Ibanez Manes Neurology 2012

VIEWS & REVIEWS
Contextualsocialcognitionand
thebehavioralvariantof
frontotemporaldementia
ABSTRACT
Agustin Iban˜ez, PhD
Facundo Manes, MD,
MS
The significance of
social situations is
commonly context-
embedded. Although
the role of context has
been
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Dr. extensively
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nez studied in basic
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Dr.
Ma
processing or
nes simple stimulus-
:
aib
response
ane settings, its
z@
ine
relevance for
co. social cognition
org
.ar
is unknown. We
or propose the
fm social context
ane
s@ network model
ine (SCNM), a
co.
org fronto-insular-
.ar temporal
network
responsible for
processing
social
contextual
effects. The
SCNM may 1)
update the
context and use
it to make
predictions, 2)
coordinate
1354
in the behavioral
te variant of
rn frontotemporal
al dementia
an (bvFTD) as a
d specific disorder
ex in which the
te reported deficits
rn in social
al cognition (e.g.,
m facial
ili recognition,
eu empathy,
s, decisionmaking,
an figurative
d language, theory
3) of mind) can be
co described as
ns context
ol impairments due
id to deficits in the
at SCNM.
e Disruption of
co orbitofrontal-
nt amygdala
ex circuit, as well
t- as the frontal,
ta temporal, and
rg insular atrophy
et in bVFTD,
as suggests a
so relationship
ci between
ati context-
ve sensitive social
le cognition and
ar SCNM. In
ni considering
ng context as an
. intrinsic part of
W social cognition,
e we highlight the
su need for a
gg situated
es cognition
t approach in
Neurology 78 April 24, 2012
1355
so ssment of
ci context-
al dependent social
co cognition
gn paradigms, the
iti SCNM, and
on their possible
re application to
se neuropsychiatric
ar disorders may
ch provide new
as insight into
op bvFTD and
po other related
se frontal
d disorders.
to Neurology®
an 2012;78:1354–1362
ab
str GLOSSARY
ac bvFTD behavioral
variant of
t, frontotemporal
un dementia; OFC
orbitofrontal cortex;
iv SCNM social context
er network model; SOS
sa superior orbital sulcus.
l,
an Context-
d
dependence
de
effects are
co
nt pervasive in
ex everyday
tu cognition.
ali When we
ze perceive
d objects and
ap colors, we
pr
always
oa
ch
perceive these
. among other
T objects and
he colors. We
as listen and
se speak within
1356
ot ngs. We
he perceive facial
r emotion
w together with
or body
d language, the
str prosody, and
ea cues from the
m situation, all
s, of them
an merged to
d understand the
ev precise
er emotional
y significance.
at Acting
o appropriately
m in social
of interactions
m requires the
ea interpretation
ni of explicit and
ng implicit
e contextual
m clues that
er orient our
ge responses
s toward being
fr polite, to make
o a joke or point
m out an irony,
a to say or not
ba say
ck something.
gr Cognitive
ou science and
nd neuroscience
of research have
m evidenced
ea context-
ni dependence
1357
ef cognition15,16 in
fe both normal
ct and
s neuropsychiatr
in ic conditions.
si But what is
m context?
ila Simply put, a
r contextual
do factor (X) is
m something that
ai has an effect
ns on a cognitive
of event and can
vi be determined
su by observing
al how that event
pe is affected
rc when X is
ep changed.17
ti However, this
on basic
,1– definition
3
seems to miss
e the essence of
m contextual
ot effects, which
io is best
n, illustrated
4–7
with a simple
la
optical
ng
illusion. The
ua
Ebbinghaus
ge
illusion (figure
,8–
14 1A) depicts 2
identical
an
