International Psychogeriatrics

Research Article

Pitfall Intention Explanation Task with Clue Questions (Pitfall task): assessment of comprehending other people's behavioral intentions in Alzheimer's disease

Tomoharu Yamaguchia1a2 c1, Yohko Makia1a3 and Haruyasu Yamaguchia1

a1 Gunma University Graduate School of Health Sciences, Gunma, Japan

a2 Department of Rehabilitation, Gunma University of Health and Welfare, Gunma, Japan

a3 Geriatrics Research Institute and Hospital, Gunma, Japan


Background: In Alzheimer's disease (AD) patients, deficits in contextual understanding and intentions/beliefs of other people (theory of mind; ToM) cause communication problems between patients and caregivers. To evaluate deficits of contextual understanding/ToM, we developed the Pitfall Intention Explanation Task with Clue Questions (Pitfall task).

Methods: We recruited 26 healthy older adults in clinical dementia rating (CDR) 0, and 62 outpatients: 12 with amnestic mild cognitive impairment (aMCI) in CDR 0.5; 36 mild AD in CDR 1; and 14 moderate AD in CDR 2. The Pitfall task consists of a single-frame cartoon that shows a character's intention and seven serial questions that provide clues for contextual understanding/ToM.

Results: The total score (0–7) was decreased with progression of AD (CDR 0, 5.4 ± 2.6; CDR 0.5, 3.7 ± 2.7; CDR 1, 1.9 ± 3.1; CDR 2, 0.0 ± 0.0; respectively). In CDR 0, two-third of the participants responded correctly without clue questions. In CDR 0.5, one-third of the participants responded correctly without clue questions, and half of them understood with the help of the clue questions. In CDR 1, one-fourth of the participants responded correctly without clue questions, and the clue questions did not increase the correct response. In CDR 2, none responded correctly. Additionally, the Pitfall task provided the chance for patients’ families to observe patients’ responses.

Conclusion: Contextual understanding/ToM, a kind of social cognition, was impaired with progression of AD. The Pitfall task evaluates the function quickly with low burden for memory function, and may provide helpful clues for caregivers to achieve good communication with AD patients.

(Received April 01 2012)

(Reviewed April 18 2012)

(Revised May 26 2012)

(Accepted May 30 2012)

(Online publication July 03 2012)

Key words:

  • dementia;
  • carers;
  • behavioral and psychological symptoms of dementia (BPSD);
  • cognitive assessment;
  • family therapy


c1 Correspondence should be addressed to: Tomoharu Yamaguchi, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8514, Japan. Phone: +81-27-220-8946; Fax: +81-27-220-8946. Email: