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Cognitive and affective theory of mind in Korsakoff’s syndrome

Published online by Cambridge University Press:  18 December 2018

Rolinda Drost*
Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands Slingedael Korsakoff Center, Rotterdam, The Netherlands
Albert Postma
Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands Slingedael Korsakoff Center, Rotterdam, The Netherlands
Erik Oudman
Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands Slingedael Korsakoff Center, Rotterdam, The Netherlands
Author for correspondence: Rolinda Drost, Helmholtz Research Institute, Experimental Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands. Tel.: +31 30 253 4281; Fax: +31 30 253 4511; E-mail:



Korsakoff’s syndrome (KS) is a chronic neuropsychiatric disorder characterised by severe anterograde amnesia and executive deficits. Theory of Mind (ToM) is the capacity to represent others’ mental states such as their knowledge, thoughts, feelings, beliefs, and intentions in order to explain and predict their behaviour. Surprisingly this topic has received hardly any attention in research on KS, although the severity of behavioural problems in KS suggest possible ToM difficulties. The aim of the present study was therefore to assess whether cognitive and affective ToM are impaired in patients with KS.


We examined 21 KS patients and 21 age- and gender-matched healthy controls on three standardised tests that assess cognitive and affective ToM, including the subtests of the mini-Social Cognition and Emotional Assessment battery and a specialised version of the Sally–Anne Test.


KS patients showed largely impaired cognitive and affective ToM compared to healthy controls, as reflected in large effect sizes on both cognitive and affective ToM tests. Executive deficits explained problems in emotion recognition, but not other ToM aspects.


KS patients have large impairments in both cognitive and affective aspects of social cognition. Their ability to recognise emotions, take the perspective of others, and understand socially awkward situations is vastly compromised. The impairments in ToM functioning are to a large degree functionally discrepant from executive disorders that are commonly present in KS. This study therefore highlights the importance to properly index ToM functioning in neuropsychological assessments for individuals with a possible KS diagnosis.

