Buunk Anne M, Spikman Jacoba M, Veenstra Wencke S, van Laar Peter Jan, Metzemaekers Jan D M, van Dijk J Marc C, Meiners Linda C, Groen Rob J M
University of Groningen, University Medical Centre Groningen, Department of Neurology, Subdepartment of Neuropsychology, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands; University of Groningen, Department of Clinical and Developmental Neuropsychology, Hanzeplein 1, P.O. Box 30.001, Poortweg 4, 2nd floor, 9700 RB, Groningen, the Netherlands.
University of Groningen, University Medical Centre Groningen, Department of Neurology, Subdepartment of Neuropsychology, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands; University of Groningen, Department of Clinical and Developmental Neuropsychology, Hanzeplein 1, P.O. Box 30.001, Poortweg 4, 2nd floor, 9700 RB, Groningen, the Netherlands.
Neuropsychologia. 2017 Aug;103:131-139. doi: 10.1016/j.neuropsychologia.2017.07.015. Epub 2017 Jul 16.
Behavioural disturbances are frequently found after aneurysmal subarachnoid haemorrhage (aSAH). Social cognition impairments have been suggested as a possible underlying mechanism for behavioural problems. Also, aSAH is likely to result in damage affecting frontal-subcortical circuits underlying social cognition. Therefore, we aimed to investigate social cognition after aSAH and its associations with behavioural problems (deficits in interpersonal behaviour, apathy, and impaired self-awareness) and focal as well as diffuse brain damage. 88 aSAH patients (in the subacute phase post-aSAH) and 60 age-, sex- and education-matched healthy controls participated. Tasks for emotion recognition, Theory of Mind (ToM), and empathy as well as questionnaires were used. Cortical infarctions in frontal and non-frontal areas on MRI, aneurysm circulation and aSAH-related events were taken into account. Compared to healthy controls, aSAH patients performed significantly worse on tasks for emotion recognition, ToM and empathy. Poor performance on ToM and emotion recognition was associated with proxy-ratings indicating impaired interpersonal behaviour and apathy and with indications of impaired self-awareness. No associations were found between deficits in social cognition and frontal or non-frontal cortical lesions on MRI. Also, aneurysm circulation and aSAH-related events such as hydrocephalus, vasospasm, and treatment method did not explain why and how social cognitive deficits did occur after aSAH. In conclusion, emotion recognition, ToM and empathy were clearly impaired in aSAH patients and these deficits were related to apathy and deficits in interpersonal behaviour as reported by proxies and to impaired self-awareness. This association strengthens the assumption of impaired social cognition as an underlying construct of behavioural problems after aSAH. Consequently, social cognition tests and proxy-ratings should be used in clinical practice, irrespective of lesion location on MRI or aneurysm circulation, to improve the detection and treatment of apathy and deficits in interpersonal behaviour after aSAH.
行为障碍在动脉瘤性蛛网膜下腔出血（aSAH）后很常见。社会认知障碍被认为是行为问题的一种可能潜在机制。此外，aSAH可能导致影响社会认知基础的额叶-皮质下回路受损。因此，我们旨在研究aSAH后的社会认知及其与行为问题（人际行为缺陷、冷漠和自我意识受损）以及局灶性和弥漫性脑损伤的关系。88例aSAH患者（aSAH亚急性期）和60名年龄、性别和教育程度匹配的健康对照者参与了研究。使用了情绪识别、心理理论（ToM）、共情任务以及问卷。考虑了MRI上额叶和非额叶区域的皮质梗死、动脉瘤循环和aSAH相关事件。与健康对照者相比，aSAH患者在情绪识别、ToM和共情任务上的表现明显更差。ToM和情绪识别方面的表现不佳与表明人际行为受损和冷漠的代理评分以及自我意识受损的指标相关。在MRI上，未发现社会认知缺陷与额叶或非额叶皮质病变之间存在关联。此外，动脉瘤循环和aSAH相关事件，如脑积水、血管痉挛和治疗方法，无法解释aSAH后社会认知缺陷为何以及如何发生。总之，aSAH患者的情绪识别、ToM和共情明显受损，这些缺陷与代理报告的冷漠和人际行为缺陷以及自我意识受损有关。这种关联强化了社会认知受损是aSAH后行为问题潜在结构的假设。因此，在临床实践中应使用社会认知测试和代理评分，无论MRI上的病变位置或动脉瘤循环如何，以改善aSAH后冷漠和人际行为缺陷的检测和治疗。
