Get Beyond the Joke: Use of Cartoon Jokes in Theory of Mind Assessment in Dementia: A Dutch Cartoon Test

Changes in social cognition, encompassing all cognitive processes that underlie social interaction, have been noted in various types of dementia. Theory of Mind (ToM) is a key aspect of social cognition, defined as the ability to understand the mental state of another person, including their emotions, intentions and beliefs. Cartoon tests aim to adopt humour using cartoon jokes to assess ToM. In this study, a new Dutch cartoon test aimed to be applicable in clinical assessment of dementia was developed and validated. The test includes 12 cartoons (6 requiring ToM to understand the joke and 6 that do not), which were collected through an extensive search and were rated by experts (n = 17) on content and funniness. Normative data for the selected cartoons was obtained by control participants (n = 39), through annotation of these, scoring categories were formed. The test was then validated in a clinical sample, including patients referred to a memory clinic for cognitive complaints and...Show moreChanges in social cognition, encompassing all cognitive processes that underlie social interaction, have been noted in various types of dementia. Theory of Mind (ToM) is a key aspect of social cognition, defined as the ability to understand the mental state of another person, including their emotions, intentions and beliefs. Cartoon tests aim to adopt humour using cartoon jokes to assess ToM. In this study, a new Dutch cartoon test aimed to be applicable in clinical assessment of dementia was developed and validated. The test includes 12 cartoons (6 requiring ToM to understand the joke and 6 that do not), which were collected through an extensive search and were rated by experts (n = 17) on content and funniness. Normative data for the selected cartoons was obtained by control participants (n = 39), through annotation of these, scoring categories were formed. The test was then validated in a clinical sample, including patients referred to a memory clinic for cognitive complaints and suspected dementia (n = 9), in an observational cross-sectional study with a case-control type selection of participants. Patients were expected to score lower on the cartoon test than controls. An ANCOVA with demographic variables as covariates was performed: no significant differences between patients (n = 9) and control participants (n = 9) were found (p > .05). Further, the internal validity (Cronbach’s α of .864 for the total cartoon test) and convergent validity of test was good. Divergent validity was found to be questionable. Regarding demographics: females were expected to score higher than males; older participants were expected to score higher than younger participants; and higher educated participants were expected to score higher than lower educated participants on the cartoon test. A Mann-Whitney U analysis showed no gender differences (p > .05); assessment of Spearman-rank order correlation coefficients showed age was significant in its negative relation to cartoon test performance (p < .05); and education level significant in its positive relation to test performance (p < .05). Future investigation with a larger patient sample including differential dementia diagnoses is recommended to substantiate the results and make the test clinically applicable.Show less

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Get Beyond the Joke: Use of Cartoon Jokes in Theory of Mind Assessment in Dementia: A Dutch Cartoon Test