Theory of mind deficits in neurological patients

This chapter reviews lesion studies that have been increasingly capable in clarifying the relationship between brain structures and social-cognitive functions, specifically emphasizing the role of the prefrontal cortex (PFC) in this domain. Accumulating lesion-based evidence suggests that the behavioral and social difficulties witnessed in patients with prefrontal neuropathologies are related, in part, to impaired theory of mind (ToM). For instance, deficits in taking another’s perspective, recognizing people’s social emotional expressions, or understanding when someone is being sarcastic may all result from difficulties making inferences about mental states, and consequently affect real-life social interactions. More specifically, patients with prefrontal lesions often display a specific deficit in making affective mental state attributions, and ToM tasks involving affective processing appear to depend on a distinct neural network involving the ventromedial prefrontal (VM) region and subcortical limbic structures. Since affective ToM seems to be understood at a later age than cognitive ToM, probably relating to neurodevelopmental patterns, future lesion studies should aim to compare between early and adult neurological patients, and perform longitudinal studies.