Relationship Between Cognitive Estimation, Executive Functions, and Theory of Mind in Patients With Prefrontal Cortex Damage

Abstract

OBJECTIVE: Conflicting evidence has arisen from the few studies that have examined the role of the prefrontal cortex and executive control functions in theory of mind (ToM). Moreover, the involvement of other cognitive domains in the ability to infer mental states is still under debate. This study aims to examine, in addition to the potential contribution of executive functions, the role of cognitive estimation in ToM abilities, given that cognitive estimation processes are strongly associated with some aspects of executive control functions. METHOD: The cognitive estimation task, along with a set of neuropsychological tasks assessing executive functions, was administered to 30 patients with prefrontal cortex damage and 30 control subjects matched by gender, age, and education level. RESULTS: Patients with prefrontal cortex damage were impaired in all measures of executive functions, cognitive estimation, and theory of mind compared with control subjects. Regression analysis showed a significant interaction between executive measures and cognitive estimation in predicting ToM performance for patients with prefrontal cortex damage. Additionally, voxel-based lesion analysis identified a partially common bilaterally distributed prefrontal network involved in all three domains, centered within the ventral and dorsomedial areas with extension to the dorsolateral prefrontal cortex. CONCLUSION: Our findings highlight that, apart from executive functions, cognitive estimation plays a crucial role in the ability to interpret others' cognitive and emotional states in both patients with prefrontal cortex damage and control subjects.