positively or negatively valenced, or spoken only. Immediate and delayed recalls were measured. Results showed that: (i) OA perform worse than YA in immediate and delayed recall; (ii) sung lyrics are better remembered than spoken ones in OA, but only when the associated music is positively-valenced; (iii) this pattern is observed regardless the retention delay. These findings support the benefit of a musical encoding on verbal learning in healthy OA and are consistent with the positivity effect classically reported in normal aging. Added to the potential applications in daily life, the results are discussed with respect to the theoretical hypotheses of the mechanisms underlying the advantage of musical encoding.

Facial emotional congruence in healthy adults and patients suffering from a psychiatric or neurological disorder.

The production of facial emotions is an important conveyor of social communication. The present review of the literature concerns the congruence of facial emotions, that is the facial muscular activation that takes place in response to the emotional facial expression perceived in others. Although scientific interest in facial emotions has increased exponentially in the last few years, the production of facial emotions is still underexplored as compared to emotional perception. Several studies, mainly conducted with electromyography, have shown that facial emotional congruence exists in a robust way, largely for anger and happiness. While facial emotional congruence was long considered as innate and automatic, recent work has demonstrated that several sociocultural factors may influence or reduce this ability, challenging its automaticity. From a neuroanatomical point of view, studies have clearly highlighted the implication of mirror neurons but our knowledge is still limited because of the few methodologies assessing this system and the lack of homogeneity between the protocols used. Many explanatory, and probably not mutually exclusive, theories of emotional facial congruence have been put forward. In experimental neuropsychology, emotional facial congruence has seldom been investigated but the few available results suggest an impairment in psychiatric and neurological patients. In view of the important role of emotional facial productions in human relations and social interactions, new methods for easy clinical assessment need to be designed for the diagnosis and the cognitive care of these abilities. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Explicit and implicit abilities in humor processing in patients with relapsing-remitting multiple sclerosis.

Sociocognitive impairment is well known in the relapsing-remitting form of multiple sclerosis (RR-MS). The purpose of the present study was to assess explicit and implicit humor abilities in this population. Based on clinical observation and contrary to the current cognitive model, we hypothesized that implicit performances (happy facial expressions) would be better than explicit ones (humor judgment assessed by explicit humor comprehension, subjective feeling of amusement as a conscious appreciation of funniness, and verbal justifications of funniness). Twenty-five RR-MS patients and twenty-five healthy participants completed the tasks. Their face was filmed during humor ratings. Patients' results suggest that 32% of them showed an impairment in explicit humor comprehension, with normal facial expressions. Both groups found great difficulty in justifying the cause of their amusement. All these results may suggest the existence of a supplementary implicit pathway in humor processing. The preservation of this implicit pathway may be advantageous for future remediation. Contrary to the current model, we found that the subjective feeling of amusement was preserved when comprehension was impaired. Further studies will be needed to clarify this component, and adjust the theoretical modeling.

Multidimensional assessment of social cognition using non-immersive virtual reality in dementia with Lewy bodies and Alzheimer's disease: an exploratory study.

INTRODUCTION: Few studies have focused on social cognition in dementia with Lewy bodies (DLB), even though some brain structures being well known as underlying social cognitive processes are directly impacted in this disease. Furthermore, social cognition processes have been mostly studied independently using evaluations with poor ecological validity. We aimed at studying the ability of a new naturalistic and multidimensional social cognition task to reveal impairments in DLB patients. We chose to compare the profile of these patients with that of Alzheimer's disease (AD) patients, for which social cognition is better preserved. METHOD: Fifteen patients (DLB: n = 7; AD: n = 8) and 28 healthy controls underwent the REALSoCog task. They encountered several social situations (e.g. control versus transgressions) in a non-immersive virtual city environment allowing the assessment of moral cognition, cognitive and affective theory of mind (ToM), emotional empathy and behavioral intentions. RESULTS: The main results showed (i) a lower ability to detect transgressions in DLB patients, particularly conventional ones, whereas moral cognition seemed better preserved in AD patients; (ii) a cognitive ToM impairment in both DLB and AD patients, while affective ToM is impaired only in DLB patients; (iii) a decreased emotional empathy specifically observed in DLB patients; (iv) more inappropriate behavioral intentions, mainly in DLB patients, but also in some AD patients. CONCLUSIONS: This study suggests the feasibility and potential interest of the REALSoCog task in revealing social cognition deficits, particularly for DLB patients by showing different social patterns as compared to AD patients. These results offer interesting clinical perspectives to develop more naturalistic tasks in such populations and for clinical differential diagnosis. Limitations and future perspectives are discussed.