central circles,
d
surrounded by
so
rings of
ci
circles.
al
Despite the
1358
fa The contextual
ct information
th available (the
at surrounding
th circles) creates
ey the perception
ar that the center
e circles are
th different sizes.
e Context seems
sa to be more
m than a variable
e that affects a
si particular
ze cognitive
, process.
on Rather,
e contextual
ci cues seem to
rc be an intrinsic
le part of the
is cognitive
pe processes that
rc enable the
ei understanding
ve of
d
as From the INECO
(Institute of Cognitive
s Neurology) and
m Institute of
Neurosciences (A.I.,
all F.M.), Favaloro
University, Buenos
an Aires; Laboratory of
d Cognitive Neuroscience
(A.I), Universidad
th Diego Portales,
Santiago, Chile; and
e National Scientific and
ot Technical Research
Council (CONICET)
he (A.I.), Buenos Aires,
Argentina.
r
Study funding:
as Supported by
CONICET and
bi Foundation INECO
g. grants.
1359
Figure 1 Context-dependent effects from visual perception to social cognition
(A) The Ebbinghaus illusion. (B) The role of social context in semantic and situational meaning. Two different social contexts (in this case, indexed by the emotional expression, the
dancing situation, and the other’s actions) dramatically alter the meaning of the same sentence: “Mike, you are such a good dancer!” This figure makes a comparison between
visual perception and social cognition by pointing out that they can both generate instances where the same stimulus is differentially experienced as a function of context. But there
is also a difference. The perceptual illusion is obligatory (i.e., intrinsic to the hard-wiring of the visual system) whereas the utterance and interpretation of the comments in B are
conditional. The femme fatale has the choice not to utter the comment and the young man has the option of interpreting the comment as wistful/friendly or sarcastic/cruel. The
critical input of our brain (mainly prefrontal cortex) is probably based on its ability to coordinate conditional behaviors and interpretations in social situations. Illustration by Carlos
Go the authors, if any, are
to provided at the end of
Ne this article.
uro
log
Copyright © 2012 by
y.o
AAN Enterprises, Inc.
rg
Becerra (B).
for
full
dis
clo
sur the specific
es.
Dis significance
clo
sur
of an object.
es This is
dee
me illustrated by
d
rele
figure 1B.
van Like the size
t by
1360
of the circles in internal
the
Ebbinghaus illusion,
and
the meaning of external
the
sentence “Mike, youevents
are such a good that
dancer!” occur
is
dependent on during the a
contextual particul
information. ar
cognitiv
are present at every
e
level, from basic process.
perception to social
Context
interaction. ual cues
This
means that we evoke do
previou
not perceive objects
or process cognitive
s
experie
events in an abstract
and universal way. nces,
The allowin
specific
significance of gan
object, coordin
emotion,
word, or social ation
situation depends between
on
the contextual
internal
effects. (previou
During
normal cognition,
s
our brains do not experie
process targets andnces)
and
contexts separately;
rather, targets areexternal
in
context. The brain (specifi
dynamically c
constrains situatio
and
shapes cognitive
ns)
process
processing, parallel
to external context.
es for
If this is true, all
cognition is a highly
cognitio
n.
situated process that
is dependent on Context
the
1361
-based predictions CONTEXT
AND
streamline cognitive
SOCIAL
processing, and
COGNITIO
ambiguous objects N
can be correctly Compreh

