This systematic review and meta-analysis examined the relationship between social cognition (SC) — measured with performance-based tests of emotion recognition and theory of mind (ToM) — and social behavior (disinhibition, apathy, irritability, agitation) rated by proxies, across adult patients with neurodegenerative diseases (AD, FTD, PD, HD, and others). Twenty-one cross-sectional studies published up to September 2023 were included.
Evidence for a consistent SC–social behavior link was weak. Meta-analyses found only small pooled effects: better emotion recognition correlated with fewer total behavioral symptoms (r = −.23, 95% CI [−0.42, −0.02]) and less apathy (r = −.24, 95% CI [−0.46, 0.01]), the latter non-significant. Disinhibition was most often associated with SC deficits (~50% of studies for total emotion recognition score); affective ToM was more consistently linked to behavioral symptoms than cognitive ToM. No associations were found between SC and irritability or agitation.
- Only 21 cross-sectional studies with small samples (median n = 26) were available, limiting meta-analytic power and causal inference. - High heterogeneity across studies in SC and social behavior instruments (I² = 69–75%) prevented broader meta-analyses. - Proxy ratings of behavior are subjective and may be influenced by caregiver burden; no correction for multiple comparisons was applied in the qualitative synthesis.
Clinicians should not rely on SC test scores alone to predict or explain social behavioral changes in neurodegenerative disease — the link is weak and inconsistent. Standardized, ecologically valid SC and behavioral measures are needed before SC testing can serve as a reliable early indicator of behavioral deterioration.
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