Determinants of cognitive dysfunction in adults with sickle cell related stroke or suspected neurological morbidity.

The prognosis of sickle cell disease (SCD) in adults is determined primarily by damage to targeted organs such as the brain. Cognitive dysfunction in SCD is a common chronic neurological mani-festation but studies remain mostly descriptive in adults. The objective of this study was to better characterize the cognitive profile and the association between cognitive dysfunction and brain lesions. We included adult SCD patients referred for a neurological assessment. An adapted bat-tery of neuropsychological tests was used to assess cognitive deficits. Brain (white matter lesions or infarcts) or arterial (stenosis or occlusion) abnormalities were assessed using brain MRI/MRA and a cervical and transcranial Doppler ultrasound. The battery was completed in 96 patients. The cognitive profile was characterized by deficits in processing speed (58% (95% CI [48-68])), short-term memory (34% (95% CI [24-43])) and working memory (24% (95% CI [15-33])). Brain in-farcts were found in 56% of patients and intracranial vasculopathy in 49%. Twenty percent of pa-tients had no brain abnormalities. Processing speed dysfunction was associated with territorial in-farcts (OR 3.1, p=0.03) and education outside of France (OR 4.7, p=0.02). Short-term memory dysfunction was associated with territorial infarcts (OR 3.4, p=0.01) and a low educational level (OR 8.2, p=0.01). Working memory dysfunction was associated with a low educational level (OR 4.3, p=0.05) and vasculopathy (OR 3.7, p=0.03). Cognitive dysfunction appears to be a hallmark sign of SCD, particularly for adults with sickle cell related stroke or suspected neurological mor-bidity. Assessment of such dysfunction could be used in longitudinal follow up and clinical trials.

Dynamic and/or multimodal assessments for social cognition in neuropsychology: results from a systematic literature review.

Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.

Using a Computer-Based Virtual Environment to Assess Social Cognition in Aging: An Exploratory Study of the REALSoCog Task.

Although previous studies have suggested that some component processes of social cognition decline in normal aging, several methodological limitations can be pointed out. Traditional sociocognitive tasks assess processes separately and lack ecological validity. In the present study, the main aim was to propose an integrative social cognition assessment in normal aging using an original computer-based task developed in non-immersive virtual reality. Forty-five young adults (YA) and 50 older adults (OA) were asked to navigate in a simulated city environment and to judge several situations that they encountered. These situations investigated social norms by displaying control or (conventional/moral) transgressions. Following each situation, the participants were asked several questions in order to assess their ability to make moral judgments, affective and cognitive theory of mind, emotional reactivity and empathy, and the propensity to act in a socially appropriate or inappropriate way. The main results showed (i) a preserved ability to detect moral and conventional transgressions with advancing age; (ii) participants' preserved cognitive ToM abilities; (iii) an age-related decline in affective ToM, that disappeared when the victim was a senior; (iv) preserved emotional reactivity and emotional empathy in normal aging; (v) an increase in inappropriate behavioral intentions in normal aging. Offering more naturalistic conditions, this new task is an interesting integrative measure of sociocognitive functioning to better reflect social behavior in daily living.

Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN).

Over the past decades European societies have become increasingly diverse. This diversity in culture, education, and language significantly impacts neuropsychological assessment. Although several initiatives are under way to overcome these barriers - e.g. newly developed and validated test batteries - there is a need for more collaboration in the development and implementation of neuropsychological tests, such as in the domains of social cognition and language.To address these gaps in cross-cultural neuropsychological assessment in Europe, the European Consortium on Cross-Cultural Neuropsychology (ECCroN) was established in 2019.ECCroN recommends taking a broad range of variables into account, such as linguistic factors, literacy, education, migration history, acculturation and other cultural factors. We advocate against race-based norms as a solution to the challenging interpretation of group differences on neuropsychological tests, and instead support the development, validation, and standardization of more widely applicable/cross-culturally applicable tests that take into account interindividual variability. Last, ECCroN advocates for an improvement in the clinical training of neuropsychologists in culturally sensitive neuropsychological assessment, and the development and implementation of guidelines for interpreter-mediated neuropsychological assessment in diverse populations in Europe.ECCroN may impact research and clinical practice by contributing to existing theoretical frameworks and by improving the assessment of diverse individuals across Europe through collaborations on test development, collection of normative data, cross-cultural clinical training, and interpreter-mediated assessment.

