Social cognition in multiple sclerosis: A systematic review and meta-analysis

Investigating Domain-Specific Cognitive Impairment Among Patients With Multiple Sclerosis Using Touchscreen Cognitive Testing in Routine Clinical Care

Cognitive dysfunction is present in up to 70% of patients with multiple sclerosis (MS) and has been reported at all stages and in all subtypes of the disease. These deficits have been reported across a variety of cognitive domains, but are generally under-recognized and incompletely evaluated in routine clinical practice. The aim of this study was to investigate the spectrum of cognitive impairment in patients with MS presenting to a specialist MS clinic using the Cambridge Neuropsychological Test Automated Battery (CANTAB), administered on a touchscreen platform. Ninety MS patients completed computerized CANTAB tasks assessing working memory, executive function, processing speed, attention, and episodic memory. Scores were adjusted for age, sex, and level of education and classified as normal or impaired based on comparison with a large normative data pool. We also investigated the impact of clinical and demographic variables which could potentially influence cognitive performance including patient educational level (a proxy for cognitive reserve), disease status (duration, course, and severity of MS), and depression. CANTAB testing detected cognitive impairment in 40 patients (44% of the sample). The most frequently impaired domain was executive function, present in 55% of cognitively impaired individuals. Disease duration and severity were significantly associated with performance across various cognitive domains. Patients with depressive symptoms were also more likely to exhibit impaired processing speed. Results from this study confirm that cognitive impairment is common and occurs across a range of domains among MS patients attending routine clinical visits. CANTAB tasks provide a sensitive and practical approach to cognitive testing in MS patients as part of a holistic patient assessment.

The neuropsychiatry of multiple sclerosis

Multiple sclerosis (MS), an immune-mediated demyelinating condition, is the most common neurological disease affecting young adults in the UK. It has a high psychiatric comorbidity and over half of patients have some degree of cognitive impairment that adds to the burden of disability. This article reviews the psychiatric and cognitive manifestations of MS and their detection and treatment. Recent advances in the treatment of the disease are briefly reviewed and the impact of disease-modifying therapies on psychiatric morbidity and cognitive impairment is discussed.

LEARNING OBJECTIVES

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DECLARATION OF INTEREST

None.

Coping behavior in multiple sclerosis-complementary and alternative medicine: A cross-sectional study

Main Problem

Treatment options for multiple sclerosis (MS) have enlarged tremendously over the last years. Nonetheless, lots of patients look for alternative treatment options. The use of complementary and alternative medicine (CAM) is widespread in MS, however, its scientific investigation is limited so far. The aim of the study is to analyse clinical and demographical differences of MS patients in dependency of their CAM utilization as coping strategy.

Methods

A total of 254 patients with a clinically definite MS were examined in a semistructured interview. Additional standardized questionnaires were used to measure different aspects of coping with illness. All patients underwent neurological examination.

Results

About 206 of all enrolled patients are CAM users (81.1%). They have a longer disease duration (8.3 years vs 7.3 years, P = 0.028) and show higher disability (median EDSS 4.0 vs 2.0, P < 0.001) than nonusers. CAM users differed significantly from nonusers in their coping behavior (P = 0.035). Users are brooding more heavily over the disease, looking for more information about MS, and are looking for a sense of their disease in religion more often than nonusers. CAM users are at a higher risk of depression. Almost two‐thirds of CAM users (57.6%) reported positive effects on the well‐being of their state of health.

Conclusion

Coping behavior differs significantly between CAM users and nonusers. CAM utilization is associated with higher disability and depression. More than 80% of our cohort has used alternative or complementary methods. CAM utilization may mirror unmet needs in the treatment of MS.

Relationship between Social Cognition and traditional cognitive impairment in Progressive Multiple Sclerosis and possible implicated neuroanatomical regions

BACKGROUND

Cognitive impairment is a relevant contributor of the medical and social burden in Progressive MS. Social Cognition, the neurocognitive processes underlying social interaction, has been explored mainly in European and North American cohorts, influencing social aspects of quality of life (QOL) of early MS patients and families. Few studies have studied Social Cognition in Progressive MS and the literature on its neuroanatomical bases or brain atrophy measurements is still scarce.

OBJECTIVES

To explore the relationship between Social Cognition performance and its correlations with traditional cognitive domains, brain atrophy and QOL in primary and secondary Progressive MS patients.

METHODS

Cross-sectional analysis including: mini-Social-Cognition-and-Emotional-Assessment (mini-SEA), neuropsychological battery, disability, depression, fatigue, QOL, and brain volume.

RESULTS

Forty-three MS patients, 23 primary and 20 secondary Progressive, 65% women, mean age and disease duration of 57.2 and 15.7 years, respectively, with high levels of disability (median EDSS 6.0) and a widespread impairment in traditional domains (mostly episodic verbal/visual and working memories) were assessed. The Mini-SEA score was correlated with executive functions (cognitive shifts Rho:0.55; p = 0.001) analyzing the whole group, and with visual episodic memory (Rho:0.58, p = 0.009) in the primary Progressive MS group. Mini-SEA score was also correlated with total normalized grey matter volume (Rho:0.48; p = 0.004). Particularly, atrophy within bilateral cortical regions of orbitofrontal, insula and cerebellum, and right regions of fusiform gyrus and precuneus were significantly associated with higher Social Cognition impairment. In this cohort, QOL was not correlated with Social Cognition, but with EDSS, fatigue and depression.

