Social cognition impairments in the long term post stroke

Objective: To examine the presence of social cognition deficits and the relationship between social and general cognition (eg, attention, mental speed, verbal, visual, or memory abilities) in a large sample of chronic stroke patients and to identify stroke-related factors associated with social cognitive performance.

Design: Inception cohort study in which social cognition was assessed at 3-4 years post stroke.

Setting: Stroke units in 6 general hospitals.

Participants: The data of 148 patients were available. Fifty controls without stroke (consisting of partners of patients and acquaintances of researchers) were recruited (N = 198).

Interventions: Not applicable.

Main Outcome Measures: Patients underwent neuropsychological assessment by means of tests for social cognition (emotion recognition, theory of mind [ToM], empathy, and behavior regulation) and general cognition. Subgroup analysis was performed to compare right hemisphere stroke patients with left hemisphere stroke patients. Correlations between general and social cognition tests were assessed. Multiple regression analyses were performed to identify demographic and stroke-related predictors of social cognitive performance.

Results: Patients performed significantly worse on emotion recognition (assessed with the Ekman 60-Faces test on total score as well as on the emotion anger), ToM (assessed with the Cartoon test), and behavior regulation (assessed with the Hayling test). Subgroup analysis revealed no differences between right and left hemisphere patients. Social cognition tests showed significant correlations with each other and with tests for visual perception, language, mental speed, cognitive flexibility, and memory. Older age, low level of education (and for ToM, also female sex) were predictors of worse performance on social cognition tests.

Conclusion: Social cognition impairments are present in the long term post stroke, even in a group of mildly affected stroke patients, which may contribute to their long-term problems. Severity of impairments is determined mainly by demographic factors.