Executive Functions and Theory of Mind in Aging: History
View Latest Version
Please note this is an old version of this entry, which may differ significantly from the current revision.
Contributor:
Livio Clemente
,
Daphne Gasparre
,
Federica Alfeo
,
Fabiana Battista
,
Chiara Abbatantuono
,
Antonietta Curci
,
Tiziana Lanciano
,
Paolo Taurisano

Social cognition is essential for maintaining relationships throughout life, with Theory of Mind (ToM) as its central component. ToM encompasses both cognitive and affective processes, enabling individuals to decipher concealed social cues and make moral judgments within various social contexts. ToM is a current topic of interest investigated in diverse age-related conditions, such as Mild Cognitive Impairment (MCI), a transitional stage between healthy and pathological aging. Recognizing ToM difficulties is crucial, as they can significantly impact decision-making and social interactions while also serving as valuable indicators for tracking disease progression. However, assessing ToM poses challenges, given the variety of available tests and the ongoing debate about its connection with other cognitive abilities. Existing literature suggests that executive functions (EF) can influence ToM performance, but only a few studies have delved into this aspect deeply. Improving the understanding of the dynamics of ToM, its interaction with age-related changes, and its possible variations in MCI is critical to promoting social well-being and cognitive health in older people.

  • MCI
  • working memory
  • executive functions
  • social cognition

1. Introduction

Social cognition encompasses a range of skills that are necessary for maintaining harmony in both personal and social connections throughout a lifetime [1][2]. The Theory of Mind (ToM), also known as mentalizing or mindreading, is a fundamental component of social cognition [3]. It involves the ability to comprehend and anticipate behavior by meta-representing one’s own and other people’s mental states [4].
ToM involves cognitive (referred to as “cold”) and emotive (referred to as “hot”) sub-processes [5]: Cognitive ToM implicates deducing others’ cognitive aspects like beliefs, thoughts, intentions, and motivations, while affective ToM entails understanding their emotions and affective states [6]. These attributes allow to identify cognitive and emotional states in others through concealed social cues like eye-gaze expressions, irony, metaphors, and implied speech meanings [7][8][9]. The growing interest in the study of ToM’s skills is due to its relevance for effective social functioning, enabling moral judgments that integrate ToM information with knowledge about the potential consequences of actions or beliefs. This allows people to discern what is right or wrong in a social context [10]by permitting them to manage complex social dynamics [11].

2. Exploring the Debate: ToM Integrity and Age-Related Changes

A debate exists on ToM’s association with age [2][12]. Happé and colleagues [13] found that older adults excel in ToM tasks. This superiority in understanding the thoughts and feelings (reported in a unit score) of characters in the provided stories for ToM assessment suggests the potential influence of accumulated life experience [2]. However, recent studies contradict these findings, revealing an age-related ToM decline [12][14][15]. Maylor and colleagues [15] and Sullivan and Ruffman [16] conducted studies that replicated Happé et al.’s research and noted divergent results. The outcomes revealed that ToM performance decreases as individuals grow older, a conclusion that has been further refined with time, detailing poorer performance mainly in the cognitive subcomponent of ToM [17]. These results appear to be in line with evidence of the cognitive decline that occurs with age [18]. Cognitive aging, a natural process of change over the years, can lead to a reduction in specific skills’ performance [14]. In particular, skills that rely on previously acquired information (i.e., crystallized abilities) are less impacted by aging compared to abilities that need more mental effort, novelty, and information complexity (i.e., fluid abilities) [19].
Executive Functions (EFs) are defined as control processes responsible for planning, assembling, coordinating, sequencing, and monitoring other cognitive operations. EFs encompass abilities such as inhibition, working memory (WM), and attention, all of which are affected by cognitive aging [20]. These abilities are closely connected to the performance at ToM tasks. Indeed, some studies have shown that a decline in EFs is the underlying cause of reduced ToM ability: while EFs decrease, the underlying ToM skills are preserved. In other words, it has been suggested that EFs appear to be the primary sources of age-related deterioration in ToM [21][22].
In particular, the role of WM (as a component of EFs) has been extensively studied in relation to ToM performance [23][24][25]. WM refers to the process of temporarily retaining or storing information and perceived stimuli for brief periods -typically lasting between 3 and 10 seconds [26]- while also actively manipulating them [27]. WM can be useful for acquiring and expressing ToM knowledge, allowing individuals to hold conflicting perspectives in their minds [23][28][29]. Therefore, it is possible that difficulties in the WM may partially explain their challenges in ToM tasks [30].

