**8. Conclusion**

terms of their severity and regarding the predominant disturbance of certain social cognitive domains. According to Henry, while testing empathy and ToM skills, it is also recommended to perform in parallel direct mapping of underlying MS‐related neuropathology for detecting a link between structural brain pathology and social cognitive impairments. Pöttgen estab‐ lished a deficient ability to reason about the mental state of others (ToM) and to have insight into the emotional stages and feelings of others (empathy) in the early stages of RRMS [21, 22], even in patients who have no substantial neuropsychological deficits. Emotional prosody comprehension may also be disrupted in the early stages of RRMS [6]. It is argued that this is the earliest social cognitive impairment in patients with MS. Deteriorated emotional percep‐ tion at this early stage can create a difficulty in perceiving nuances, such as sarcasm, irony and sincerity, which may lead to interpersonal problems. To confirm these observations, interna‐ tional research with larger groups of patients is required. Data from this study indicate that one year after diagnosing a patient with CIS and RRMS, they experience diminished power of attention and memory speed, which is related to a capacity for fewer working hours, fatigue, depression and may have a negative impact, as opposed to self‐efficacy, which affects working hours positively. The level of ToM abilities and their relation to the above‐mentioned conse‐

Information on social cognition impairments and different forms of MS is still scarce. The main controversies that we encountered in the course of reviewing the material on the topic are about how the grade of disturbance of social cognition skills relates to the state of general cognition, on the one hand, and to the grade of physical disability and/or the duration of the disease, on the other. These issues remain disputable due to the small size of patient cohorts and the lack of homogeneity within the groups of conducted studies. Moreover, the majority of studies on social cognition skills in MS assess the patients' social cognitive skills at a given point without following up on their development over time. This prevents us from making conclusions about their dynamics during the course of the disease or taking into account the effect of a therapeutic and/or rehabilitation approach. Extensive long‐term follow‐up studies with well‐defined inclusion criteria, consistent sample characteristics and a wide range of clinical and imaging measurements could establish which domains of ToM change in the

We devoted a lot of time to reviewing studies on social cognition also in other neurodegener‐ ative and mental diseases. We were impressed with the extensive research in skills for interpersonal problem solving, for recognizing social cues, for detecting situational character‐ istics and for solving situation connection tasks. Our opinion is that a similar approach towards social cognitive impairments in MS would throw additional light on the objective evaluation of the patient's dealing with real situations in a social context. Even studies on the relation between social cognition disturbances and functional outcome define this relation in general terms, without specifying which domains of social cognition should refer to which functional outcome domains. Resolving these issues in the MS field is a challenge for scientists requiring uniform strategies, long‐term follow‐up, creativity and interdisciplinary cooperation among

quences have not been followed up.

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researchers.

course of the disease, in what way and at to what extent.

Social cognitive impairments are a common finding in patients with MS and are often manifested at the initial stages of the disease. Both empathy and ToM deficits, regardless of physical disability, lead to psychosocial consequences such as failure to achieve life goals, limitations to employment and leisure activities, inadequacy in social relationships and daily activities [58, 61]. The preservation of a better quality of life in patients with MS requires special attention to the above mentioned aspects of the disease. Timely recognition of the deficit and adequate rehabilitation of social cognition would help patients enjoy a fulfilling social life for a longer time.
