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Masterclass October 2017
Prof Bruno Brochet
Professor of Neurology at Université Bordeaux-Segalen, France, and Head of the deparment of Neurology, Centre Hospitalier-Universitaire of Bordeaux, France.

Social cognition in Multiple Sclerosis

Bruno Brochet, Cécile Dulau

Service de Neurologie, CHU de Bordeaux, France

Social cognition (SC) encompassed the cognitive processes underlying personal relationships. It is the capacity to recognize and interpret interpersonal cues that guide social behaviour.1 Recent studies showed that, persons with Multiple Sclerosis (MS), could be impaired for SC.2 Studies mainly focused on emotion recognition, facial emotion recognition or theory of mind (ToM) in its 2 components, cognitive and affective ToM.2 Facial emotion recognition has been investigated in MS in several studies,3-11 and the most frequently used paradigm was Ekman faces test.12Several studies2 but not all3,4,11 showed differences between MS patients and healthy subjects (HS). A recent study showed that the proportion of impaired patients for facial recognition varies from 7 to 27% according to phenotype, the greater proportion being observed in primary progressive MS (PPMS).11 Another recent study reported that patients with PPMS performed worse than both HS and patients with relapsing-remitting MS (RRMS) on the recognition of fearful facial expressions, while patients with secondary progressive MS (SPMS) performed worse on the recognition of facial expressions of sadness.13 Correlations between facial recognition and cognitive scores at classical neuropsychological tests used in MS were not consistently found.

ToM have been found impaired in many studies using different tasks, including attribution of intentions or thoughts, such as False belief tasks, Eyes Test, Strange Stories Tasks or video tasls such as the Movie for the Assessment of Social Cognition (MASC) and the Conversations and Insinuations Video (C&I) Task.2,4,5,8,13-17, Considering phenotypes, the proportion of ToM impaired MS patients varied from 20 to 37%, the later in RRMS. Another study found more ToM impairment in progressive MS.13

The correlation of ToM impairment with CI is still a matter of debate but some studies found some correlations between ToM tasks and neurocognitive performances, especially with effective functions, processing speed and working memory.13,14,17 In a recent study, a significant correlation between executive functioning, episodic and working memory and ToM scores was observed using a relatively large cognitive battery.11 Scores in these domains accounted for more than 50% of ToM impairment and the correlations were observed for the three ToM tests used in this study, the Reading the Mind in the Eyes test, the Attribution of Intention test and the Faux Pas test. These results suggested that efficient executive functions contribute to normal SC functioning.

Two important questions remain to be answered. The first one is the importance of the consequences in the daily lives of MS patients of these impairments. Especially the consequences on inter-personal relationships in familial and social activities are unknown. The second is the question of the neuroanatomic basis of SC impairment in MS. Only a few functional and structural MRI studies (fMRI) studies have investigated SC in MS and their results are preliminary17-21 and other studies are needed for understanding the relationship between SC impairment and the disease process in MS.



  1. Dulau C. Introduction to social cognition. In: Brochet B., Ed: Neuropsychiatric symptoms of inflammatory demyelinating diseases. Springer, Cham, 2015: pp181-194.

  2. Dulau C. Social cognition in multiple sclerosis. In: Brochet B., Ed: Neuropsychiatric symptoms of inflammatory demyelinating diseases. Springer, Cham, 2015: pp213-226.

  3. Jehna M, Neuper C, Petrovic K, Wallner-Blazek M, Schmidt R, Fuchs S, et al. An exploratory study on emotion recognition in patients with a clinically isolated syndrome and multiple sclerosis. Clin Neurol Neurosurg. 2010;112:482-4.

  4. Henry JD, Phillips LH, Beatty WW, Mcdonald S, Longley WA, Joscelyne A, et al. Evidence for deficits in facial affect recognition and theory of mind in multiple sclerosis. J Int Neuropsychol Soc. 2009;15:277-285.

  5. Henry A, Tourbah A, Chaunu M-P, Rumbach L, Montreuil M, Bakchine S. Social Cognition Impairments in Relapsing-Remitting Multiple Sclerosis. J Int Neuropsychol Soc 2011;17:1122-31.