[Processing facial identity and emotional expression in normal aging and neurodegenerative diseases]. / La reconnaissance des visages et de leurs expressions faciales au cours du vieillissement normal et dans les pathologies neurodégénératives.

The ability to recognize facial identity and emotional facial expression is central to social relationships. This paper reviews studies concerning face recognition and emotional facial expression during normal aging as well as in neurodegenerative diseases occurring in the elderly. It focuses on Alzheimer's disease, frontotemporal and semantic dementia, and also Parkinson's disease. The results of studies on healthy elderly individuals show subtle alterations in the recognition of facial identity and emotional facial expression from the age of 50 years, and increasing after 70. Studies in neurodegenerative diseases show that - during their initial stages - face recognition and facial expression can be specifically affected. Little has been done to assess these difficulties in clinical practice. They could constitute a useful marker for differential diagnosis, especially for the clinical differentiation of Alzheimer's disease (AD) from frontotemporal dementia (FTD). Social difficulties and some behavioural problems observed in these patients may, at least partly, result from these deficits in face processing. Thus, it is important to specify the possible underlying anatomofunctional substrates of these deficits as well as to plan suitable remediation programs.

Music as a mnemonic strategy to mitigate verbal episodic memory in Alzheimer's disease: Does musical valence matter?

Introduction: Music is increasingly used to improve cognition in clinical settings. However, it remains unclear whether its use as a mnemonic strategy is effective in Alzheimer's disease (AD). The present study aimed at determining whether a musical mnemonic might mitigate patients' learning of new verbal information and at exploring the effect of factors such as retention delay and emotional valence of the musical excerpt used. Method: 13 patients with AD and 26 healthy comparisons (HC) with a low musical expertise were included. They learned texts about everyday life themes that were either set to familiar instrumental music, which was positively- or negatively-valenced, or spoken only. Immediate and delayed recalls (after 10 min and 24 hours) were measured. Results: Main results showed that (i) HC demonstrated better verbal episodic memory performance than participants with AD; (ii) participants with AD encoded texts paired with positively-valenced music better than texts paired with negatively-valenced music; (iii) participants with AD recalled sung texts better than spoken texts (after 10 min and 24 hours), regardless of musical valence while HC displayed better recall for texts paired with positively-valenced music. Conclusions: Musical mnemonics may help people with AD learn verbal information that relates to their daily life, regardless the musical expertise of the patients. This result gives promising clinical insights showing that music processing is robust to brain damage in AD. Possible hypotheses explaining the effectiveness of musical mnemonics in AD regardless the musical valence are discussed (e.g., different processing between musical and spoken conditions; disappearance of the positivity bias and implications with respect to the underlying socio-emotional selectivity theory).

How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases?

Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer's disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.

Burnout in nursing staff caring for patients with dementia: role of empathy and impact of empathy-based training program.

OBJECTIVES: Although relationships between empathy and burnout have been reported, it remains unclear whether empathy should be considered as a predictive or a protective factor. A multidimensional approach towards empathy was selected to determine whether cognitive and emotional aspects might differently contribute to the burnout (first study). In a second study, we aimed at investigating the effect of empathy-based training program on empathic skills and burnout. METHODS: The first survey was conducted among 124 nursing staff from 10 geriatric residential facilities. They filled out (i) the Maslach burnout inventory (assessing emotional exhaustion, depersonalization and personal accomplishment); (ii) two empathy questionnaires assessing both cognitive (perspective-taking, i.e. the tendency to adopt another person's point of view) and emotional empathy (compassionate care, i.e. the propensity to take patients' feelings into account; and personal distress, i.e. feelings of discomfort in relationships). In the second study, questionnaires were filled out by 41 caregivers before and after an empathy-based training program (Validation®). RESULTS: results showed that higher personal distress predicted higher burnout scores while higher compassionate care predicted lower emotional exhaustion and higher perspective-taking predicted lower depersonalization as well as higher accomplishment. Results from the second study showed that personal distress decreased after the Validation training and nursing staffs reported lower depersonalization and higher accomplishment. CONCLUSION: The first study suggests that, in predicting the decrease of burnout symptomatology, perspective-taking and the propensity for compassionate care should be considered as protective factors, whereas personal distress can be considered as a predictive factor. Moreover, empathy-based training programs such as Validation® could contribute to the prevention of burnout by decreasing signs of personal distress. The nature of this component (empathy or sympathy) is discussed.

