Poorer Social Cognition Linked to Worse Fatigue, Depression, and Anxiety in People with MS

Social cognitive deficits in patients with multiple sclerosis (MS) are associated with higher levels of fatigue, depressive symptoms, and anxiety, new research conducted at the Kessler Foundation has found.

Even though the study included only a small group of participants, it represents a step toward better understanding of the underlying mechanisms of MS, and researchers believe the findings suggest that problems in social cognition may play a part in common MS symptoms.

The study, “Relationship between social cognition and fatigue, depressive symptoms, and anxiety in multiple sclerosis,” was published in the Journal of Neuropsychology.

An increasing number of studies suggest that people with MS may experience impairments in social cognition, in addition to the well-known physical and cognitive deficits that mark the disease.

In MS, two cornerstones of social interaction seem to be primarily affected: facial recognition, or the ability to understand emotions from facial expressions, and; Theory of Mind (ToM), which is the ability to understand other’s beliefs, thoughts, and emotions. But how such deficits relate to non-physical problems commonly experienced in MS, such as emotional changes and fatigue, is still poorly understood.

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To address that, Kessler Foundation researchers explored the association of social cognition with fatigue, depressive symptoms, and anxiety in people with MS.

The study included 28 participants — 17 with relapsing-remitting MS (RRMS), three with primary progressive MS (PPMS), three with secondary progressive MS (SPMS), and two with progressive-relapsing MS. Among the patients 22 were women, and the study population had a mean age of 52 years.

Researchers screened patients for problems in social cognition using tests of facial recognition and Theory of Mind, and looked for associations with patient-reported fatigue, depression, and anxiety. They also measured non-social cognitive impairments, such as attention and processing speed.

Test results revealed that poorer performance on measures of social cognition was linked to worsened symptoms of depression, anxiety, and fatigue, particularly psychosocial fatigue. Still, these relationships did not seem to depend on the cognitive ability of each patient, “suggesting that social cognitive abilities contribute independently to factors such as mood and fatigue,” researchers wrote.

These findings “help us better understand the association between social cognitive abilities and other symptoms in MS,” they added. However, the team also raised issues regarding the type of link driving those associations. “The nature of the relationships among these variables remains unclear,” Helen Genova, PhD, said in a press release. Genova is the assistant director of the Center for Neuropsychology and Neuroscience Research at the Kessler Foundation, and lead author of the study.

“We cannot say whether deficits of social cognition worsen mood condition and fatigue, or vice versa,” she said, adding those relationships may be reciprocal. “Poor social cognition may worsen fatigue, depression and anxiety, leading to greater social isolation. That, in turn, may worsen social cognitive function.”

As such, the research team cautions the findings are preliminary, and more research will be needed to clarify and bolster the results. Studies in other populations with non-neurologic conditions and healthy controls also will be important.

“All of these conditions adversely affect quality of life,” Genova said. “To alleviate their impact, we need to understand the interplay of social cognition, mood, and fatigue. Our study is an initial step toward understanding these dynamics in the population with MS.”

The research was supported by the Consortium of Multiple Sclerosis Centers.