  6. Berneiser J, Wendt J, Grothe M, Kessler C, Hamm AO, Dressel A. Impaired recognition of emotional facial expressions in patients with multiple sclerosis. Mult Scler Relat Disord. 2014 Jul;3(4):482-8.

  7. Phillips LH, Henry JD, Scott C, Summers F, Whyte M, Cook M. Specific impairments of emotion perception in multiple sclerosis. Neuropsychology. 2011;25:131‑6

  8. Banati M, Sandor J, Mike A, Illes E, Bors L, Feldmann A, et al. Social cognition and Theory of Mind in patients with relapsing-remitting multiple sclerosis. Eur. J. Neurol. 2010;17:426‑33.

  9. Beatty WW, Goodkin DE, Weir WS, Staton RD, Monson N, Beatty PA. Affective judgments by patients with Parkinson’s disease or chronic progressive multiple sclerosis. Bull. Psychon. Soc. 1989;27:361‑4.

  10. Prochnow D, Donell J, Schäfer R, Jörgens S, Hartung HP, Franz M, et al. Alexithymia and impaired facial affect recognition in multiple sclerosis. J. Neurol. 2011; 258:1683‑8.

  11. Dulau C, Deloire M, Diaz H, Saubusse A, Charre-Morin J, Prouteau A, Brochet B. Social cognition according to cognitive impairment in different clinical phenotypes of multiple sclerosis. J Neurol. 2017 Apr;264(4):740-748.

  12. Ekman P, Friesen W. Pictures of facial affect Palo Alto, CA: Consulting Psychologist Press; 1976.

  13. Henry A, Tourbah A, Chaunu MP, Bakchine S, Montreuil M. Social Cognition Abilities in Patients With Different Multiple Sclerosis Subtypes. J Int Neuropsychol Soc. 2017 Jun 28:1-12.

  14. Kraemer M, Herold M, Uekermann J, Kis B, Wiltfang J, Daum I, Dziobek I, Berlit P, Diehl RR, Abdel-Hamid M. Theory of mind and empathy in patients at an early stage of relapsing remitting multiple sclerosis. Clin Neurol Neurosurg. 2013 Jul;115(7):1016-22.

  15. Ouellet J, Scherzer PB, Rouleau I, MéTras P, Bertrand-Gauvin C, Djerroud N, et al. Assessment of social cognition in patients with multiple sclerosis. J. Int. Neuropsychol. Soc. 2010;16:287.

  16. Roca M, Manes F, Gleichgerrcht E, Ibanez A, Gonzalez de Toledo ME, Marenco V, Bruno D, Torralva T, Sinay V. Cognitive but not affective theory of mind deficits in mild relapsing-remitting multiple sclerosis.Cogn Behav Neurol. 2014. Mar;27(1):25-30.

  17. Pöttgen J, Dziobek I, Reh S, Heesen C, Gold SM. Impaired social cognition in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2013 May;84(5):523-8.

  18. Krause M, Wendt J, Dressel A, Berneiser J, Kessler C, Hamm AO, et al. Prefrontal function associated with impaired emotion recognition in patients with multiple sclerosis. Behav Brain Res. 2009;205:280‑5.

  19. Passamonti L, Cerasa A, Liguori M, Gioia MC, Valentino P, Nistico R, et al. Neurobiological mechanisms underlying emotional processing in relapsing-remitting multiple sclerosis. Brain. 2009;132:3380‑91.

  20. Jehna M, Langkammer C, Wallner-Blazek M, Neuper C, Loitfelder M, Ropele S, et al. Cognitively preserved MS patients demonstrate functional differences in processing neutral and emotional faces. Brain Imaging Behav. 2011;5:241‑51.

  21. Mike A, Strammer E, Aradi M, Orsi G, Perlaki G, Hajnal A, et al. Disconnection Mechanism and Regional Cortical Atrophy Contribute to Impaired Processing of Facial Expressions and 

  22. Theory of Mind in Multiple Sclerosis: A Structural MRI Study. PLoS ONE. 2013;8:e82422.

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