Association between social cognition and real-world social functioning in older adults across the cognitive spectrum: A scoping review protocol

Social cognition refers to the capacity to perceive, process, and interpret social cues to understand others (Adolphs, 2001). It involves the complex set of mental operations underpinning social interactions, including the perception of self and others, the interpretation of behaviors and intentions, and the understanding of interpersonal and social norms (Setién-Suero et al., 2022). Social cognition was recognized as a new cognitive domain in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (Sachdev et al., 2014). Social cognition encompasses key components, namely: (a) theory of mind (ToM), the ability to infer others’ mental states while understanding that they can be different from ours; (b) empathy, the ability to share and infer emotions in self and others; (c) social perception, the ability to recognize and respond to basic social and emotional cues, such as interpreting facial expressions, body language or voices, or responding to social cues, such as eye gaze; and (d) social behavior (Henry et al., 2016). Social functioning is conceptualized as the dynamic interaction between individuals and their environments, encompassing the capacity to effectively fulfill normative roles across diverse domains, including occupational, interpersonal, recreational, and familial contexts (Weissman, 1975). Based on the commonly used Social Functioning Scale (SFS), it can be divided into seven domains: (a) social engagement/withdrawal; (b) interpersonal behavior; (c) pro-social activities; (d) recreation; (e) independence-competence; (f) independence-performance; and (g) employment/occupation (Birchwood et al., 1990). A review focusing on the schizophrenia population revealed that ToM and emotion recognition were found to correlate more strongly with social skills than with broad real-world social functioning, which showed small-to-moderate associations (Lemmers-Jansen et al., 2023). Social cognitive deficits, especially emotion recognition, are associated with impaired social functioning in bipolar disorder (Vlad et al., 2018). Furthermore, emotion recognition correlates with social connectedness and social ability in individuals with human immunodeficiency virus (Vance et al., 2025). Exploring the association between social cognition and social functioning could inform future interventions to improve quality of life through social cognitive training (Tas et al., 2013). Growing evidence indicates that social cognitive impairment is observed in older adults across the cognitive spectrum, encompassing normal cognition, subjective cognitive decline, mild cognitive impairment (MCI), and dementia (Green et al., 2015; Shim et al., 2025). For instance, impaired social cognition serves as core clinical symptom of behavioral variant frontotemporal dementia (bvFTD) (Pressman & Miller, 2014). Several meta-analytic reviews indicate that social cognition is also compromised in Alzheimer's disease and is already affected at the MCI stage (Bora & Yener, 2017; Demichelis et al., 2020). Recent research suggests that social cognition undergoes a progressive decline from normal cognition to dementia (Roheger et al., 2022; Shi et al., 2025). Beyond being a marker of cognitive deterioration, social cognition holds significant potential for predicting future functional status. Longitudinal evidence demonstrates that baseline social cognition serves as an independent predictor of future functional decline in both bvFTD and Alzheimer's disease (Cosentino et al., 2014; Chatzidimitriou et al., 2025). For older adults across the cognitive spectrum, social functioning—particularly social interaction—is of paramount importance. Notably, lack of social interaction is identified as one of the 12 major modifiable risk factors for dementia (Livingston et al., 2024). Previous evidence has primarily focused on general cognition, demonstrating a bidirectional relationship: social interaction protects against general cognitive decline, while general cognitive impairment conversely compromises social interaction (Kelly et al., 2017; Kuiper et al., 2016; Piolatto et al., 2022). While there is emerging evidence linking social cognition to real-world social functioning, this body of literature has not yet been systematically synthesized. Clarifying the association between them is critical for developing effective, patient-centered interventions. Therefore, this scoping review aims to map the existing literature on the association between them in older adults across the cognitive spectrum. For this review, we focus on three specific domains from the SFS: social engagement/withdrawal, interpersonal behavior, and pro-social activities. These domains are highly applicable to older adults and directly align with the concept of social cognition. Their importance is reflected in validated tools tailored for dementia populations, such as the social functioning in dementia (SF-DEM) scale.