Have you ever tried to guess what someone else was thinking or feeling? Maybe you assumed someone was sad because they were quiet, or a family member was overwhelmed because they sighed a lot.
The ability to place yourself in another person’s shoes and adopt their perspective is a key cognitive skill for most relationships. However, to understand how others think and feel, we first need to develop something called Theory of Mind. This occurs between the ages of 3 and 4, but may be lost when dementia progresses. In fact, the loss of Theory of Mind predicts the onset of several behavioural and psychological symptoms of dementia.
What is Theory of Mind?
Theory of Mind is the ability to understand that other people have their own thoughts, feelings, and perspectives. This skill helps us get along with other people, predict what they’ll do, and demonstrate kindness in meaningful ways.
An Example . . .
Imagine noticing that your mom or dad looks tired while working on a task. As their caregiver, you intuitively know they need to rest.
As dementia progresses, several cognitive skills (a.k.a., thinking abilities) decline gradually over time. This means that caregivers may miss out on subtle changes, as a person living with dementia usually displays very gradual changes in their relationships and social abilities over many months. Looking back, the cognitive deficits are quite pronounced, and caregivers may feel overwhelmed by multiple changes building up over time!
A Quick Test for Theory of Mind
Imagine someone is shown a box they think contains candies. Upon opening this box, they discover it’s actually a box of chocolates!
Here’s the test…
Assuming others don’t know what’s inside the box, you ask them what others might guess is inside the box. They should assume others would guess the box has candies inside (and not, chocolates!). This demonstrates Theory of Mind.
How Dementia Affects Theory of Mind
There are many types of dementia, each affecting different parts of the brain.
In most cases, Theory of Mind is lost when the prefrontal cortex and temporal lobes are affected by the progression of dementia.
Lacking Theory of Mind might result in missed social cues, like not noticing when a caregiver is tired or overworked. Because the brain might not pick up on these cues, people living with dementia might keep asking for things or seem more demanding than usual. This isn’t because they are “selfish”, but it is more likely related to their inability to understand other people’s perspectives.
Common Symptoms of Social Deficits
When social cognition is lost, caregivers may observe that the person living with dementia begins to:
- Misread social signals: Jokes and casual comments are misinterpreted.
- Limit social participation: Other people notice that they are more withdrawn and less interested in social activities.
- Struggle with routine social interactions: Social activities become more difficult to sustain and may be marked by confusion or disorientation.
Why This Matters . . .
Knowing a bit about Theory of Mind helps caregivers understand the person behind the disease. For example, it helps to communicate from their perspective so caregivers notice ‘absence’ instead of perceiving rejection. It also helps caregivers to put themselves in the other person’s shoes, by exploring the lived experience of dementia instead of behaviours.
Research into Theory of Mind started in paediatric settings, working with conditions like autism. Since the early 2000’s, research has confirmed that some types of dementia – like Frontotemporal Dementias (FTD) – have more pronounced deficits in Theory of Mind while other aspects of cognition are relatively unchanged.
Emerging technologies have also shown promise for helping to improve social deficits. This can help people living with dementia to reconnect and maintain critical relationships, including with caregivers over time. With awareness of Theory of Mind deficits, caregivers can potentially change how the communicate to sustain more moments of joy as dementia progresses.