ension of
processed by
social
contextual cues.
cognition
Considering abstract
, from
or decontextualizedbasic
targets, which emotiona
are
rarely encountered l facial
in processin
everyday
cognition, g
would to
increase complex
the
social
ambiguity of
decision-
cognitive making,
processing. This areis
not a trivial pointmostly
and implies that embedde
cognitive process
d in a
models based social on
universal context.
and
The
acontextual
essence
approaches are blind
of social
to an intrinsic
phenome
property naofoccurs
cognition: inits a
contextual and
situation
situated nature.
al frame
Depending oron
contextual backgrou
nd in
processing,
which
perception of the
the
same targets
specific
(objects, language,social
emotion, or social meaning
cues) would be veryemerges.
These
different, and neural
processes may also context-
differ. sensitive
aspects
include
1362
face processing,
the
empathy, emotional
frames
inference, theory and of
mind, figurative
contextu
language, decision-
al
making, social norms, shortcuts
and attitudes. The those
structural processing
states are
and emotional
embedde
recognition of a face d in can
usually occur withinbea
background that
accessed.
includes emotional
Multiple
body language and figurativ
other convergent
e aspects
information (e.g.,
of
prosody, situational
language
clues). The empathy (e.g., the
for pain involves way the of
capacity to share and saying
recognize feelings that
somethin
are being experienced g other
by another in pain. than the
When we see a person literal
suffering from physical
meaning
pain (e.g., during ofan the
assault), we can
words)
experience empathy,
are used
but depending on during
the
contextual situation, everyday
we
might feel at risk andsocial
decide to escape speech.or
attack. The theory The of
mind consists of intrinsic
the
ability to attribute “figurati
cognitive and affective
ve”
mental states to oneself
content
and others. Usually, of
the the
emotional and
speech
cognitive mental states
(e.g.,
of others are inferredrhetorica
using contextual
l, ironic,
information. Beliefs, or
intentions, and other metaphor
mental states are moreical) is
reliably inferred wheneasily
1363
and correctly
circumst
recognized when ances the
audience has accessthat to help
paralinguistic cues,
build
emotional body
intrinsic
language, and socialthe
specific situational
meaning.
circumstance
Neuroscience of the
speech.
researchWe has make
hundreds
assessed of the rolesmall
decisions every day.
of context in In
somelower situations,
domains we
decide
(e.g., based visual on
ambiguous
perception) with clues
without predicting the
relatively
outcome,
exhaustivebut in other
situations
anatomicwe and cannot
make a
explanatory decision
without
models,full1,19knowledge
but its
of rolethe in risks higherand
potential consequences.
domains (e.g.,
Social norms
social guide our
cognition)
behavior;
is not itwell is
appropriate
understood.to be
serious and quiet at a
Although
funeral, but friendly,
contextual
humorous,
effects and sociable
have
at abeen
party. Finally,
proposedhow
we asexpress
an intrinsic feelings
about
partotherof races social or
ethnic or social20groups
phenomena,
are andmodulated
it is well by
different
known that brain social
situations, specifically
region activation
the is
presence
modulated or absence
by
of social
memberscontext, of these
groups.
no In brief, social
current
cognition
model hasprocesses been
(e.g., facial processing,
suggested. We
emotional
propose that theinference,
empathy,
contextual theory of
mind, decision-making,
influence on
social
social norms,
cognitiveand
social attitudes) seem
processing
to depends
be embedded on a in
specific
fronto-insular-contextual
1364
te the internal and
m external milieus,
po and 3)
ral consolidates
ne context-target
tw associative
or learning.
k Moreover, we
th propose that a
at specific
1) neuropsychiatric
up disorder can be
da described as
te having strong
s contextual social
co cognition
nt impairments.
ex
tu FRONTOTEMPORAL
al DEMENTIA AND
cu SOCIAL
es CONTEXT The
an behavioral
d variant of
us frontotemporal
es dementia
th (bvFTD) is
e characterized by
m insidiously
to progressive
m changes in
ak personality and
e social
pr interaction that
ed typically
ict precede other
io cognitive
ns deficits. On the
, whole,
2) perception,
co episodic
or memory,
di visuospatial
na abilities, and
te praxias are
s intact or
1365
re disinhibition,
lat and