3. The Importance of ToM Evaluation in MCI

Social cognition challenges, including those tied to ToM skills, are commonly reported among older individuals, potentially affecting their well-being, social engagement, and feelings of isolation [31]. These issues become more pronounced as aging coincides with the development of neurological and behavioral disorders due to various pathologies, which tend to become more prevalent with advancing age, including conditions like Alzheimer’s disease (AD) and Mild Cognitive Impairment (MCI) [32][33].
MCI is a transitional stage between healthy and pathological neurocognitive aging, characterized by a slight, yet measurable, decline in cognitive abilities beyond the expected range for one’s age and education [34][35][36]. Although deficits in various cognitive domains can be identified through neuropsychological assessment, they usually do not significantly disrupt daily activities [37][38][39].
Identifying deficits is crucial for categorizing MCI types based on memory and impaired domains [40][41]. MCI’s cognitive deficits do not always progress to dementia; efforts focus on monitoring and enhancing well-being and social engagement to mitigate decline. In particular, it has been suggested that participating in social activities is associated with a decreased risk of further cognitive decline among those with MCI [42]. From this perspective, it is evident that difficulties related to the social cognition domain can be associated with pathological development and are worth evaluating. Specifically, assessing ToM ability is important for tracking disease progression [43][44]. However, there is a wide variety of tests currently used to investigate ToM, and this heterogeneity can pose a limitation to the field, potentially leading to ambiguous results: The affective and cognitive aspects are often assessed separately, using different instruments, and not all studies examine both components [45].
Moreover, despite various studies examining ToM challenges in older adults [46] or cognitive disorders, the underlying mechanisms remain debated [9]. It is unclear whether deficits in ToM are linked to other cognitive functions. Thus, the impairment might result from poor performance in other skills like EFs, or these factors may be unrelated. Indeed, while EFs are presumed to impact ToM performance, some findings suggest that impaired ToM can manifest independently of other cognitive difficulties [47][48]. Several results indicate that EFs do not significantly correlate with ToM performance, sparking an ongoing debate that the literature has not addressed sufficiently [6][49][50]. 
Recently, a new perspective has emerged, shedding light on the potential link between EFs and ToM in the performance of healthy elderly subjects, while revealing a discrepancy in those with MCI. This suggests that, despite the presence of a decline in cognitive performance, the pathology could impact these abilities differently [1].
The debate surrounding ToM and its relationship with other cognitive functions remains complex and ongoing, but improving understanding of the dynamics of ToM, its interaction with age-related changes, and its possible variations in MCI, can exert a substantial influence on the overall welfare of the elderly individuals and it is critical to promoting social well-being and cognitive health in older people.

