Study Validates Use of Social Cognition Measure in ALS Patients

Although cognitive impairment is common in patients with ALS, the reliability of the “Reading the Mind in the Eyes Test” (RMET), a measure of social cognitive function, had yet to been established. Here, researchers confirm this is a reliable and efficient measure of social cognition in amyotrophic lateral sclerosis (ALS) patients, and can also provide relevant information in clinical and research settings.

The study, “Measurement of Social Cognition in Amyotrophic Lateral Sclerosis: A Population Based Study,” conducted by Tom Burke and his colleagues at Trinity Biomedical Sciences Institute in Ireland, was published in the journal PLoS One.

“Social cognition can be defined as the ability to represent and attribute affective and cognitive mental states,” the authors wrote in their report. “It integrates cognitive processes such as the ability to follow eye-gaze, share attention, recognize emotion, and to distinguish between self and other.

“(…) in recent years the relationship between neurodegeneration and social cognitive processes has gained much attention and assessments of neuropsychological and social cognitive performance are more routine in neurologic conditions where muscular atrophy is the dominant feature,” they wrote.

In ALS and in frontotemporal dementia (FTD), dysfunction of cognitive processes has been indicated as the main predictor of social cognition performance. One common test used to evaluate social cognition is the RMET, which consists of showing photographs of the eye regions of human faces to participants, who then infer their mental or emotional state out of four possible choices.

Although this test has been used in several neurological conditions such as ALS, Kennedy’s disease, Huntington’s disease, Parkinson’s, epilepsy, and others, the reliability of this measure still raises doubt.

The researchers used the RMET to study social cognition in 106 patients with ALS and in 50 healthy people matched by age and IQ. The ALS patients were subdivided according to whether they had no cognitive abnormalities (70), a single executive deficit (19), or multi-executive deficits/cognitively impaired (19).

They observed that the RMET had excellent psychometric properties when discriminating between ALS patients who were cognitively intact and those who had impaired cognitive processes. The analysis of patients taking into account the level of impairment also provided a useful reference in terms of severity of social cognitive deficits.

Together, these findings support the inclusion of RMET and other social cognitive measures in standardized neuropsychological tests. Moreover, the existence of ALS-FTD comorbidity supports the evaluation of patient performance using this test.

“Future studies could investigate the relationship between social cognitive performance and behavioral features associated with ALS; could determine whether social cognitive decline has a negative impact on caregiver burden in ALS; and whether there are additional negative implications on the psychological well-being of patients and caregivers,” the authors concluded.