Original Article
© Scandinavian College of Neuropsychopharmacology 2018 

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1. Arts, NJ, Walvoort, SJ and Kessels, RP (2017) Korsakoff’s syndrome: a critical review. Neuropsychiatr Dis Treat 13, 28752890.CrossRefGoogle Scholar
2. Kopelman, MD (2002) Disorders of memory. Brain 125, 21522190.CrossRefGoogle Scholar
3. Kopelman, MD, Thomson, AD, Guerrini, I and Marshall, EJ (2009) The Korsakoff syndrome: clinical aspects, psychology and treatment. Alcohol Alcohol 44, 148154.CrossRefGoogle ScholarPubMed
4. Squire, LR (1982) Comparisons between forms of amnesia: some deficits are unique to Korsakoff’s syndrome. J Exp Psychol Learn Mem Cogn 8, 560571.CrossRefGoogle ScholarPubMed
5. Arnsten, AF and Li, BM (2005) Neurobiology of executive functions: catecholamine influences on prefrontal cortical functions. Biol Psychiatry 57, 13771384.CrossRefGoogle ScholarPubMed
6. Maharasingam, M, Macniven, JA and Mason, OJ (2013) Executive functioning in chronic alcoholism and Korsakoff syndrome. J Clin Exp Neuropsychol 35, 501508.CrossRefGoogle ScholarPubMed
7. Oscar-Berman, M (2012) Function and dysfunction of prefrontal brain circuitry in alcoholic Korsakoff’s syndrome. Neuropsychol Rev 22, 154169.CrossRefGoogle ScholarPubMed
8. Oscar-Berman, M, Shagrin, B, Evert, DL and Epstein, C (1997) Impairments of brain and behavior: the neurological effects of alcohol. Alcohol Health Res World 21, 6575.Google ScholarPubMed
9. Kril, JJ and Harper, CG (2012) Neuroanatomy and neuropathology associated with Korsakoff’s syndrome. Neuropsychol Rev 22, 7280.CrossRefGoogle Scholar
10. Pitel, AL, Chételat, G, Le Berre, AP, Desgranges, B, Eustache, F and Beaunieux, H (2012) Macrostructural abnormalities in Korsakoff syndrome compared with uncomplicated alcoholism. Neurology 78, 13301333.CrossRefGoogle ScholarPubMed
11. Stuss, DT, Winocur, G and Robertson, IH (2008) Cognitive neurorehabilitation evidence and application, 2nd edn. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
12. Gilboa, A and Verfaellie, M (2010) Telling it like it isn’t: the cognitive neuroscience of confabulation. J Int Neuropsychol Soc 16, 961966.CrossRefGoogle ScholarPubMed
13. Egger, JI, Wester, AJ, De Mey, HR and Derksen, JJ (2002) Korsakoff’s syndrome on the MMPI-2. Acta Neuropsychiatr 14, 231236.CrossRefGoogle ScholarPubMed
14. Corcoran, R (1999) Autonoetic awareness, executive social skills, and the appreciation of intention: figurative reasoning in amnesia, confabulation, and schizophrenia. Cogn Neuropsychiatry 4, 5580.CrossRefGoogle Scholar
15. Frith, CD and Frith, U (1999) Interacting minds–a biological basis. Science 286, 16921695.CrossRefGoogle Scholar
16. Premack, D and Woodruff, G (1978) Chimpanzee problem-solving: a test for comprehension. Science 202, 532535.CrossRefGoogle Scholar
17. Kalbe, E, Grabenhorst, F, Brand, M, Kessler, J, Hilker, R and Markowitsch, HJ (2007) Elevated emotional reactivity in affective but not cognitive components of theory of mind: a psychophysiological study. J Neuropsychol 1, 2738.CrossRefGoogle Scholar
18. Kalbe, E, Schlegel, M, Sack, AT, Nowak, DA, Dafotakis, M, Bangard, C, Brand, M, Shamay-Tsoory, S, Onur, OA and Kessler, J (2010) Dissociating cognitive from affective theory of mind: a TMS study. Cortex 46, 769780.CrossRefGoogle ScholarPubMed
19. Shamay-Tsoory, SG, Harari, H, Aharon-Peretz, J and Levkovitz, Y (2010) The role of the orbitofrontal cortex in affective theory of mind deficits in criminal offenders with psychopathic tendencies. Cortex 46, 668677.CrossRefGoogle ScholarPubMed
20. Hynes, CA, Baird, AA and Grafton, ST (2006) Differential role of the orbital frontal lobe in emotional versus cognitive perspective-taking. Neuropsychologia 44, 374383.CrossRefGoogle Scholar
21. Shamay-Tsoory, SG and Aharon-Peretz, J (2007) Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study. Neuropsychologia 45, 30543067.CrossRefGoogle ScholarPubMed
