Social cognition in Parkinson's disease: a comprehensive systematic review and integrative conceptual framework

Parkinson's disease (PD) is characterized not only by motor symptoms but also by non-motor impairments, including deficits in social cognition (SC), defined as the ability to recognize, interpret, and respond to others' emotions, intentions, and behaviors. This systematic review synthesizes evidence on SC in PD, focusing on three core aspects: emotion recognition, empathy/Theory of Mind (ToM), and social problem-solving.

We included 191 behavioral and neuroimaging studies based on a PRISMA-guided search of four databases.

The literature review findings revealed relatively consistent impairments in the recognition of negative emotions, such as fear and anger, and heterogeneous findings for empathy/ToM, with deficits being more pronounced in advanced PD or in patients with mild cognitive impairment (MCI). Social problem-solving remains understudied, though emerging evidence links it to dopaminergic modulation.

Across all three aspects, methodological heterogeneity and the scarcity of neuroimaging studies addressing complex SC aspects underscore the need for standardized, multimodal research. Beyond synthesizing the literature, we propose an integrative neurofunctional model of SC in PD that emphasizes its componential nature and highlights the need for future studies to clarify interrelations among SC domains and their neural substrates.