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Background: Intact socio-cognitive abilities, such as theory of mind (ToM), facial emotion recognition (FER), social decision making (SDM) and visual perspective taking (VPT), are essential for human well-being and quality of life. Impairment in social cognition can have major implications for health in affected individuals and society as a whole. Evidence for changes in social cognition in healthy and pathological aging processes, such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI), is currently either sparse or inconclusive. It is important to determine how social cognition changes in healthy and pathological aging and provide grounds for targeted and early assessment and intervention. The aims of this thesis were to investigate social cognition across four domains, in particular, ToM, FER, SDM and VPT, in healthy young and older individuals, as well as in individuals with cognitive deficits, such as SCD and MCI. In the case of a decline, further goals were to investigate the degree of impairment and the domains affected.
Methods: A systematic literature search was conducted in four major academic databases, MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo, for studies investigating social cognition in healthy young and old individuals as well as individuals affected by SCD and MCI which met the inclusion criteria. The primary outcome was ToM and secondary outcomes were FER, SDM and VPT. After a systematic review was performed, studies eligible for meta-analysis were divided according to comparison groups and outcomes. Random-effects meta-analyses were conducted using standardized mean differences (SMD). Risk of Bias was assessed using the “Tool to assess risk of bias in cohort studies” modified for the present study design.
Results: After a thorough systematic literature search, 86 studies containing 88 comparisons were included in the systematic review, of which 47 were eligible for quantitative analysis. The meta-analysis revealed a progressive decline in ToM and FER abilities from young adulthood to MCI. Varying effect sizes demonstrated different trajectories of change for specific domains. Due to a lack of research, data investigating SDM and VPT, as well as SCD were insufficient for quantitative analysis.
Conclusion: ToM and FER decline gradually from healthy to pathological aging. Therefore, assessment of social cognition is important and should be incorporated in routine neurocognitive testing, so that targeted interventions can be introduced when needed. With this information in mind, future research should focus on the development of new assessment tools, as well as preventive and treatment strategies. This review also identified research gaps in certain populations (e.g. SCD, middle age, MCI-subtypes) as well as domains (VPT and SDM) that need to be addressed in the future.