This entry is adapted from the peer-reviewed paper 10.3390/brainsci13101356

References

  1. Livio Clemente; Daphne Gasparre; Federica Alfeo; Fabiana Battista; Chiara Abbatantuono; Antonietta Curci; Tiziana Lanciano; Paolo Taurisano; Theory of Mind and Executive Functions in Individuals with Mild Cognitive Impairment or Healthy Aging. Brain Sci. 2023, 13, 1356, .
  2. Moran, J.M. Lifespan development: The effects of typical aging on theory of mind. Behav. Brain Res. 2013, 237, 32–40.
  3. Kalbe, E.; Schlegel, M.; Sack, A.T.; Nowak, D.A.; Dafotakis, M.; Bangard, C.; Brand, M.; Shamay-Tsoory, S.; Onur, O.A.; Kessler, J. Dissociating cognitive from affective theory of mind: A TMS study. Cortex 2010, 46, 769–780.
  4. Baglio, F.; Castelli, I.; Alberoni, M.; Blasi, V.; Griffanti, L.; Falini, A.; Nemni, R.; Marchetti, A. Theory of Mind in Amnestic Mild Cognitive Impairment: An fMRI Study. J. Alzheimer’s Dis. 2011, 29, 25–37.
  5. Shamay-Tsoory, S.G.; Harari, H.; Aharon-Peretz, J.; Levkovitz, Y. The role of the orbitofrontal cortex in affective theory of mind deficits in criminal offenders with psychopathic tendencies. Cortex 2010, 46, 668–677.
  6. Kemp, J.; Després, O.; Sellal, F.; Dufour, A. Theory of Mind in normal ageing and neurodegenerative pathologies. Ageing Res. Rev. 2012, 11, 199–219.
  7. Ladegaard, N.; Larsen, E.R.; Videbech, P.; Lysaker, P.H. Higher-order social cognition in first-episode major depression. Psychiatry Res. 2014, 216, 37–43.
  8. Rodríguez Sosa, J.T.; Acosta Ojeda, M.; Rodríguez Del Rosario, L. Teoría de la mente, reconocimiento facial y procesamiento emocional en la esquizofrenia. Rev. Psiquiatr. Y Salud Ment. 2011, 4, 28–37.
  9. Yi, Z.; Zhao, P.; Zhang, H.; Shi, Y.; Shi, H.; Zhong, J.; Pan, P. Theory of mind in Alzheimer’s disease and amnestic mild cognitive impairment: A meta-analysis. Neurol. Sci. 2020, 41, 1027–1039.
  10. Young, L.; Cushman, F.; Hauser, M.; Saxe, R. The neural basis of the interaction between theory of mind and moral judgment. Proc. Natl. Acad. Sci. USA 2007, 104, 8235–8240.
  11. Moran, J.M.; Young, L.L.; Saxe, R.; Lee, S.M.; O’Young, D.; Mavros, P.L.; Gabrieli, J.D. Impaired theory of mind for moral judgment in high-functioning autism. Proc. Natl. Acad. Sci. USA 2011, 108, 2688–2692.
  12. Pardini, M.; Nichelli, P.F. Age-Related Decline in Mentalizing Skills Across Adult Life Span. Exp. Aging Res. 2009, 35, 98–106.
  13. Happé, F.G.; Winner, E.; Brownell, H. The getting of wisdom: Theory of mind in old age. Dev. Psychol. 1998, 34, 358–362.
  14. Dumas, J.A. What Is Normal Cognitive Aging? Evidence from Task-Based Functional Neuroimaging. Curr. Behav. Neurosci. Rep. 2015, 2, 256–261.
  15. Maylor, E.A.; Moulson, J.M.; Muncer, A.M.; Taylor, L.A. Does performance on theory of mind tasks decline in old age? Br. J. Psychol. 2002, 93, 465–485.
  16. Sullivan, S.; Ruffman, T. Social understanding: How does it fare with advancing years? Br. J. Psychol. 2004, 95, 1–18.
  17. Wang, Z.; Su, Y. Age-related differences in the performance of theory of mind in older adults: A dissociation of cognitive and affective components. Psychol. Aging 2013, 28, 284–291.
  18. Gazzaley, A.; D’Esposito, M. The Contribution of Functional Brain Imaging to Our Understanding of Cognitive Aging. Sci. Aging Knowl. Environ. 2003, 2003, pe2.
