Emotional empathy may be preserved in people with Alzheimer's disease

People with Alzheimer's disease may retain their ability to empathize, despite declines in other social abilities, finds a new study led by University College London (UCL) researchers.

The researchers found that people with Alzheimer's disease scored slightly higher on a measure of empathy than peers of the same age with mild cognitive impairment, despite scoring worse on other measures of social cognition such as recognising facial emotions and understanding the thoughts of others.

The authors of the study, published in Alzheimer's & Dementia and supported by Wellcome, say this may be the first time a cognitive domain has been found to improve in dementia.

We found compelling evidence of preserved, or potentially even increased emotional empathy in people with Alzheimer's disease, compared to people in earlier stages of cognitive decline.

This finding could present an opportunity for researchers and health professionals to leverage these empathy skills in psychological supports for people with Alzheimer's disease, to help them to build and maintain social connections."

Dr. Andrew Sommerlad, Lead Author, UCL Psychiatry

The authors of the paper reviewed data from 28 previous studies conducted across the globe, with a total of 2,409 participants who had either mild cognitive impairment or dementia. Mild cognitive impairment is considered a risk state for dementia and is characterised by cognitive decline which is worse than expected for someone's age, but not yet affecting daily functioning.

The researchers found consistent evidence of progressive decline in the ability of people with dementia to recognise facial emotions and understand the thought processes of others, as those with Alzheimer's disease or frontotemporal dementia had worse scores than those with mild cognitive impairment.

The study's first author, Puyu Shi (UCL Psychiatry), commented: "The impairments in social cognition experienced by people with dementia often result in difficulties in understanding others' intentions and emotions, and responding appropriately in social interactions, which can cause distress for both patients and caregivers, and can also further contribute towards loneliness among people with dementia. Families of people with dementia should be supported so that they can understand and adapt to changes in their loved one's demeanour."

Intriguingly, the researchers found weak evidence of higher emotional empathy among those with Alzheimer's disease compared to those with mild cognitive impairment.

Of the research analysed, the study with the largest effect size for emotional empathy reported heightened emotional reactivity to negative emotions among those with Alzheimer's disease, which the researchers say may contribute to difficulties regulating emotions faced by in Alzheimer's patients as they lose other cognitive coping skills.

The researchers say more longitudinal data is needed to track how empathy and other social abilities change over time in healthy older adults without cognitive impairment, and those with dementia, and to better understand how measures of social cognition could help in dementia diagnosis and monitoring. Puyu Shi's PhD in the UCL Division of Psychiatry, funded by Alzheimer's Research UK, will examine these questions in more detail.

Dr Sommerlad added: "There remains a need for better tests that can enable early identification of these social cognitive impairments, which could help in diagnosis and potentially also help in predicting how cognitive decline will continue to progress."