Impaired Social Cognition May Affect Well-being of RRMS Patients

Impaired social cognition — lacking the ability to understand and process others’ emotions — may affect how people with relapsing-remitting multiple sclerosis (RRMS) feel on a day-to-day basis, a small, three-year study has found.

RRMS patients with such difficulties were “characterized at follow-up by a higher level of depression and anxiety, a higher level of fatigue, and a lower level of quality of life regarding social functioning,” the researchers wrote.

“These results confirm that social cognition exerts a key role in MS, affecting individuals’ everyday lives,” Helen M. Genova, PhD, assistant director of Kessler Foundation’s Center for Neuropsychology and Neuroscience Research and one of the study co-authors, said in a press release.

“Our research highlights the need to identify treatments to improve social cognition in this population,” said Genova, also the director of Kessler’s social cognition and neuroscience laboratory.

The study, “Social Cognition in Multiple Sclerosis: A 3-Year Follow-Up MRI and Behavioral Study,” was published in the journal Diagnostics.

Previous studies have shown that social cognition, or how people interact with others in social situations, may be compromised in those with MS who otherwise have no cognitive impairments.

Social cognition is vital, according to investigators, because it allows people to connect and build relationships with others. Difficulties in this area can affect a person’s quality of life.

Impaired social cognition has been linked to damage to the amygdala — an area of the brain that deals with memory, decision-making, and emotions.

However, no study has evaluated the relationship between the two in longitudinal research, where investigators collect data repeatedly from the same group of individuals to see what changes might occur over time.

Now, an international team of researchers based in the U.S. and Italy looked at how social cognition impairment and amygdala damage changed over time in a group of RRMS patients.

The study included 26 patients, including 20 women, with a mean age of 39.5 and a mean disease duration of 11.5 years. The participants’ mean duration of education was 12.8 years.

This group had been the subject of a previous study in which impaired social cognition was linked to amygdala damage — even in the absence of generalized cognitive impairment.

Indeed, based on the results of a battery of neuropsychological tests, all of the patients were confirmed to be cognitively normal. In other words, there was no evidence of a cognitive decline.

As part of the study, the patients were asked to perform a series of social cognition tasks to assess theory of mind — the ability to build empathy and understanding of others — facial emotion recognition, and empathy. Based on the scores in all three tests, a composite measure of social cognition was calculated.

The researchers found that patients’ average social cognition scores remained stable over the three-year period, and were not impacted by age or sex. However, people with a higher number of years of education performed significantly better in the social cognition tasks, while those with longer disease duration had a worse performance.

To evaluate how social cognition might relate to damage to the amygdala, the researchers collected magnetic resonance imaging (MRI) scans from patients. The results were compared with the data collected from the same patients three years prior.

According to the initial data, poor social cognition correlated with a greater lesion volume of the cortex (the brain’s outer layer) in the amygdala. Three years later, worse social cognition also correlated with a higher cortical lesion volume, but the best predictor was a smaller amygdala volume.

“We confirmed the longitudinal stability of social cognition deficits in cognitively-normal people with [RRMS], mirroring the amygdala structural damage and psychological well-being,” Genova said.

Next, the researchers found that a worsening in social cognition over the three-year period correlated with poorer “psychological outcomes of daily living, such as depression, anxiety, fatigue, and social functioning quality of life,” the researchers wrote.

“The results confirmed that, despite being classified as cognitively normal, people with relapsing-remitting MS showed a significantly lower performance in several social cognition domains as compared to a matched group of healthy controls,” the investigators said.