Neural correlates of social cognition in stroke and traumatic brain injury: A systematic review

Social cognition (SC) encompasses the cognitive and affective processes underlying social interaction. Deficits in SC are common after acquired brain injury (ABI), including stroke and traumatic brain injury, and can profoundly affect social and functional outcomes. Following PRISMA guidelines (PROSPERO: CRD42024528643), a systematic search was conducted for peer-reviewed behavioural and neuroimaging studies examining SC in ABI. Forty-three studies meeting predefined inclusion and exclusion criteria were reviewed, covering four main SC domains: emotion recognition; Theory of Mind; perspective taking; and empathy. Both stroke and traumatic brain injury populations showed consistent alteration across all SC domains. Neuroimaging findings revealed partially convergent neural correlates, with the insula, cingulate cortex, and middle frontal gyrus frequently implicated across domains, alongside the corpus callosum supporting interhemispheric integration. These convergences suggest that SC relies on distributed but interconnected neural systems rather than on isolated regions. Findings demonstrate pervasive SC alteration following ABI and emphasise the clinical importance of comprehensive, domain-specific assessment and targeted rehabilitation.