Polet Kevin, Hesse Solange, Morisot Adeline, Kullmann Benoît, Louchart de la Chapelle Sandrine, Iakimova Galina, Pesce Alain
Centre de gérontologie clinique Rainier-III, centre hospitalier Princesse-Grace, Monaco.
Centre de gérontologie clinique Rainier-III, centre hospitalier Princesse-Grace, Monaco, Département de santé publique, CHU de Nice, France.
Geriatr Psychol Neuropsychiatr Vieil. 2021 Dec 1;19(4):427-439. doi: 10.1684/pnv.2021.0978.
Theory of mind (ToM) and empathy are severely impaired in the behavioral-variant of frontotemporal dementia (bvFTD) and more mildly in Alzheimer's (AD) and Parkinson's diseases (PD). Such impairments are associated with behavioral disorders (BD). Modification of visual scanning strategies of complex visual scenes is also found in these pathologies. We hypothesized that these patients applied atypical gaze strategies when observing social events, which would not allow to properly process social cues and would result in the production of erroneous inferences and lack of empathy towards others.
Fifty-five participants were divided into four groups: five bvFTD, 19 AD, 17 PD and 14 matched controls subjects. ToM and empathy were assessed by eye movements recording (eye-tracking) and by a questionnaire during a painting observation. Scores obtained were compared between each group and to social cognition reference tests, and correlated to the NeuroPsychiatric Inventory.
Our paradigm was suitable for assessing cognitive ToM while it lacked sensitivity for empathy assessment. Severe ToM impairment was highlighted in bvFTD while milder difficulties were observed in AD and for PD. bvFTD and AD groups produced erroneous inferences from cognitive mental states. ToM performances were linked to visual exploration strategies of the painting. Atypical visual observation was highlighted in bvFTD and AD groups causing a time shift in perspective taking of the character. Finally, we have highlighted that social cognition performances, gaze strategies and BD were correlated.
The observation of a painting in association with eye-tracking technology can be a good support for social cognition assessment. We highlighted a link between atypical visual scanning strategies, ToM impairment and BD in these pathologies. ToM skills could be improved by training in the search for visual social cues. Therefore, this kind of remediation could have positive effects on BD.
心理理论（ToM）和同理心在前额颞叶痴呆行为变异型（bvFTD）中严重受损，在阿尔茨海默病（AD）和帕金森病（PD）中受损程度较轻。这些损伤与行为障碍（BD）相关。在这些疾病中还发现了复杂视觉场景视觉扫描策略的改变。我们假设这些患者在观察社会事件时采用了非典型的注视策略，这将导致无法正确处理社会线索，并产生错误推断以及对他人缺乏同理心。
55名参与者被分为四组：5名bvFTD患者、19名AD患者、17名PD患者和14名匹配的对照受试者。通过眼动记录（眼动追踪）和在绘画观察期间使用问卷对ToM和同理心进行评估。比较每组获得的分数与社会认知参考测试的分数，并与神经精神科问卷相关联。
我们的范式适用于评估认知ToM，但对同理心评估缺乏敏感性。bvFTD中突出显示出严重的ToM损伤，而AD和PD中观察到的困难较轻。bvFTD和AD组从认知心理状态产生了错误推断。ToM表现与绘画的视觉探索策略相关。bvFTD和AD组突出显示出非典型的视觉观察，导致在对人物的视角采择上出现时间偏移。最后，我们强调了社会认知表现、注视策略和BD之间的相关性。
结合眼动追踪技术对绘画进行观察可以为社会认知评估提供良好支持。我们强调了这些疾病中非典型视觉扫描策略、ToM损伤和BD之间的联系。通过训练寻找视觉社会线索可以提高ToM技能。因此，这种补救措施可能对BD有积极影响。
