Social cognition across bipolar disorder and behavioral-variant frontotemporal dementia: an exploratory study

Barbosa, Izabela Guimarães; Leite, Flávia da Mata Chiácchio; Bertoux, Maxime; Guimarães, Henrique Cerqueira; Mariano, Luciano Inácio; Gambogi, Leandro Boson; Teixeira, Antônio Lúcio; Caramelli, Paulo; de Souza, Leonardo Cruz

doi:10.47626/1516-4446-2022-2935

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Brazilian Journal of Psychiatry

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BRIEF COMMUNICATION • Braz J Psychiatry 45 (2) • Mar-Apr 2023 • https://doi.org/10.47626/1516-4446-2022-2935 copy

Social cognition across bipolar disorder and behavioral-variant frontotemporal dementia: an exploratory study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

Bipolar disorder type 1 (BD1) and behavioral-variant frontotemporal dementia (bvFTD) share similar behavioral and cognitive symptoms, rendering the differential diagnosis between them a clinical challenge. We investigated the accuracy of social cognition (SC) measures to differentiate bvFTD from BD.

Methods:

We included three groups of participants: early-onset BD1 (in remission, n=20), bvFTD (n=18), and cognitively healthy controls (HC) (n=40), matched for age, schooling, and sex. All participants underwent cognitive assessment, including the Facial Emotion Recognition (FER) and Modified Faux-Pas (mFP) tests, which assess mentalizing.

Results:

Compared to HC, BD1 and bvFTD patients underperformed on both SC measures. BD1 and bvFTD did not differ regarding FER or mFP total scores, although patients with bvFTD had significantly higher difficulties than those in the BD1 group to detect social faux-pas (p < 0.001, d = 1.35).

Conclusion:

BD1 and bvFTD share deficits in the core SC functions. These findings should be considered in the development of tasks aiming to improve clinical differentiation between the two disorders.

Dementia; cognitive impairment; executive functioning; mania; mood disorder

	bvFTH(n=18)	BD1(n=20)	HC(n=40)	Kruskal-Wallis test (all groups)	bvFTH vs. BD1(Mann-Whitney test)	bvFTH vs. HC (Mann-Whitney test)	BD1 vs. HC (Mann-Whitney test)
Sex	9F/9M	12F/8M	27F/13M	NA	p = 0.51 χ²	p = 0.07 χ²	p = 0.02 χ²
Disease duration (years)	3.6 (± 2.1)	32.1 (± 13.1)	NA	NA	p < 0.0001; d = 3.04	NA	NA
Age (years)	65.0±8.8	57.4±11.4	61.2±9.9	p = 0.12	p = 0.04; d = 0.76	p = 0.21; d = 0.42	p = 0.23; d = 0.35
Educational level (years)	12.7±3.2	12.0±2.7	12.5±2.9	p = 0.91	p = 0.88; d = 0.21	p = 0.93; d = 0.03	p = 0.63; d = 0.02
MMSE (out of 30)	26.1±1.9	27.1±1.7	28.9±1.2	p < 0.001	p = 0.65; d = 0.55	p = 0.38; d = 1.84	p = 0.0001; d = 1.26
FAB (out of 18)	11.7±3.6	13.7±3.7	16.3±1.6	p < 0.001	p = 0.07; d = 2.65	p < 0.0001; d = 1.59	p < 0.0001; d = 1.15
FMT (5-minute recall)	6.7±2.4	7.5±2.3	9.2±1.4	p < 0.001	p = 0.35; d = 0.47	p < 0.0001; d = 1.31	p < 0.002; d = 0.92
FER (out of 35)	20.6±6.3	22.6±4.4	28.7±2.4	p < 0.001	p = 0.03; d = 0.59	p = 0.01; d = 0.76	p < 0.0001; d = 1.73
Theory of mind: FPRT
Total score (out of 40)	20.4±7.4	25.7±8.4	35.9±3.8	p < 0.001	p = 0.20; d = 0.53	p < 0.0001; d = 2.65	p < 0.0001; d = 1.55
Detection of faux-pas (out of 5)	3.3±1.3	4.7±0.6	4.9±0.4	p < 0.001	p < 0.001; d = 1.29	p < 0.0001; d = 1.54	p = 0.23; d = 0.39
Detection of absence of faux-pas (out of 5)	4.0±1.0	3.4±1.4	4.8±0.6	p < 0.001	p = 0.27; d = 0.50	p < 0.0001; d = 0.95	p < 0.0001; d = 1.27
Attribution (out of 10)	2.9±1.4	3.3±1.4	4.8±1.0	p < 0.001	p = 0.44; d = 0.27	p = 0.38; d = 1.59	p < 0.001; d = 1.25
Identification (out of 10)	2.1±2.0	2.4±1.6	4.3±0.9	p < 0.001	p = 0.42; d = 0.21	p < 0.0001; d = 1.51	p < 0.0001; d = 1.41
Knowledge (out of 10)	0.9±1.0	1.8±1.5	3.8±1.0	p < 0.001	p < 0.12; d = 0.55	p < 0.0001; d = 2.37	p < 0.0001; d = 1.50
Intentionality (out of 10)	2.6±1.4	2.4±1.5	4.0±0.9	p < 0.001	p < 0.42; d = 0.27	p < 0.001; d = 1.04	p < 0.0001; d = 1.29
Empathy (out of 10)	2.6±1.2	3.3±1.5	4.6±0.7	p < 0.001	p < 0.25; d = 0.44	p < 0.0001; d = 1.82	p < 0.001; d = 1.13
Recognition of social norms violation (out of 20)	12.0±4.6	13.8±4.3	18.7±1.9	p < 0.001	p < 0.27; d = 0.38	p < 0.38; d = 1.89	p < 0.0001; d = 1.48
Mentalizing (out of 20)	6.5±3.5	7.4±4.2	12.4±2.1	p < 0.001	p < 0.65; d = 0.23	p < 0.38; d = 2.02	p < 0.0001; d = 1.47
Mini-SEA total score (out of 30)	17.1±4.8	19.3±4.3	25.7±1.9	p < 0.001	p < 0.28; d = 0.50	p < 0.0001; d = 2.44	p < 0.0001; d = 1.92

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[1] Correspondence: Izabela Guimarães Barbosa, Universidade Federal de Minas Gerais, Faculdade de Medicina, Av. Professor Alfredo Balena, 190, sala 281, Santa Efigênia, CEP 30130-100, Belo Horizonte, MG, Brazil. E-mail: izabelagb@gmail.com