iv impulsiveness22
el are evident. The
y recently revised
w criteria require
ell possible bvFTD
pr cases to present
es with 3 out of 6
er clinically
ve discriminating
d. features:
C disinhibition,
on apathy/inertia,
ve loss of
rs sympathy/empat
el hy,
y, perseverative/co
de mpulsive
fi behaviors,
cit hyperorality,
s and
in dysexecutive
so neuropsychologi
ci cal profile.
al Probable bvFTD
in is further
te characterized by
ra functional
cti disability and
on characteristic
, neuroimaging,
la and bvFTD with
ck definite
of frontotemporal
e lobar
m degeneration
pa requires
th histopathologic
y confirmation or
fo pathogenic
r mutation
ot identification.22
he Patients may
rs, present with
21
compulsiveness,
1366
pe activities or
rs hobbies, or
ev withdrawal and
er apathy.25
ati Increased
on appetite with a
s, tendency for
or sweet foods is
st common, and
er hypersexuality
eo and hyperorality
ty may develop,
pe especially in the
d advanced stages
re of the disease.
pe Early diagnosis
tit is difficult
iv because
e behavioral
ac problems
ts, dominate the
23
clinical picture
lo while cognitive
ss functions are
of still relatively
se intact. People
lf- with bvFTD
co often score
ns normally on
ci mental status
ou screens, and
sn conventional
es structural brain
s,2 imaging (CT
4
and MRI) may
di not be sensitive
m to the early
in changes
is associated with
he bvFTD.21
d Therefore, early
in diagnosis relies
te on clinical
re interviews and
st caregiver
fo reports; it can be
r Neurology 78 April 24, 2012
1367
co y psychiatric
ns syndromes.
id BA21, BA38);
and insula
er
(BA48).
ab
ly
di Patients with
ffi bvFTD have
cu consistent
lt deficits in
to several domains
di of social
sti cognition such
ng as recognizing
ui emotions in
sh facial
bv expressions,26
F empathy
T processing,27
D decision-
fr making,28,29
o figurative
m language,15
pr theory of
i mind, 30,31
and
m interpersonal
ar norms.32 We
propose that this
Figure 2 The social context network model (SCNM) and behavioral variant of frontotemporal dementia (bvFTD)
(A) The SCNM. Lateral view of the left hemisphere showing the proposed fronto-insular-temporal network (light blue, violet, and green regions of interest, respectively). In this
context network, prefrontal areas (PFC) such as frontopolar and dorsolateral-prefrontal cortices would be involved in the generation of focused predictions via the update of
associative activation of representations in the specific context. The insular cortex would provide the convergence point for emotional and cognitive states related to the
coordination between external and internal milieus, facilitating the fronto-temporal interaction in social context processing. Finally, target-context associations stored in the
temporal regions would be integrated with feature-based information processed in frontal regions. Connected nodes represent the fronto-insular-temporal interactions. (B) bvFTD
atrophy pattern. Lateral view of earliest regions thought to be damaged in bvFTD, in the frontal, insular, and temporal areas (light blue, violet, and green regions of interest,
respectively). Note the partial overlap with the nodes of the SCNM. Highlighted regions correspond to the following Brodmann areas: frontal (BA46, B10, BA11, BA24); temporal
1368
(BA20,
specific pattern sulcus)of
social cognition
update
impairment can and be
understood as a general
associate
impairment of social ongoing
context processing
contextu
information that is al the
result of an abnormal informati
fronto-insular-temporal
on in
network. relation
to
A NEUROANATOMICepisodic
PATHWAY: THE SOCIAL
memory
CONTEXT NETWORK MODEL
and
Context-based
target-
predictions make social
context
cognition more
associati
efficient. Prototypical
ons. The
situations in the
temporal
environment are
regions
represented in “context
(amygdal
frames” that integrate
a,
information about the
hippoca
meanings of social
mpus,
targets (e.g., an
emotional face, perirhina
a
l and
speech) that are likely
parahipp
to appear in a specific
ocampal
scene with information
cortices)
about their
index the
relationships.
value
learning
there exists a cortical
of target-
network that mediates
context
the processing of such
associati
contextual associations.
ons.
This social context
Finally,
network involves
the
regions of the frontal,
insular
insular, and temporal
cortex
cortices. As detailed in
coordinat
figure 2, we postulate
es
that frontal areas (e.g.,
