Exploring Theory of Mind abilities in patients with probable idiopathic normal pressure hydrocephalus

This study investigated Theory of Mind (ToM) deficits in patients with suspected idiopathic normal pressure hydrocephalus (iNPH), a condition affecting motor, cognitive and autonomic functions. Given the overlap between ToM-related neural networks and those affected in iNPH, we examined whether ToM impairments are a feature of the disease. Thirty-eight patients with possible/probable iNPH and 25 healthy controls completed the Reading the Mind in the Eyes Test (RMET) along with typically administered neuropsychological tests in this population. Group differences were analysed while controlling for age and education. Pre- and post-lumbar puncture (LP) cognitive changes were also examined, and regression analyses explored cognitive and disease-specific predictors of ToM performance. Compared to the controls, patients performed significantly worse on all cognitive tests (p > .005), including the RMET [F(1, 59) = 7.209, p < .012, partial η² = .102, 95% CI [0.009, 0.278])]. Evans Index and education were significant predictors of ToM performance (p =.005). Post-LP, while a subset of patients improved in gait and verbal fluency, their ToM scores remained unchanged. ToM deficits are part of the cognitive profile of iNPH. The association between ventricular enlargement and ToM impairment necessitates further research into the neural mechanisms underlying social cognitive dysfunction in iNPH. Incorporating ToM measures in neuropsychological evaluations may aid early identification of patients with social cognitive deficits and facilitate targeted interventions.