Sex differences in the neural basis of false-belief and pragmatic language comprehension

Increasing research evidence suggests that women are more advanced than men in pragmatic language comprehension and Theory of Mind (ToM), which is a cognitive component of empathy. We measured the hemodynamic responses of men and women while they performed a second-order false-belief (FB) task and a coherent story (CS) task. During the FB condition relative to the baseline (unlinked sentences [US]), we found convergent activity in ToM network regions, such as the temporoparietal junction (TPJ) bilaterally and precuneus, in both sexes. We also found a greater activity in the left medial prefrontal cortex (mPFC) and a greater deactivation in the ventromedial prefrontal cortex (vmPFC)/orbitofrontal cortex (OFC) bilaterally in women compared to men. However, we did not find difference in the brain activity between the sexes during the FB condition relative to the CS condition. The results suggest a significant overlap between neural bases of pragmatic language comprehension and ToM in both men and women. Taken together, these results are in line with the extreme male brain (EMB) hypothesis by demonstrating sex difference in the neural basis of ToM and pragmatic language, both of which are found to be impaired in individuals with Autism Spectrum Conditions (ASC). In addition, the results also suggest that on average women use both cognitive empathy (dorsal mPFC) and affective empathy (vmPFC) networks more than men for false-belief reasoning.