This monocentric, non-interventional study (SELFSOC) investigates the relationship between self-awareness and social cognition in patients with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD). The primary objective is to assess metacognitive efficiency related to social cognitive performance using a computerized facial emotion recognition task combined with confidence judgments. Metacognitive indices (including Mratio) will quantify the correspondence between subjective and objective performance. Thirty-four participants (17 bvFTD, 17 AD; age 50-80; MMSE ≥20) will complete two study visits involving tasks assessing emotion recognition, theory of mind, and memory.
Self-awareness impairments are common in neurodegenerative diseases, yet their relationship with social cognition remains poorly understood. This study aims to characterize metacognitive processes associated with social cognition in bvFTD and AD, and to determine whether these processes differ across diagnostic groups. The primary objective is to evaluate metacognitive efficiency during a facial emotion recognition task using trial-by-trial retrospective confidence judgments, allowing computation of Mratio. This index reflects the alignment between perceived and actual performance. Secondary objectives include: (1) assessing additional metacognitive measures (prospective and global judgments), (2) comparing metacognition between bvFTD and AD, (3) examining correlations between metacognitive judgments and social cognitive performance, (4) testing domain specificity by comparing social cognition and memory, (5) evaluating the effect of task complexity, (6) assessing the impact of performance feedback, (7) comparing subjective versus objective metacognitive assessments, (8) investigating the role of anosognosia in AD, and (9) exploring associations with hypnotic suggestibility. Participants will attend two visits (\~2 hours each). The first visit includes eligibility assessment, sociodemographic data collection, and a computerized emotion recognition task with metacognitive judgments. The second visit includes additional computerized tasks assessing theory of mind and memory, and an optional hypnotic suggestibility assessment. Statistical analyses will include between-group comparisons using non-parametric tests, within-subject analyses, and exploratory correlational and regression analyses.
Study Type
OBSERVATIONAL
Enrollment
34
Eighteen facial photographs from the FACES database (Ebner et al., 2010) were selected, each depicting one of six emotions: joy, sadness, disgust, fear, anger, and neutral. For each face, the patient must identify the emotion being expressed by choosing from six verbal labels displayed on the screen.
The task consists of 32 silent black-and-white videos featuring two characters interacting in a social situation, adapted from the Pierre and Marie task (Caillaud et al., 2020). Each video lasts between 8 and 9 seconds and shows one of the two characters experiencing a specific emotion. Patients will be asked to infer the emotion felt by that character. The emotions depicted are either positive or negative and vary in complexity: embarrassment, pride, anger, and surprise (8 videos for each emotion). After each video, the name of an emotion will appear on the screen, and patients will be asked to indicate whether the displayed emotion matches the one felt by the protagonist (half of the options will be congruent and the other half incongruent). The measured variable will be the rate of correct responses.
The UCLA Structured Insight Interview (Mendez \& Shapira, 2011), translated into French, will be used to quantify anosognosia. This is a structured interview, conducted by the investigator, designed to assess patients' awareness of their symptoms in cases of neurodegenerative disease.
The participant, who must keep their eyes closed throughout the administration of the scale, receives a standardized series of suggestions read aloud by the experimenter in a specific order. These suggestions pertain to motor, sensory, verbal, and mnemonic responses (lowering or raising the arm, clenching the hands, feeling thirsty, speech inhibition, immobility, post-hypnotic response, and amnesia).The scale consists of 8 items and is therefore scored on a scale of 0 to 8 : minimum score 0/8 = no suggestibility; maximum score 8/8 = maximum suggestibility.
Cognitive Neurology Center, Lariboisière-Fernand Widal Hospital Group, APHP
Paris, France
RECRUITINGMetacognitive efficiency during facial emotion recognition (Mratio)
Metacognitive efficiency (Mratio) derived from a computerized facial emotion recognition task with trial-by-trial retrospective confidence judgments. This measure quantifies the correspondence between subjective confidence and objective performance in social cognition.
Time frame: Day 0
Prospective and global metacognitive judgments
Assessment of metacognitive performance using prospective (pre-task) and global (post-task) confidence judgments related to social cognitive tasks.
Time frame: Day 0, with the second evaluation taking place between Day 1 and Day 20.
Between-group differences in metacognitive efficiency
Comparison of metacognitive indices (including Mratio) between bvFTD and Alzheimer's disease groups during social cognition tasks.
Time frame: Day 0, with the second evaluation taking place between Day 1 and Day 20
Association between metacognition and social cognition performance
Correlation between metacognitive judgments and objective performance on social cognition tasks (emotion recognition and theory of mind).
Time frame: Day 0, with the second evaluation taking place between Day 1 and Day 20
Domain specificity of metacognition (social cognition vs memory)
Comparison of metacognitive efficiency indices (Mratio) between social cognition tasks and memory tasks.
Time frame: A single evaluation conducted between Day 1 and Day 20
Effect of task complexity on metacognitive performance
Comparison of metacognitive performance across tasks of varying complexity (low-level emotion recognition vs higher-level theory of mind).
Time frame: A single evaluation conducted between Day 1 and Day 20
Effect of feedback on metacognitive adjustment
Evaluation of changes in metacognitive judgments following feedback on actual performance.
Time frame: Day 0, with the second evaluation taking place between Day 1 and Day 20
Subjective versus objective metacognitive assessment
Comparison between questionnaire-based (subjective) and task-based (objective) metacognitive measures and their relationship with social cognition.
Time frame: Day 0, with the second evaluation taking place between Day 1 and Day 20
Impact of anosognosia on social cognition in Alzheimer's disease
Comparison of social cognitive and metacognitive performance between Alzheimer's disease patients with and without anosognosia.
Time frame: Day 0, with the second evaluation taking place between Day 1 and Day 20
Association between hypnotic suggestibility and metacognition
Exploration of the relationship between hypnotic suggestibility scores and metacognitive performance in bvFTD and AD patients.
Time frame: A single optional evaluation conducted between Day 1 and Day 20
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