Differential effects of levodopa on social cognition in people with Parkinson's disease

Social cognition impairment is a frequent non-motor feature of Parkinson's disease. While dopaminergic therapy modulates motor symptoms, its effects on social cognition remain incompletely understood. We investigated the effects of acute levodopa administration on cognitive and affective Theory of Mind, as well as on emotional resonance to dynamic whole-body social interactions, in 36 people with Parkinson's disease with motor fluctuations and 14 matched healthy controls. Social cognition was assessed using the Mini-Social Cognition and Emotional Assessment (Mini-SEA) and a point-light display task indexing emotional resonance through emotional valence ratings. Patients were evaluated in OFF and ON states during an acute dopaminergic challenge performed according to the CAPSIT-PD protocol, with responsiveness defined as an improvement greater than 50% on the MDS-UPDRS part III. Compared with healthy controls, patients showed impaired cognitive Theory of Mind performance, particularly on the faux pas subtest (p = 0.0001), while affective Theory of Mind based on facial emotion recognition was preserved. Acute levodopa did not improve cognitive or affective Theory of Mind (faux pas OFF vs ON, p = 0.7049). In contrast, emotional resonance was impaired in the OFF state and selectively improved in the ON state, with increased ratings of positive (p = 0.0035) and negative (p = 0.0387) emotional valence. These findings demonstrate a dissociation between Theory of Mind and emotional resonance in Parkinson's disease and show that acute levodopa selectively modulates emotional resonance without restoring Theory of Mind abilities.