internal
orbitofrontal cortex,
and
lateral prefrontal
external
cortex, superior orbital
milieus
1369
in ntal an areas
internal
motivational
(orbitofrontalstate. In
this cortex,
way, the lateral
insula
wouldprefrontal provide
information
cortex, superior
integration
fromorbital
internal sulcus)
states and
social
seem contexts
to be to
produce
involveda global
in
feeling
predictions,
state.
U using the
pd context to
ati update the
ng encoding and
an retrieval of
d
pr
episodic
ed learning.33–36
ict Animal studies
in provide direct
g: evidence for this
A
hypothesis.
cr
uc Prefrontal
ial neurons show
ro rapid frontal
le adaptation to
fo
contextdepende
r
th
nt behavioral
e significance in
fr short-term
on context
tal paradigms.37
lo
These cells
be
in seem to update
co the same targets
nt in different
ex contexts.38 In the
tu
orbitofrontal
al
int cortex (OFC),
eg neurons encode
ra motivational
tio context
n.
information.35
Se Primate lateral
ve prefrontal cortex
ra neurons are
l context-
fr dependent,
o Neurology 78 April 24, 2012
1370
irr rior orbital
es sulcus (SOS)
pe has also been
cti directly related
ve to the contextual
of update of visual
di targets.1 This
ff frontal site
er would play an
en important role in
ce the generation
s of focused
in predictions via
th the update of
e associative
cu activation of
e’ representations
s in the specific
ph context.19
ys Patients with
ic frontal lobe
al lesions fail to
pr recognize how
op context alters
er the meaning of
tie stimuli.39
s.3 Thinking
5
becomes
In concrete, and a
an patient’s
i behavior is
m guided by
al superficial cues
an from the
d environment;
hu some patients
m ignore the
an incongruity of
st context.39
ud Conversely,
ie although these
s, patients exhibit
th some
e characteristics
su that affect their
pe behavior,40 they
1371
be entrolateral
prefrontal
ha cortex. a
ve References e1–
Table Representative examples of contextual effects in social cognition
Social cognition
a
Study Participants function Context-manipulation Main results Reference
Leitman et al (2011) 16 SCZ, 17 controls Facial affect Congruent/incongruent Patients presented reduced OFC/ e1
recognition emotional contexts VLPFC activation in response to
contextual modulation
Hadjikhani et al (2009) 12 ASD, 7 controls Emotion perception Emotional body language Decreased activation in the frontal e2
cortex and insula in ASD
Akitsuki and Decety (2009) 26 healthy adults Empathy for pain Social context scenes Insular modulation of target e3
stimuli; contextual effects trigger
increased activity in MFG, IFG, and
OFC
Jenkins and Mitchell (2010) 15 healthy students ToM Contextual ambiguity of Increased MPC during ambiguous e4
the stimuli mental inference
Rankin et al (2009) 20 FTD, 51 ONC, 13 controls Figurative language Vocal and facial Smaller volume (VBM analysis) in e5
(sarcasm ) paralinguistic cues PHC, temporal poles, and MPC
associated with poorer sarcasm
comprehension
Davis et al (2010) 47 healthy participants Social conditioning Contextual learning of Amygdala and additional temporal e6
social outcomes regions involved in social learning
Moll et al (2005) Review Moral cognition Situational context Evidence of interaction between e7
social knowledge (PFC) and social
semantic knowledge (TL) engaged
in contextual moral cognition
Zahn et al (2009) 29 healthy participants Social values Self-other perspective and Coactivation of stable abstract e8
valence of social values social conceptual representations
(TL) and context-dependent moral
cognition (FMR)
Wright et al (2011) 32 healthy participants Social decision- Contextual fairness PFC and insular modulation in the e9
making interaction of decisions and
context
Abbreviations: ASD autism spectrum disorder; FMR fronto-mesolimbic regions; FTD frontotemporal dementia; IFG inferior frontal gyrus; MFC medial frontal cortex; MFG medial
frontal gyrus; MPC medial prefrontal cortex; OFC orbitofrontal cortex; ONC other neurodegenerative conditions; PFC prefrontal cortex; PHC parahippocampal cortex; SCZ
schizophrenia; TL temporal lobe; ToM theory of mind; VBM voxel-based
e9 are available
m
on the
o
Neurology Web
r
site at
p
www.neurology
h
.org.
o
m
e
t impeccab
r
y
ly in the
; office.
This is
V consisten
L t with the
P
F
idea that
C these
patients
v are most
1372
impaired under
associati
circumstances with
ve
minimal external
processe
control of behavior. s such as
extinctio
Interplay between
