Yeh Zai-Ting, Lo Chiao-Yu, Tsai Ming-Dar, Tsai Ming-Cheng
a Department of Clinical Psychology , Fu Jen Catholic University , Taipei , Taiwan.
J Clin Exp Neuropsychol. 2015;37(2):128-39. doi: 10.1080/13803395.2014.992864. Epub 2015 Feb 18.
Mentalizing ability is the issue in the social cognition of patients with brain injury that has received the most attention. The present study investigated mentalization ability in patients with prefrontal cortex damage. The aims of this study were to investigate: (a) whether patients with prefrontal cortex damage are impaired in mentalizing ability, including theory of mind (ToM) and empathy; (b) whether patients with ventromedial prefrontal cortex damage are impaired in different aspects of ToM; (c) whether patients with ventromedial prefrontal cortex damage are impaired in different aspects of empathy; and (d) whether impairment of mentalizing ability in patients with prefrontal cortex damage can be explained by executive dysfunction.
Mini-Mental State Examination (MMSE), Matrix Reasoning subtest, working memory, executive function, theory of mind, and empathy assessments were conducted on eight patients with ventromedial prefrontal cortex damage, 15 patients with dorsolateral prefrontal cortex damage, and 19 normal comparisons matched for level of education and intelligence.
The results showed that performance on affective and nonverbal theory of mind was significantly lower in patients with dorsolateral prefrontal cortex damage than in the comparison group. Performance on personal distress items of empathy was significantly lower in the ventromedial prefrontal cortex damage group than in the dorsolateral prefrontal cortex damage group. In addition, further multiple regression analysis showed that affective theory of mind could be explained by the Wisconsin Card Sorting Test-Modified (WCST-M), with an explained variance of up to 44%.
The present study suggests that the impairment of mentalizing ability in patients with prefrontal cortex damage is partially the result of executive dysfunction.
心理化能力是脑损伤患者社会认知中最受关注的问题。本研究调查了前额叶皮质损伤患者的心理化能力。本研究的目的是调查：(a)前额叶皮质损伤患者的心理化能力是否受损，包括心理理论（ToM）和同理心；(b)腹内侧前额叶皮质损伤患者在心理理论的不同方面是否受损；(c)腹内侧前额叶皮质损伤患者在同理心的不同方面是否受损；以及(d)前额叶皮质损伤患者的心理化能力受损是否可以用执行功能障碍来解释。
对8例腹内侧前额叶皮质损伤患者、15例背外侧前额叶皮质损伤患者和19名在教育程度和智力方面相匹配的正常对照者进行简易精神状态检查表（MMSE）、矩阵推理分测验、工作记忆、执行功能、心理理论和同理心评估。
结果显示，背外侧前额叶皮质损伤患者在情感和非语言心理理论方面的表现显著低于对照组。腹内侧前额叶皮质损伤组在同理心的个人痛苦项目上的表现显著低于背外侧前额叶皮质损伤组。此外，进一步的多元回归分析表明，情感心理理论可以由威斯康星卡片分类测验修订版（WCST-M）来解释，解释方差高达44%。
本研究表明，前额叶皮质损伤患者心理化能力受损部分是执行功能障碍的结果。
