Cognitive Empathy Following Orbitofrontal Cortex and Dorsolateral Prefrontal Cortex Damage

Empathy is a multifaceted and complicated construct, encompassing several subprocesses and relying on diverse neural networks. In the current study, I focus on cognitive empathy, one facet of empathy that includes the process of taking another person's perspective and the ability to accurately identify his or her emotions. Frontal lobe regions underlie many social and emotional processes and may be critical for cognitive empathy. Specifically, injuries to the orbitofrontal cortex (OFC) result in wide-ranging emotional and behavioral disturbances that may in part reflect deficits in cognitive empathy. Additionally, the dorsolateral prefrontal cortex (DLPFC) is critical in emotion regulation and many higher-order cognitive processes, suggesting a contribution of this region to emotional functioning when cognitive abilities are implicated. In the current study, cognitive empathy was examined in six patients with OFC damage, six patients with DLPFC damage, and twelve control participants. Participants completed an extensive assessment of cognitive empathy, including self-report measures of the process of taking others' perspectives and performance-based measures of the ability to accurately identify others' emotions (also referred to as "empathic accuracy"). Additionally, relationships between cognitive empathy and neuropsychological performance on executive function measures were examined in patients. On self-report measures, both patient groups endorsed lower levels of cognitive empathy, but these scores were not associated with executive functioning. In all measures of empathic accuracy, OFC patients were indistinguishable from control participants, suggesting that socioemotional deficits seen in this patient group cannot be attributed to an inability to discern the emotions of others. However, DLPFC patients showed extensive impairments on empathic accuracy measures. Among patients, associations between neuropsychological performance and empathic accuracy were strongest on a task with static stimuli requiring patients to detect small changes in emotion. Results demonstrating preserved empathic accuracy in OFC patients are in contrast with previous work suggesting damage to this area results in extensive socioemotional deficits. Furthermore, these data suggest that understanding others' emotions relies on lateral frontal lobe regions, which are critical for tasks that require a blend of cognitive and emotional abilities