"Theory of mind" impairments and their relationship to executive functioning following frontal lobe excisions

It has been suggested that mental states play an important role in determining behaviour and that mental state attributions ("theory of mind") underlie the ability to understand and predict other peoples' behaviour. Theory of mind was investigated in 31 patients with unilateral frontal lobe lesions (15 right-sided and 16 left-sided) by comparing their performance with that of 31 matched control subjects. The ability to infer first- and second-order beliefs was tested by requiring subjects to listen to stories in which a protagonist acted upon a false belief. Both patient groups exhibited significantly impaired performance on the two theory of mind measures. Both frontal lobe groups also exhibited a range of deficits in tests of executive functions, but analyses revealed that these seemed to be independent of theory of mind impairments. These findings are discussed in terms of the hypothesis of a specialized, adaptive brain system underlying theory of mind reasoning ability, and are related to observed difficulties in social functioning among patients with frontal lobe damage.