22. Baron-Cohen, S, Jolliffe, T, Mortimore, C and Robertson, M (1997) Another advanced test of theory of mind: evidence from very high functioning adults with autism or asperger syndrome. J Child Psychol Psychiatry 38, 813822.CrossRefGoogle ScholarPubMed
23. Baron-Cohen, S, O’Riordan, M, Stone, V, Jones, R and Plaisted, K (1999) Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. J Autism Dev Disord 29, 407418.CrossRefGoogle ScholarPubMed
24. Shamay-Tsoory, SG, Tomer, R, Berger, BD, Goldsher, D and Aharon-Peretz, J (2005) Impaired ‘affective theory of mind’ is associated with right ventromedial prefrontal damage. Cogn Behav Neurol 18, 5567.CrossRefGoogle Scholar
25. Buitelaar, JK, van der Wees, M and Swaab-Barneveld, H (1999) van der Gaag RJ.Verbal memory and Performance IQ predict theory of mind and emotion recognition ability in children with autistic spectrum disorders and in psychiatric control children. J Child Psychol Psychiatry 40, 869881.CrossRefGoogle Scholar
26. Henry, JD, Phillips, LH, Crawford, JR, Ietswaart, M and Summers, F (2006) Theory of mind following traumatic brain injury: the role of emotion recognition and executive dysfunction. Neuropsychologia 44, 16231628.CrossRefGoogle Scholar
27. Fine, C, Lumsden, J and Blair, RJ (2001) Dissociation between ‘theory of mind’ and executive functions in a patient with early left amygdala damage. Brain. 124(Pt 2):287298.CrossRefGoogle Scholar
28. Pearson, A, Ropar, D, de, C and Hamilton, AF (2013) A review of visual perspective taking in autism spectrum disorder. Front Hum Neurosci 7, 652.CrossRefGoogle Scholar
29. Hiatt, LM, Trafton, JG, Harrison, AM and Schultz, AC (2004) A cognitive model for spatial perspective taking. Proceedings of the International Conference on Cognitive Modelling, ICCM, Pittsburgh, Pennsylvania, USA, July 30, August 1, 2004.Google Scholar
30. Tversky, B and Hard, BM (2009) Embodied and disembodied cognition: spatial perspective-taking. Cognition 110, 124129.CrossRefGoogle ScholarPubMed
31. Bertoux, M, Delavest, M, de Souza, LC, Funkiewiez, A, Lépine, JP, Fossati, P, Dubois, B and Sarazin, M (2012) Social cognition and emotional assessment differentiates frontotemporal dementia from depression. J Neurol Neurosurg Psychiatry 83, 411416.Google Scholar
32. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Washington, DC: APA.Google Scholar
33. Montagne, B, Kessels, RP, Wester, AJ and de Haan, EH (2006) Processing of emotional facial expressions in Korsakoff’s syndrome. Cortex. 42, 705710.CrossRefGoogle ScholarPubMed
34. Oosterman, JM, de Goede, M, Wester, AJ, van Zandvoort, MJ and Kessels, RP (2011) Perspective taking in Korsakoff’s syndrome: the role of executive functioning and task complexity. Acta Neuropsychiatr 23, 302308.CrossRefGoogle ScholarPubMed
35. Hurtado-Pomares, M, Carmen Terol-Cantero, M, Sánchez-Pérez, A, Peral-Gómez, P, Valera-Gran, D and Navarrete-Muñoz, EM (2018) The frontal assessment battery in clinical practice: a systematic review. Int J Geriatr Psychiatry 33, 237251.CrossRefGoogle ScholarPubMed
36. Wimmer, H and Perner, J (1983) Beliefs about beliefs: representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition 13, 103128.CrossRefGoogle Scholar
37. Bauminger-Zviely, N (2013) False-belief task. Encyclopedia of autism spectrum disorders, New York: Springer, p. 124912409.Google Scholar
38. Flavell, JH (2000) Development of children’s knowledge about the mental world. Int J of Behav Develop 24, 1523.CrossRefGoogle Scholar
39. Baron-Cohen, S, Leslie, AM and Frith, U (1985) Does the autistic child have a ‘theory of mind’? Cognition 21, 3746.CrossRefGoogle Scholar
40. Duits, A, Kessels, R (2014) Estimating premorbid intelligence [in Dutch]. In: M Hendriks, R Kessels, M Gorissen, B Schmand and A Duits, editors, Neuropsychologische diagnostiek: De klinische praktijk; p. 173186. Amsterdam, The Netherlands: Boom.Google Scholar
