Comprehensive Summary
In this article, Martín-Fernández et al. present e-Motions, a novel neuropsychological tool that can assess social cognition during neurosurgery. This tool contains 34 four-second video stimuli that feature realistic avatars displaying complex emotions generated via an AI-based facial motion-capture system that was applied to professional actors. The tool was designed specifically to be used within the constraints of the operating room. It was validated in adult Spanish-speaking healthy participants (n=226), healthy participants from other Spanish-speaking nationalities (n=81), participants with schizophrenia (n=33) and participants with Autism Spectrum Disorder (ASD) (n=30), and its performance was compared against the movie for the assessment of social cognition (MASC), the reading the mind in the eyes test (RMET) and the Ekman 60-faces test (Ekman-60f), three existing tools for measuring social cognition. e-Motions, RMET and Ekman-60F were administered twice, with six weeks in between testing periods. The e-Motions test demonstrated high internal consistency (KR-20 = 0.86) that was not notably affected when participants from other Spanish-speaking nationalities were included, and also displayed good test-retest reliability (ICC = 0.73). There was moderate correlation between the e-Motions, MASC, RMET and Ekman-60F test results. e-Motions displayed good ability to discriminate between healthy subjects, subjects with schizophrenia (AUC = 0.89) and subjects with ASD (AUC = 0.79). These results suggest that e-Motions effectively measures social cognition while overcoming limitations of existing tests.
Outcomes and Implications
Social cognition is an important mental function that may be significantly affected after brain tumor surgery. Deficits in social cognition can lead to major decreases in quality of life and affect post-treatment outcomes, so preserving social cognition in patients is important. However, the mapping and monitoring of social cognition is understudied and not often performed. This study presents a tool that could be used to assess social cognition during neurosurgery and ensure that it is preserved. This could improve many patient outcomes. However, e-Motions has not been clinically validated in neither intraoperative settings nor postoperative patients with brain tumors. This study also has several other limitations, such as the fact that it is unclear to what extent other higher-order functions may have influenced the results, certain clinical data has not been collected and may have introduced confounding variables, the order in which tests were introduced may have influenced results, and e-Motions was not tested with the elderly.