Dysexecutive disorders and their diagnosis: A position paper.

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

Does impaired socioemotional functioning account for behavioral dysexecutive disorders? Evidence from a transnosological study.

Behavioral dysexecutive disorders are highly prevalent in patients with neurological diseases but cannot be explained by cognitive dysexecutive impairments. In fact, the underlying mechanisms are poorly understood. Given that socioemotional functioning underlies appropriate behavior, socioemotional impairments may contribute to the appearance of behavioral disorders. To investigate this issue, we performed a transnosological study. Seventy-five patients suffering from various neurological diseases (Alzheimer's disease (AD), Parkinson's disease (PD), frontotemporal lobar degeneration, and stroke) were included in the study. The patients were comprehensively assessed in terms of cognitive and behavioral dysexecutive disorders and socioemotional processes (facial emotion recognition and theory of mind). As was seen for cognitive and behavioral dysexecutive impairments, the prevalence of socioemotional impairments varied according to the diagnosis. Stepwise logistic regressions showed that (i) only cognitive executive indices predicted hypoactivity with apathy/abulia, (ii) theory of mind impairments predicted hyperactivity-distractibility-impulsivity and stereotyped/perseverative behaviors, and (iii) impaired facial emotion recognition predicted social behavior disorders. Several dysexecutive behavioral disorders are associated with an underlying impairment in socioemotional processes but not with cognitive indices of executive functioning (except for apathy). These results strongly suggest that some dysexecutive behavioral disorders are the outward signs of an underlying impairment in socioemotional processes.

The TMA-93: A New Memory Test for Alzheimer's Disease in Illiterate and Less Educated People.

The present study aimed at validating the Memory Associative Test of the district of Seine-Saint-Denis (TMA)-93, a new test of episodic memory. The TMA-93 was proposed to mostly less educated and multicultural elderly population composed of 376 healthy controls (HC) and 94 patients with Alzheimer's disease (AD). The construct validity was checked by studying correlations with a widely used memory test (the Free and Cued Selective Reminding Test [FCSRT]) in the subsample of literate patients. Results showed that (i) all the TMA-93 scores of the patients with AD were lower than those of the HC, (ii) the TMA-93 total score identified patients with AD with a high sensitivity (88%) and very high specificity (97%), and (iii) the TMA-93 total score was strongly correlated with both free recall and total recall scores of the FCSRT. Taken together, results showed that the TMA-93 is a reliable tool to assess episodic memory in a multicultural, less educated, or illiterate population, with good construct validity for AD diagnostic accuracy.

Dysexecutive syndrome in Parkinson's disease: the GREFEX study.

The objectives of this study were to characterize the frequencies and profiles of behavioral and cognitive dysexecutive syndromes in PD (based on validated battery and diagnostic criteria) and to develop a shortened diagnostic battery. Eighty-eight non-demented patients with a diagnosis of PD were examined with an executive validated battery. Using a validated framework, the patients' test results were interpreted with respect to normative data from 780 controls. A dysexecutive syndrome was observed in 80.6% of the patients [95% confidence interval: 71.1-90.1]. The dysexecutive profile was characterized by prominent impairments in deduction, flexibility, inhibition and initiation in the cognitive domain, and by global hypoactivity with apathy and hyperactivity in the behavioral domain. This finding implies that patients with PD should be assessed with cognitive tests and a validated inventory for behavioral dysexecutive syndromes. A shortened battery (based on three cognitive tests and three behavioral domains) provided high diagnostic accuracy.