internal and external n48 and
milieus in the insular environ
cortex. ment
seems to be represent
a
convergence area that ation49
integrates internal andengage
external milieus.the
This cortex hippoca
uses
previous experiencesmpus,to
connect intentions and amygdal
motivations for a, a and
related
specific cognitive task.
The insula integrates temporal
modality-specific sites
feeling states (e.g.,
and
uncertainty perirhina
with
individual preferences l cortex).
and Contextu
contextual
information to produce al
a global feeling state.markers
Thus, in our model, are the
insula would provide initially
the convergence point stored in
for emotional and the
cognitive medial
processes
related to temporal
the
coordination between lobes,
external and internal where
states, facilitating they
the
frontotemporal cohere
interaction in social with
context processing. featural
informati
Value-based learning of
contextual associationsonin
the temporal processe
lobe.
Target-context d in
associations can frontal be
considered to be regions.
the 50
building blocks of
Neuroimagin
contextual
g studies in
learning.
humans suggest
1373
th r mediating
at global
th contextual
e associations.1
pa The
ra parahippocampa
hi l cortex has also
pp been associated
oc with some
a aspects of
m episodic
pa memory.
l Structures in the
co medial temporal
rte lobe, including
x the
re hippocampus,
ce and perirhinal
iv and entorhinal
es cortices are
po thought to be
ly important in
se associative
ns processing.
or Unfortunately,
y there is not
an enough evidence
d to make a clear
so functional
m distinction
at between the
os subdivisions of
en the medial
so temporal lobe.1
ry Contextual
in effects in social
fo cognition have
r not been
m assessed yet in a
ati systematic and
on exhaustive
re approach.
qu Nevertheless,
ire recent reports
d using context
fo manipulations in
1374
re al context
pr network model
es (SCNM).
en
tat SCNM AND bvFTD
iv We propose that
e the SCNM
so would provide
ci an adequate
al model to
co understand
gn bvFTD-related
iti social
on impairments.
fie Disruption of
ld the
s orbitofrontal-
(ta amygdala circuit
bl is thought to be
e) responsible for
of the triad of
fe bvFTD
r symptoms that
lin includes
ks disinhibition,
to stereotyped
sp behaviors, and
ec gluttony.25 The
ifi mesial and
c orbital frontal
br regions atrophy
ai first, followed
n by the temporal
re pole,
gi hippocampal
on formation,
s dorsolateral
en frontal cortex,
ga and the basal
ge ganglia. This
d pattern of
in atrophy
th progression has
e been shown to
so correlate with
ci the volume of
1375
co evaluatio
rti n of the
ca motivatio
l nal or
an emotiona
d l content
su of
bc internal
or and
tic external
al stimuli,
re error
gi detection
on ,
s response
an selection
d and
wi decision-
th making,
un and
de subseque
rl nt
yi regulatio
ng n of
ne context-
ur dependen
on t
al behavior
lo s.53
ss Recent
. neuroima
ging
symptoms of FTD studies
suggest
reflect the involvement
that
of orbitofrontal cortex
as well as patients
the
with
disruption of the rostral
limbic FTD
system
including the insula, show
the anterior cingulatepredomin
cortex, the striatum, antly
the
amygdala, and right the
medial frontal lobes.frontal,
anterior
This system is involved
in a number insular, of
processes such as and the
1376
anterior cingulate
decontex
deterioration, with
tualized
pronounced approach
orbitofrontal cortex
. The so-
atrophy. called
some studies have theories
reported correlations
of
between behavioral
embodie
symptoms and brain d
structures, suggesting cognition
that the right
propose
orbitofrontal cortex
that
regulates behavior
human
together with mind a is
predominantly rightsidelargely
network involving determin
the
insula and striatum. ed by the
addition, voxel-based ecologic
morphometry studies al
have shown that
coupling
patients with bvFTD of
have significant gray sensorim
matter loss in otor the
anterior insula and in systems,
a
variety emotions
of frontal areas. , and the
current
research agenda linkingenviron
contextsensitive socialment.
cognition, SCNM, and Theoreti
bvFTD is proposed. cal
Implementing such claims an of
agenda would have embodie
several implications.d
cognition
A NEW RESEARCH AGENDA and
Theoretical implications.
related
In considering context fields
as an intrinsic partsuch of as
social cognition, embodie
we
highlight the need for da
situated cognition
emotion,5
approach in social 5
cognition research embodie

