Open Access Open Badges Research article

Can theory of mind deficits be measured reliably in people with mild and moderate Alzheimer’s dementia?

Caroline SM Choong1 and Gillian A Doody2*

Author Affiliations

1 Specialty Registrar, Mental Health Services for Older People, Nottinghamshire Healthcare NHS Trust, Cherry Ward, Highbury Hospital, Highbury Road, Nottingham NG6 9DR, England

2 Division of Psychiatry, Professor of General Adult Psychiatry and Medical Education, University of Nottingham, Room C22, Institute of Mental Health Building, Jubilee Campus, Triumph Road, Nottingham NG8 1BB, England

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BMC Psychology 2013, 1:28  doi:10.1186/2050-7283-1-28

Published: 5 December 2013



Patients suffering from Alzheimer’s dementia develop difficulties in social functioning. This has led to an interest in the study of “theory of mind” in this population. However, difficulty has arisen because the associated cognitive demands of traditional short story theory of mind assessments result in failure per se in this population, making it challenging to test pure theory of mind ability.


Simplified, traditional 1st and 2nd order theory of mind short story tasks and a battery of alternative theory of mind cartoon jokes and control slapstick cartoon jokes, without memory components, were administered to 16 participants with mild-moderate Alzheimer’s dementia, and 11 age-matched healthy controls.


No significant differences were detected between participants with Alzheimer’s dementia and controls on the 1st or 2nd order traditional short story theory of mind tasks (p = 0.155 and p = 0.154 respectively). However, in the cartoon joke tasks there were significant differences in performance between the Alzheimer participants and the control group, this was evident for both theory of mind cartoons and the control ‘slapstick’ jokes.


It remains very difficult to assess theory of mind as an isolated phenomenon in populations with global cognitive impairment, such as Alzheimer’s dementia, as the tasks used to assess this cognition invariably depend on other cognitive functions. Although a limitation of this study is the small sample size, the results suggest that there is no measurable specific theory of mind deficit in people with Alzheimer's dementia, and that the use of theory of mind representational models to measure social cognitive ability may not be appropriate in this population.