  19. Salthouse, T.A. Steps toward the explanation of adult age differences in cognition. In Models of Cognitive Aging; Debates in Psychology; Oxford University Press: Oxford, UK, 2000; pp. 19–49.
  20. Salthouse, T.A.; Atkinson, T.M.; Berish, D.E. Executive functioning as a potential mediator of age-related cognitive decline in normal adults. J. Exp. Psychol. Gen. 2003, 132, 566–594.
  21. Cho, I.; Cohen, A.S. Explaining age-related decline in theory of mind: Evidence for intact competence but compromised executive function. PLoS ONE 2019, 14, e0222890.
  22. German, T.P.; Hehman, J.A. Representational and executive selection resources in “theory of mind”: Evidence from compromised belief-desire reasoning in old age. Cognition 2006, 101, 129–152.
  23. Carlson, S.M.; Moses, L.J.; Breton, C. How specific is the relation between executive function and theory of mind? Contributions of inhibitory control and working memory. Infant Child Dev. 2002, 11, 73–92.
  24. Davis, H.L.; Pratt, C. The development of children’s theory of mind: The working memory explanation. Aust. J. Psychol. 1995, 47, 25–31.
  25. Dennis, M.; Agostino, A.; Roncadin, C.; Levin, H. Theory of mind depends on domain-general executive functions of working memory and cognitive inhibition in children with traumatic brain injury. J. Clin. Exp. Neuropsychol. 2009, 31, 835–847.
  26. Banich, M.T.; Mackiewicz, K.L.; Depue, B.E.; Whitmer, A.J.; Miller, G.A.; Heller, W. Cognitive control mechanisms, emotion and memory: A neural perspective with implications for psychopathology. Neurosci. Biobehav. Rev. 2009, 33, 613–630.
  27. Baddeley, A.D.; Hitch, G. Working Memory. In Psychology of Learning and Motivation; Bower, G.H., Ed.; Academic Press: Cambridge, MA, USA, 1974; Volume 8, pp. 47–89.
  28. Moreau, N.; Rauzy, S.; Bonnefoi, B.; Renié, L.; Martinez-Almoyna, L.; Viallet, F.; Champagne-Lavau, M. Different Patterns of Theory of Mind Impairment in Mild Cognitive Impairment. J. Alzheimer’s Dis. 2015, 45, 581–597.
  29. Samson, D. Reading other people’s mind: Insights from neuropsychology. J. Neuropsychol. 2009, 3, 3–16.
  30. Chainay, H.; Gaubert, F. Affective and cognitive theory of mind in Alzheimer’s disease: The role of executive functions. J. Clin. Exp. Neuropsychol. 2020, 42, 371–386.
  31. Roheger, M.; Brenning, J.; Riemann, S.; Martin, A.K.; Flöel, A.; Meinzer, M. Progression of socio-cognitive impairment from healthy aging to Alzheimer’s dementia: A systematic review and meta-analysis. Neurosci. Biobehav. Rev. 2022, 140, 104796.
  32. Bora, E.; Yener, G.G. Meta-Analysis of Social Cognition in Mild Cognitive Impairment. J. Geriatr. Psychiatry Neurol. 2017, 30, 206–213.
  33. Christidi, F.; Migliaccio, R.; Santamaría-García, H.; Santangelo, G.; Trojsi, F. Social Cognition Dysfunctions in Neurodegenerative Diseases: Neuroanatomical Correlates and Clinical Implications. Behav. Neurol. 2018, 2018, 1849794.
  34. Edmonds, E.C.; McDonald, C.R.; Marshall, A.; Thomas, K.R.; Eppig, J.; Weigand, A.J.; Delano-Wood, L.; Galasko, D.R.; Salmon, D.P.; Bondi, M.W.; et al. Early versus late MCI: Improved MCI staging using a neuropsychological approach. Alzheimer’s Dement. 2019, 15, 699–708.
