Empathy on the edge: A neurocognitive model of empathy in aging and dementia

Empathy, the ability to understand others' perspectives (cognitive empathy) and share their emotions (emotional empathy), is critical for social functioning across the lifespan. Although empathy changes with age and is often disrupted in neurodegenerative disease, prior research has largely examined isolated components or focused narrowly on healthy aging or specific disorders. This systematic review addresses this gap by synthesizing behavioral and neuroimaging evidence on empathy across typical and pathological aging, from healthy older adulthood and mild cognitive impairment to Alzheimer's disease and behavioral variant frontotemporal dementia. We reviewed empirical studies published between January 2015 and October 2025 that examined cognitive and/or emotional empathy in healthy older adults or individuals with mild cognitive impairment, Alzheimer's disease, or behavioral variant frontotemporal dementia. We propose an integrative model suggesting that cognitive and emotional empathy follow distinct trajectories across aging. Based on the model, cognitive empathy gradually declines, likely reflecting changes in prefrontal regions and large-scale brain networks, with this process beginning in normal aging and continuing through mild cognitive impairment and dementia. In contrast, emotional empathy is relatively preserved in aging and early disease stages, although it becomes more context-dependent with clearer impairment in behavioral variant frontotemporal dementia. We conclude that understanding these trajectories has important implications for early diagnosis, caregiving, and designing targeted interventions to support empathic functioning in older adults and individuals with neurodegenerative diseases. (PsycInfo Database Record (c) 2026 APA, all rights reserved).