41. Hegarty, M and Waller, D (2004) A dissociation between mental rotation and perspective-taking spatial abilities. Intelligence 32, 175191.CrossRefGoogle Scholar
42. Van Loo, EH, Wiebrands, C and Van Laar, T (2007) De ‘Frontal Assessment Battery’ (FAB) voor screening op frontaalkwabpathologie bij neurodegeneratieve ziekten. Tijdschrift voor Neurologie en Neurochirurgie (TVNN) 108, 115120.Google Scholar
43. Cohen, J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Hillsdale, NJ: Erlbaum.Google Scholar
44. Gopnik, A and Astington, JW (1988) Children’s understanding of representational change and its relation to the understanding of false belief and the appearance-reality distinction. Child Dev 59, 2637.CrossRefGoogle ScholarPubMed
45. Lee, TM, Ip, AK, Wang, K, Xi, CH, Hu, PP, Mak, HK, Han, SH and Chan, CC (2010) Faux pas deficits in people with medial frontal lesions as related to impaired understanding of a speaker’s mental state. Neuropsychologia 48, 16701676.CrossRefGoogle ScholarPubMed
46. Li, X, Wang, K, Wang, F, Tao, Q, Xie, Y and Cheng, Q (2013) Aging of theory of mind: the influence of educational level and cognitive processing. Int J Psychol 48, 715727.CrossRefGoogle ScholarPubMed
47. Lee, SJ, Lee, HK, Kweon, YS, Lee, CT and Lee, KU (2009) The impact of executive function on emotion recognition and emotion experience in patients with schizophrenia. Psychiatry Investig 6, 156162.CrossRefGoogle ScholarPubMed
48. Yang, C, Zhang, T, Li, Z, Heeramun-Aubeeluck, A, Liu, N, Huang, N, Zhang, J, He, L, Li, H, Tang, Y, Chen, F, Liu, F, Wang, J and Lu, Z (2015) The relationship between facial emotion recognition and executive functions in first-episode patients with schizophrenia and their siblings. BMC Psychiatry 15, 241.CrossRefGoogle ScholarPubMed
49. Brion, M, D’Hondt, F, Lannoy, S, Pitel, AL, Davidoff, DA and Maurage, P (2017) Crossmodal processing of emotions in alcohol-dependence and Korsakoff syndrome. Cogn Neuropsychiatry 22, 436451.CrossRefGoogle ScholarPubMed
50. Bodden, ME, Mollenhauer, B, Trenkwalder, C, Cabanel, N, Eggert, KM, Unger, MM, Oertel, WH, Kessler, J, Dodel, R and Kalbe, E (2010) Affective and cognitive Theory of Mind in patients with parkinson’s disease. Parkinsonism Relat Disord 16, 466470.CrossRefGoogle ScholarPubMed
51. Aichhorn, M, Perner, J, Kronbichler, M, Staffen, W and Ladurner, G (2006) Do visual perspective tasks need theory of mind? Neuroimage. 30, 10591068.CrossRefGoogle ScholarPubMed
52. Rascovsky, K, Hodges, JR, Knopman, D, Mendez, MF, Kramer, JH, Neuhaus, J, van Swieten, JC, Seelaar, H, Dopper, EG, Onyike, CU, Hillis, AE, Josephs, KA, Boeve, BF, Kertesz, A, Seeley, WW, Rankin, KP, Johnson, JK, Gorno-Tempini, ML, Rosen, H, Prioleau-Latham, CE, Lee, A, Kipps, CM, Lillo, P, Piguet, O, Rohrer, JD, Rossor, MN, Warren, JD, Fox, NC, Galasko, D, Salmon, DP, Black, SE, Mesulam, M, Weintraub, S, Dickerson, BC, Diehl-Schmid, J, Pasquier, F, Deramecourt, V, Lebert, F, Pijnenburg, Y, Chow, TW, Manes, F, Grafman, J, Cappa, SF, Freedman, M, Grossman, M and Miller, BL (2011) Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 134(Pt 9):24562477.CrossRefGoogle ScholarPubMed
53. Gerridzen, IJ, Moerman – van den Brink, WG, Depla, MF, Verschuur, EM, Veenhuizen, RB, van der Wouden, JC, Hertogh, CM and Joling, KJ (2017) Prevalence and severity of behavioural symptoms in patients with Korsakoff sydnrome and other alcohol-related cognitive disorders: a systematic review. Int J Geriatr Psychiatry 32, 256273.CrossRefGoogle Scholar
54. Norris, G and Tate, RL (2000) The Behavioural Assessment of the Dysexecutive Syndrome (BADS): ecological, concurrent and construct validity. Neuropsychol Rehabil 10, 3345.CrossRefGoogle Scholar
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