  35. Apostolo, J.; Holland, C.; O’Connell, M.D.; Feeney, J.; Tabares-Seisdedos, R.; Tadros, G.; Campos, E.; Santos, N.; Robertson, D.A.; Marcucci, M.; et al. Mild cognitive decline. A position statement of the Cognitive Decline Group of the European Innovation Partnership for Active and Healthy Ageing (EIPAHA). Maturitas 2016, 83, 83–93.
  36. Chertkow, H. Mild cognitive impairment. Curr. Opin. Neurol. 2002, 15, 401.
  37. Knopman, D.S.; Petersen, R.C. Mild Cognitive Impairment and Mild Dementia: A Clinical Perspective. Mayo Clin. Proc. 2014, 89, 1452–1459.
  38. Gauthier, S.; Reisberg, B.; Zaudig, M.; Petersen, R.C.; Ritchie, K.; Broich, K.; Belleville, S.; Brodaty, H.; Bennett, D.; Chertkow, H.; et al. Mild cognitive impairment. Lancet 2006, 367, 1262–1270.
  39. Chiara Abbatantuono; Federica Alfeo; Livio Clemente; Giulio Lancioni; Maria Fara De Caro; Paolo Livrea; Paolo Taurisano; Current Challenges in the Diagnosis of Progressive Neurocognitive Disorders: A Critical Review of the Literature and Recommendations for Primary and Secondary Care. Brain Sci. 2023, 13, 1443, .
  40. Petersen, R.C. Mild cognitive impairment as a diagnostic entity. J. Intern. Med. 2004, 256, 183–194.
  41. Petersen, R.C.; Caracciolo, B.; Brayne, C.; Gauthier, S.; Jelic, V.; Fratiglioni, L. Mild cognitive impairment: A concept in evolution. J. Intern. Med. 2014, 275, 214–228.
  42. Hughes, T.F.; Flatt, J.D.; Fu, B.; Chang, C.C.H.; Ganguli, M. Engagement in social activities and progression from mild to severe cognitive impairment: The MYHAT study. Int. Psychogeriatr. 2013, 25, 587–595.
  43. Cotter, J.; Granger, K.; Backx, R.; Hobbs, M.; Looi, C.Y.; Barnett, J.H. Social cognitive dysfunction as a clinical marker: A systematic review of meta-analyses across 30 clinical conditions. Neurosci. Biobehav. Rev. 2018, 84, 92–99.
  44. Rossetto, F.; Baglio, F.; Massaro, D.; Alberoni, M.; Nemni, R.; Marchetti, A.; Castelli, I. Social Cognition in Rehabilitation Context: Different Evolution of Affective and Cognitive Theory of Mind in Mild Cognitive Impairment. Behav. Neurol. 2020, 2020, e5204927.
  45. Morellini, L.; Izzo, A.; Ceroni, M.; Rossi, S.; Zerboni, G.; Rege-Colet, L.; Biglia, E.; Sacco, L. Theory of mind in patients with mild cognitive impairment: A systematic review. Front. Psychol. 2022, 13, 994070.
  46. Wang, Z.; Su, Y. The role of inhibitory control in the use of theory of mind among elders. Chin. J. Behav. Med. Brain Sci. 2010, 19, 732–734.
  47. Freedman, M.; Binns, M.A.; Black, S.E.; Murphy, C.; Stuss, D.T. Theory of Mind and Recognition of Facial Emotion in Dementia: Challenge to Current Concepts. Alzheimer Dis. Assoc. Disord. 2013, 27, 56–61.
  48. Snowden, J.; Gibbons, Z.; Blackshaw, A.; Doubleday, E.; Thompson, J.; Craufurd, D.; Foster, J.; Happé, F.; Neary, D. Social cognition in frontotemporal dementia and Huntington’s disease. Neuropsychologia 2003, 41, 688–701.
  49. Gregory, C.; Lough, S.; Stone, V.; Erzinclioglu, S.; Martin, L.; Baron-Cohen, S.; Hodges, J.R. Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer’s disease: Theoretical and practical implications. Brain 2002, 125, 752–764.
  50. Lough, S.; Hodges, J.R. Measuring and modifying abnormal social cognition in frontal variant frontotemporal dementia. J. Psychosom. Res. 2002, 53, 639–646.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
This entry is offline, you can click here to edit this entry!
Video Production Service
Feedback