as
opposed to an abstract,d theory
universal, and
of
1377
thesis and tests for
mind,
bvFTD and other
practices
neuropsychiatric
integrated with clinical
disorders. We
and experimental
proposed that
approaches to study the
the wide range
contextual effects of
of social
social phenomena.
cognition
Integrating
impairmentsprevious in
research
bvFTDintocan a benew
agenda.
partially
contextual
explainednatureby a of
social events
general deficit is far
fromin controversial,
integrating
theresocial
is nocontextunifying
theoretical
and background
behavior.
for Because
research in animal
models, lesion studies,
neuropsychologi
neuropsychiatric
cal tests
reports,
designed toand
experimental
detect
neuroscience.
impairment inThe
SCNMsocial provides
cognition an
empirically
are testable set
important
of bvFTD hypotheses
regarding
diagnosticcontextual
update,
tools,21 contextualour
prediction,
hypothesis target- of
context
social association,
context
and impairments contextual
in
coordination
bvFTD can be of internal
cognitive processes and
empirically
external
evaluated frames and in
social
can cognition
provide
paradigms.
insights Typical
into
approaches
clinical, to
emotional processing,
diagnostic, and
mental
cognitive inference,
empathy,
models offigurative
this
language,
disorder.and decision-
making can be assessed
Although the
in relation to
complexity ofcontextual
manipulations.
social context
Ne can be a
w problem in
hy experimental
po
1378
se mains of
tti contextual
ng studies7,59)
s, adapted to social
th cognition tasks
e can provide
us simple
e experimental
of shortcuts.
fr At the same
a time, a further
m contextual and
es ecological
, evaluation of
ba bvFTD would
ck provide more
gr sensitive tools
ou for bvFTD
nd research (see
in below). In fact,
fo bvFTD is one of
r the disorders in
m which patients
ati present with
on behavioral
, problems
or despite good
m neuropsychologi
ul cal test scores
ti (the so-called
m “frontal lobe
od mystery”40). This
al paradox could
de be partly
si explained by the
gn use of an
s extended
(a abstract and
s decontextualized
us neuropsychologi
ed cal evaluation.
in The mismatch
ot between
he everyday
r cognition and
do neuropsychologi
1379
ca hich would
l perform better
pr than context-
of dependent tasks.
ile That is to say,
in bvFTD
bv detection might
F improve if
T clinical tests
D were context-
ca dependent.
n
be CONTEXT AND THE
pa FRONTAL LOBE
rti MYS-
all TERY Mesulam41

