Reading the Mind in the Eyes: A Population-Based Study of Social Cognition in Older Adults

Introduction Social cognition indicates the cognitive processes involved in perceiving, interpreting, and processing social information. It is increasingly recognized in neurocognitive disorders, and it is included in DSM-5 as one of the six core cognitive domains to be assessed for the diagnosis of neurocognitive disorders. However, unlike other cognitive domains, social cognition is not routinely measured in geriatric evaluations. The Reading the Mind in the Eyes Test [RMET] is a measure of individual differences in "Theory of Mind (ToM)", the most representative mechanism of social cognition, which forms the basis of empathy. The present study aims a) to describe the distribution of the RMET scores in a population-based sample of older adults using a 10-item version of the RMET [RMET-10], b) to describe population-based norms of RMET-10, and c) to examine its associations with demographics, literacy, cognitive screen, clinical dementia rating, cognitive domains derived from a neuropsychiatric battery, anxiety and depression screens, and a test of social norms recognition. Methods Participants Participants were from the Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study which is focused on the epidemiology of mild cognitive impairment and dementia. The MYHAT cohort was accrued by age-stratified random selection from the voter registration in small-town communities in Pennsylvania, USA. Individuals were excluded if they were too ill to participate, had vision or hearing impairment, had decisional incapacity, or had substantial cognitive impairment (MMSE scores RMET-10 is an abbreviated version of the full RMET, an advanced test of ToM. The test stimuli consist of 10 grey-scale photos of people that were cropped and rescaled so that only the area around the eyes is visible. The participant is asked to select, within 20 seconds, the word which best describes what the person in the photo is thinking or feeling. Relevant to this report, the annual MYHAT assessment also included the following items: Demographics: age, sex, race (white/ non-white), level of education Cognitive screen: Mini-Mental State Examination [MMSE] Literacy: Wechsler Test of Adult Reading [WTAR] Depression symptoms: modified Center for Epidemiological Studies- Depression scale [mCES-D] Anxiety symptoms: Generalized Anxiety Disorder brief scale [GAD-7] Cognitive Composites: composite scores derived for the domains of attention, memory, language, visuospatial function, and executive function, derived from our neuropsychological test battery. Social Norms: Social Norms Questionnaire [SNQ-22] Dementia Rating: Clinical Dementia Rating [CDR®] Staging Instrument. On the CDR, ratings of 0, 0.5, and ≥1 indicate normal cognition, mild cognitive impairment or very mild dementia, and at least mild dementia. Results A total of 902 older adults age 66 to 105 years were administered RMET-10. The mean (SD) age of 76.6 (8.06) years; 62.4% were women; 38.9% had high school or less education; 61% had more than high school education; and 93.7% were of European descent. The RMET-10 scores were roughly normally distributed in our overall study sample with a range of 0-10, a median score of 7, and a mean (SD) score of 6.5 (1.9), and also among those with CDR=0, with range 0-10, median 7 and mean (SD) 6.64 (1.8). Mean (SD) RMET-10 scores were calculated for each of the categories in age, sex, education, race, MMSE, WTAR, SNQ-22, GAD-7, mCES-D, and CDR. The RMET-10 score was estimated to be significantly higher among those with younger age, higher education, white race, lower CDR, higher MMSE, WTAR, and higher cognitive scores in all five domains. Women performed significantly better than men only in the age group 65-74 years. In multivariable regression models adjusted for age, sex, and education, all the above associations remained statistically significant. RMET-10 score was also significantly higher in those with fewer anxiety and depression symptoms after adjusting for demographics. Conclusions Social cognition is relevant to the behavior and interactions of older adults and can be measured with a simple scale. Our population-based norms on the RMET could prove useful to clinicians and other researchers in calibrating the scale for their own patients and study participants. Using the scale as a continuous measure, clinicians can assess their patients’ social cognition bearing in mind that test scores will be influenced by age, sex, race, and education, as well as by anxiety and depression. Funding The work reported here was supported in part by grant # R01AG023651 from the National Institute on Aging, NIH, US DHHS.