Social cognition according to cognitive impairment in different clinical phenotypes of multiple sclerosis

Abstract

The objective of this study is to evaluate the relationship between social cognition (SC) and cognitive impairment in persons with multiple sclerosis (PwMS). A prospective study was conducted in 60 PwMS, 30 with relapsing-remitting MS (RRMS), 15 with secondary progressive MS (SPMS) and 15 with primary progressive MS (PPMS), and in healthy subjects (HS). All subjects were assessed by the Bordeaux Social Cognition Evaluation Protocol (PECS-B) (facial emotion recognition, theory of mind, emotional awareness and cognitive and affective alexithymia), by a large neuropsychological battery and by questionnaires (depression and anxiety). 43.3% of PwMS were impaired for at least one SC test. The proportion of PwMS with at least two impaired SC tests was similar in all three phenotypes (20%). Mean scores differed significantly between PwMS and HS only for the Reading the Mind in the Eyes Test, a test of Theory of Mind (ToM). ANOVA analyses showed an effect of phenotype on emotional awareness scores with lower scores in PPMS as compared to RRMS. ToM performance was significantly correlated (r = 0.56) with executive functions, working memory and episodic memory scores. SC impairment was found in all phenotypes and was more prominent in cognitively impaired MS patients. Executive functions, and working and episodic memory performance accounts for approximately 50% of ToM performance. Emotional awareness is more impaired in progressive MS.

Relationship between social cognition and fatigue, depressive symptoms, and anxiety in multiple sclerosis

“…Facial affect recognition, the ability to understand emotions from facial features, has been shown to be impaired in MS across a number of studies (Berneiser et al ., ; Henry et al ., ; Jehna et al ., ; Prochnow et al ., ). Studies assessing ToM (the ability to understand the beliefs, thoughts and emotions of others) have found deficits using tasks which vary widely in their implementation, including inferring the mental states of characters from written vignettes (Strange Stories; Ouellet et al ., , Faux Pas; Henry et al ., ), inferring mental states from facial cues (Reading the Mind in the Eyes Task; Dulau et al ., ), and inferring mental states of actors from videotaped vignettes who are using sarcasm and lies (Genova, Cagna, Chiaravalloti, Deluca, & Lengenfelder, ; McDonald Flanagan, Rollins, & Kinch, ). However, despite documentation that social cognitive deficits are pervasive in MS, researchers have generally not explored the relationship between these deficits and other MS‐related symptoms.…”

“…It is possible that social cognitive deficits are a contributing factor: for instance, alexithymia (the inability to recognize emotions in oneself) is a significant predictor of depression in MS (Gay et al ., ), indicating that deficits involved in the perception of emotions may be associated with depressive symptoms. However, the relationship between social cognition and depression/anxiety has not been well studied in MS populations, and those few studies which have examined it have resulted in inconsistent findings – sometimes detecting a relationship (Lenne et al ., ) and sometimes not (Dulau et al ., ; Pöttgen, Dziobek, Reh, Heesen, & Gold, ). Complicating matters is the periodic utilization of self‐reported deficits of social cognition, which may be confounded by the fact that some individuals with MS are unaware of the existence or pervasiveness of their own cognitive deficits (Prigatano, Hendin, & Heiserman, ; Sherman, Rapport, & Ryan, ).…”

“…The present study will also examine whether these relationships persist after controlling for cognitive ability. Prior research has identified that impairments in social cognition are more pronounced in individuals with MS who have comorbid impairments in working memory, processing speed and executive function (Bora et al ., ; Ciampi et al ., ; Dulau et al ., ; Pöttgen et al ., ); however, some have argued that social cognitive deficits are still apparent when controlling for general (non‐social) cognitive impairments, suggesting that that social cognition is independently affected by MS and is not a byproduct of cognitive impairment (Banati et al ., ; Phillips et al ., ; Pöttgen et al ., ). Thus, we will also assess cognitive ability using the Symbol Digit Modalities Test (SDMT), a measure of processing speed and attention, which is often used as a screening test for cognitive impairment in MS (Van Schependom et al ., ).…”

Social cognition: Concepts, neural basis and its role in multiple sclerosis

“…Recent evidence has shown 20% of social cognition impairment among patients, with a similar distribution for different phenotypes. 53 The largest deficit has been found for ToM tasks and for the recognition of certain negative facial emotion expressions. 54,55 Social cognition deficits show a significant correlation with the performance in other cognitive domains, such as working memory, processing speed and executive functions, [56][57][58] and also show the behavioral impact affecting the moral evaluation of others' actions (see Fig.…”

Empathy in multiple sclerosis––Correlates with cognitive, psychological and occupational functioning

“…images and videos) (Cotter et al, 2016). Impairments in social cognition in MS were generally not found to be related to disease duration, degree of disability, relapse rate or disease course (Gleichgerrcht et al, 2015;Almeida et al, 2016;Kraemer et al, 2013;Dulau et al, 2017). Positive associations have been demonstrated between social cognition and the traditionally investigated cognitive functions (i.e.…”