y suggests that
ex frontal lobe
pl symptoms
ai would not be
ne detected with
d traditional
by office-based
th neuropsychologi
e cal tests, yet
ab patients are
str impaired in their
ac everyday lives.
t Most of the
pr traditional tests
oc used to assess
es executive
si functions were
ng not originally
of created for the
st purpose of
an investigating
da patient
rd populations; in
as many cases,
se there have been
ss few
m modifications to
en these procedures
t, for new
w applications.
1380
T k, and verbal
he fluency tasks)
re are not good
fo “models of the
re world”40 because
, they are abstract
tr tasks that lack
ad the context of
iti everyday life
on situations. For
al example,
ex working
ec memory is
ut sensitive to
iv distractibility
e and interference,
te so in a context
st in which the
s environment has
(e plentiful stimuli
.g. and distracters,
, the bvFTD
th patient’s
e working
W memory is more
is likely to fail
co than in a quiet
ns and simple
in environment.
C The magnitude
ar of the deficits
d depends on the
S context of the
or testing and on
ti the degree to
ng which the test
T requires the
es suppression of
t, interference.60
th Moreo
e ver,
St standard
ro cognitive
op tests are
T included
as in an
1381
abstract and
structural
acontextual lesions
neuropsychological of the
assessment. The office ventrome
setting may introduce dial
sufficient external
prefronta
structure to suppress l cortex,
some behavioral
schizoph
tendencies. renia,
observations emphasize autism,
the importance and of
developing more
dementin
ecological measures
g illness
that include contextual of any
sensitivity evaluation. cause.
Consequently, Burgess Formulat
et al. ing the
multitasking tests
thought
(Multiple Errands Test disorder
and Six Element Test) of
that represent some schizoph
real-life situations.
renia as
Because these tests one with
represent the contextdeficits
of
real-life situations, they
in the
more clearly reflect SCNMthe
difficulties that patients
offers a
with bvFTD face. Inparsimona
similar way, Torralva ious
et al. explanati
more organic
on of
evaluation for the earlytheir
detection of executive difficulti
and social cognitive es that
impairments in bvFTD. range
from
DISCUSSION basic
variant FTD is visual the
prototypical disorderperceptu
in
which social behaviors al
are disrupted in certainproblems
contexts. However,to their
there are other diseasesdeficits
in which the SCNMinisspeech
disrupted, such and as
traumatic brain injury, social
1382
cognition. the
different
context-dependent degenera
social ting brain
cognition
paradigms, the SCNM, regions
and their (frontal,
possible
application insular,
to
neuropsychiatric temporal
disorders may provide ) in
new insight into bvFTD bvFTD
and other be tested
related
disorders. The ideal in
experimental approach relation
would be to haveto a the
battery of tasks that SCNM?
vary the degree The of
context empirical
for
emotional/social answers
stimuli, and that also to those
verify whether there questions
are
any deficits in contextmay
processing provide
for a
nonsocial strong
stimuli.
Further framewo
outstanding
questions to rkbe for
assessed assessing
with
experimental a more
paradigms are sensitive
as
follows: 1) How contextu
can
contextual information al social
be used for making cognition
predictions and acting profile in
in social situations?frontal
2)
How are social context diseases.
frames integrated in the
AUTHOR
brain, and what elicits
CONTRIBUTIONS
theirDr. Ibanez:
activation?
principal 3)
Which paradigmsandare
investigator
corresponding author.
bestF.suited to test the 3
Manes:
components
corresponding of author.the
SCNM?Dr. Ibanez4)contributed
Which
to conceptualization,
social cognition tests
drafting, and revising of
are themore sensitiveF. to
manuscript.
contextual modulation
Manes contributed to
conceptualization and
in bvFTD and related
revising the manuscript
disorders? 5) How can
1383
for earlier influence on this
con work.
tent
. DISCLOSURE
The authors report no
AC disclosures relevant to
KN the manuscript. Go to
Neurology.org for full
O disclosures.
WL
ED
ReceivedOctober17,
G
2011.Acceptedinfina
M
lformDecember14,2
EN 011.
T
The
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1397

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VIEWS & REVIEWS

Neurology 78 April 24, 2012

Neurology 78 April 24, 2012

can be correctly Compreh

Table Representative examples of contextual effects in social cognition

cognition research embodie

all TERY Mesulam41

Neurology 78 April 24, 2012

Neurology 78 April 24, 2012

Neurology 78 April 24, 2012

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