CONCLUSIONS

In Progressive MS, Social Cognition is directly correlated with traditional cognitive domains such as executive function and episodic memory. It is also associated with global grey matter atrophy and regional atrophy within associative visual and executive cortical areas, but no correlations with QOL were found in this cohort. These findings may contribute to the understanding of the pathological bases behind Social Cognition in Progressive MS.

Pediatric Multiple Sclerosis and Cognition: A Review of Clinical, Neuropsychologic, and Neuroradiologic Features

Multiple sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disease. Although cognitive impairment has been well established in adult patients with MS, its occurrence in patients with pediatric-onset MS has recently been reported. In this review, I discuss the main features of cognitive impairment in pediatric MS as determined by long-term follow-up studies, neuropsychiatric test batteries, and the results of neuroradiological imaging studies that investigated the pathogenesis of pediatric MS. The most commonly affected cognitive domains in adults are attention, processing speed, and visuomotor skills; language and intelligence are also affected in pediatric MS. A young age at disease onset is the strongest risk factor for these impairments, which may be due to the effect of inflammatory demyelination and neurodegeneration on the developing central nervous system and neural networks in children. Cognitive impairment has long-term effects on patients' academic life and the quality of their social life. Therefore, all patients with pediatric MS should be screened and monitored for cognitive impairment. This review also highlights the need for neuropsychological test batteries that assess different cognitive domains in children and adolescents with multiple sclerosis and for cognitive rehabilitation programs to improve the quality of their academic and social life.

Theory of mind in multiple sclerosis: A neuropsychological and MRI study

OBJECTIVES

Social cognition stands among the most frequently affected yet the least studied cognitive domains in multiple sclerosis (MS). Theory of mind (ToM) is a social cognitive facet that implies the one's ability to predict others' mental states. The objective of this study was to assess the relationship between ToM and neuropsychological and neuroimaging data.

METHODS

Thirty-eight consecutive MS patients completed the Reading the Mind in the Eyes test (RMET). They underwent a neuropsychological evaluation and a 3T T1-weighted brain MRI. A fully automated volume-based morphometry algorithm (MorphoBox) was applied to calculate regional brain volumes. Correlation analysis was performed using Spearman's test.

RESULTS

Among the sociodemographic and clinical data, significant correlations were found between RMET scores and each of years of education (r=0.54; p<0.01) and the duration of the disease progressive phase (r=-0.46; p<0.01). Regarding neuropsychological measures, RMET scores were directly correlated with information processing speed (r=0.58; p<0.01) and empathy (r=0.46; p<0.01) scores. As for brain volumes, RMET scores were directly correlated with parietal (left: r=0.39; right: r=0.46; p<0.05) and temporal (left: r=0.36; right: r=0.40; p<0.05) white matter volumes, as well as with cingulate (left: r=0.32; right: r=0.44; p<0.05) gray matter volumes.

CONCLUSION

These results highlight the relationship between ToM and some of the disease characteristics and cognitive domains. Importantly, ToM performance in MS is associated with brain volumes of key areas in social cognitive networks. Further works are needed to enhance the current knowledge on the underlying mechanisms of ToM deficits in this population.

Disconnection as a mechanism for social cognition impairment in multiple sclerosis

Objective:

To assess the contribution of microstructural normal-appearing white matter (NAWM) damage to social cognition impairment, specifically in the theory of mind (ToM), in multiple sclerosis (MS).

Methods:

We enrolled consecutively 60 patients with MS and 60 healthy controls (HC) matched on age, sex, and education level. All participants underwent ToM testing (Eyes Test, Videos Test) and 3T brain MRI including conventional and diffusion tensor imaging sequences. Tract-based spatial statistics (TBSS) were applied for whole-brain voxel-wise analysis of fractional anisotropy (FA) and mean diffusivity (MD) on NAWM.

Results:

Patients with MS performed worse on both tasks of ToM compared to HC (Eyes Test 58.7 ± 13.8 vs 81.9 ± 10.4, p < 0.001, Hedges g −1.886; Videos Test 75.3 ± 9.3 vs 88.1 ± 7.1, p < 0.001, Hedges g −1.537). Performance on ToM tests was correlated with higher values of FA and lower values of MD across widespread white matter tracts. The largest effects (≥90% of voxels with statistical significance) for the Eyes Test were body and genu of corpus callosum, fornix, tapetum, uncinate fasciculus, and left inferior cerebellar peduncle, and for the Videos Test genu and splenium of corpus callosum, fornix, uncinate fasciculus, left tapetum, and right superior fronto-occipital fasciculus.

Conclusions:

These results indicate that a diffuse pattern of NAWM damage in MS contributes to social cognition impairment in the ToM domain, probably due to a mechanism of disconnection within the social brain network. Gray matter pathology is also expected to have an important role; thus further research is required to clarify the neural basis of social cognition impairment in MS.