Mentalizing ability in patients with prefrontal cortex damage

Introduction: Mentalizing ability is the issue in the social cognition of patients with brain injury that has received the most attention. The present study investigated mentalization ability in patients with prefrontal cortex damage. The aims of this study were to investigate: (a) whether patients with prefrontal cortex damage are impaired in mentalizing ability, including theory of mind (ToM) and empathy; (b) whether patients with ventromedial prefrontal cortex damage are impaired in different aspects of ToM; (c) whether patients with ventromedial prefrontal cortex damage are impaired in different aspects of empathy; and (d) whether impairment of mentalizing ability in patients with prefrontal cortex damage can be explained by executive dysfunction. Method: Mini-Mental State Examination (MMSE), Matrix Reasoning subtest, working memory, executive function, theory of mind, and empathy assessments were conducted on eight patients with ventromedial prefrontal cortex damage, 15 patients with dorsolateral prefrontal cortex damage, and 19 normal comparisons matched for level of education and intelligence. Results: The results showed that performance on affective and nonverbal theory of mind was significantly lower in patients with dorsolateral prefrontal cortex damage than in the comparison group. Performance on personal distress items of empathy was significantly lower in the ventromedial prefrontal cortex damage group than in the dorsolateral prefrontal cortex damage group. In addition, further multiple regression analysis showed that affective theory of mind could be explained by the Wisconsin Card Sorting Test-Modified (WCST-M), with an explained variance of up to 44%. Conclusion: The present study suggests that the impairment of mentalizing ability in patients with prefrontal cortex damage is partially the result of executive dysfunction.