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Theory of Mind in multiple system atrophy: comparison with Parkinson’s disease and healthy subjects

  • Neurology and Preclinical Neurological Studies - Original Article
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Abstract

Theory of Mind is defined as the ability to attribute mental state and emotions to other people and is relevant to social relationships. The cortical and subcortical regions involved in Theory of Mind are damaged by neurodegenerative processes of Parkinsonian syndromes, so the aim of the present study was to explore, for the first time, possible deficits of Theory of Mind and their cognitive correlates in multiple system atrophy (MSA). Twenty-six patients with MSA, 25 patients with Parkinson’s disease (PD) and 25 healthy subjects were enrolled. Cognitive and affective subcomponents of Theory of Mind, executive functions, long-term memory and apathy were evaluated. The three groups did not differ on demographic variables. MSA and PD groups performed worse than healthy subjects on both cognitive (advanced test of ToM) and affective (emotion attribution task) ToM tasks, but no significant difference was found between patients’ groups. However, when using another affective ToM task (Eyes Test), MSA group had poorer performance than healthy subjects and Parkinsonian patients, whereas Parkinsonian patients had similar performance to healthy subjects. Regression analysis revealed an association between poor cognitive flexibility and dysfunctional cognitive component of Theory of Mind. Deficit of cognitive and affective components of Theory of Mind occurred in MSA. Dysfunction of cognitive component was related to executive dysfunction (i.e. cognitive rigidity). These findings might suggest the usefulness of an early evaluation of social cognition in MSA to identify individuals with impaired Theory of Mind who are at risk of social withdrawal, and reduced quality of life.

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Funding

GS received salary from the University of Campania Luigi Vanvitelli, Italy. SC received salary from the University of Salerno, Italy. MTP received salary from the University of Salerno, Italy. RE received consultancies from Zambon and honoraria for speaking from Teva. PB received salary from the University of Salerno, Italy. PB Consultancies: Novartis, Schwarz Pharma/UCB, Merck-Serono, Eisai, Solvay, General Electric and Lundbeck; Advisory Boards: Novartis, Schwarz Pharma/UCB, Merck-Serono, Eisai, Solvay, General Electric and Lundbeck; Grants: Research supports from Boehringer Ingelheim, Novartis, Schwarz Pharma/UCB, MerckSerono, Solvay, and Lundbeck. MP received salary from the University of Salerno, Italy.

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Authors and Affiliations

  1. Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy

    Gabriella Santangelo

  2. Neuroscience Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy

    Gabriella Santangelo, Sofia Cuoco, Marina Picillo, Roberto Erro, Paolo Barone & Maria Teresa Pellecchia

  3. Department of Medical Sciences, AOU San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

    Massimo Squillante & Giampiero Volpe

  4. Neurology Operative Unit and Stroke Unit”, AORN San Giuseppe Moscati, Avellino, Italy

    Autilia Cozzolino & Giulio Cicarelli

Authors
  1. Gabriella Santangelo
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  2. Sofia Cuoco
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  3. Marina Picillo
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  7. Autilia Cozzolino
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  8. Giulio Cicarelli
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  9. Paolo Barone
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  10. Maria Teresa Pellecchia
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Contributions

GS: (1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the first draft; SC: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; MP: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; RE: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; MS: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; GV: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; AC: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; GC: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; PB: (1) Research project: C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: B. Review and Critique; MTP: (1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: C. Review and Critique; (3) Manuscript: A. Writing of the first draft, B. Review and Critique.

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Correspondence to Gabriella Santangelo.

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All participants gave their written informed consent to participate to the study, which was approved by the Local Ethics Committee and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Santangelo, G., Cuoco, S., Picillo, M. et al. Theory of Mind in multiple system atrophy: comparison with Parkinson’s disease and healthy subjects. J Neural Transm 127, 915–923 (2020). https://doi.org/10.1007/s00702-020-02181-3

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