Multidimensional Assessment Of Empathic Abilities In Patients With Insular Glioma

Background:Empathy, a multidimensional psychological construct that comprised affective and cognitive components. The former, which is defined as the ability to experience an appropriate emotional response of another’s state, and the latter, which is related to our capacity to predict and understand another’s mental state using cognitive processes. The empathy is vital to our emotional experience and social interaction. The insula is an anatomically and functionally complex structure that is located deep in sylvian fissure. It is hidden by the operculum, which consists of the frontal, temporal and parietal lobes. However, it is a lack of studies concerning its role of advanced cognition in humans, especially the study of the insula to participate in the process of empathy.Objective:To explore the influence of the insular glioma to affective empathy and cognitive empathy processing and whether these two systems are laterality effected in patients with an insular glioma by adopting the Interpersonal Reactivity Index (IRI) and empathy paradigms. In order to further improve the research and treatment of glioma, we also hope to apply the theories and methods of cognitive neuroscience to monitor the advanced function of brain.Methods:Twenty-nine patients with a localized glioma that was limited to either the insular (N= 15) or non-insular glioma controls (N= 18) that were evaluated in the neurosurgery clinic of the Anhui Provincial Hospital Affiliated to Anhui Medical University from March 2014 to December 2015 were considered for participation in the present study. Additionally,24 right-handed healthy controls (HC) were matched with the patients for age, gender, education and ethnicity. All participants had normal MRI scans and completed the Beijing version of the Montreal Cognitive Assessment (MoCA) to evaluate the basic cognitive functions. The NEO-Five-Factor Inventory was used to assess general personality traits and Raven’s Progressive Matrices was applied to estimate basic intelligence. We used the Toronto Alexithymia Scale (TAS-20) to explore the alexithymia of patients. The Self-Rating Depression Scale (translated into Chinese) was administered to obtain a measure of depressive symptoms for the participants. In the present study, we simultaneously assessed both components of empathy in insular patients through a method that combined a self-reported empathy questionnaire with the emotion recognition task (ERT), empathy for others’ pain (EOP) assessment and emotional perspective-taking (EPT) paradigm.Results:① Background information:there were no significant difference among the groups with regard to gender, age, education, Raven’s Progressive Matrices, MoCA scores, NEO-Five-Factor Inventory, and Self-Rating Depression Scale.②TAS-20 and IRI Scale:the TAS-20 scores of the patients with an insular glioma were lower than those of the others controls (F= 23.360, Ps< 0.001). Patients with an insular glioma were significantly different from patients in the other groups in the Empathy total scores, AE, CE, PT and EC subscales (F= 11.677, Ps< 0.001; F= 5.423, Ps= 0.007; F= 5.137, Ps= 0.009; F= 6.139, Ps= 0.004; F= 6.112, Ps= 0.004, respectively); however, there were no significant differences in PD and FS subscales. ③ Empathy paradigms:the experimental tasks demonstrated that insula patients group was significantly different from the other groups in the three tasks ((F= 63.190, Ps< 0.001; F= 15.035, Ps< 0.001; F= 13.301, Ps< 0.001, respectively). Patients with insular glioma were impaired in all tasks compared to the HC, and PC groups. The PC and HC groups did not differ from each other. For reaction times, only perception of others’pain task showed the insular patients group was significantly different from the HC groups. ④ Affective and Cognitive empathy indices:the results revealed a significant correlation between AE (EC sub-scale) and ER (r= 0.890, Ps< 0.001; r= 0.643, Ps= 0.010). The results indicated significant correlation between the AE and EOP (r= 0.646, Ps-0.009). Moreover, the same analysis was conducted between the CE (PT and FS sub-scales) and EPT. Cognitive empathy significantly correlated with EPT (r= 0.687, Ps= 0.005); however, only the PT sub-scale was significantly correlated with emotional perspective-taking (r= 0.591, Ps= 0.020). Our results indicated that patients with insular lesions were not only impaired in the affective index (Ps< 0.05) but also impaired in the cognitive index (Ps< 0.05) when compared to the PC and HC groups. However, the analysis indicated no significant difference between sub-groups in both the affective index (Ps-0.89) well as the cognitive index (Ps= 0.14).Conclusion:Using a self-report empathy questionnaire and empathy paradigms, the present study provides neuropsychological evidence of (a) both AE and CE being impaired in patients with an insular glioma when compared to a lesion-control group and healthy volunteers matched on sex, age, education and ethnicity and (b) no obvious laterality effects on AE or CE in insular lesions. This study also confirmed that using the methods of cognitive neuroscience could reveal the relations of intracranial lesions with high-level cognitive functions.