**Social Cognition Impairments in Patients with Multiple Sclerosis and Comparison with Imaging Studies, Disease Duration and Grade of Disability**

Valentina Ignatova, Lyudmila Todorova and Jivko Surchev

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/63465

#### **Abstract**

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sclerosis (MACFIMS). J Int Neuropsychol Soc. 2006;12(4):549–558

Cognitive impairments in multiple sclerosis (MS) are heterogeneous and their rate varies between 43% and 70%. A less studied aspect of cognition is social cognition, which is not a uniform theoretical construct. It includes emotion perception, prosody, empathy, theory of mind (ToM) and assessment of mood. In addition to progressive physical disability, social cognitive impairments are a reason for job loss in 24–80% of patients with MS, increased divorce rate, dissolution of partnerships and social communication difficulties.

Social cognitive impairments are the result of disruptions in the mentalization network at the neuroanatomical, neurochemical and/or genetic level, which can lead to malfunc‐ tions in the dopaminergic–serotoninergic system and to compromising the develop‐ ment of neuroanatomical targets within the network. The wide dissemination of demyelinating lesions and cortical thinning typical of patients with MS often lead to anatomic and functional disorders of the above‐mentioned specific brain structures. A correlation has been established among specific cortical areas involved in emotion identification from facial expression (right and left fusiform face area, frontal eye), emotion processing (right entorhinal cortex) and socially relevant information (left temporal pole). The most active brain region involved in social cognitive processing is the medal frontal cortex (MFC), which is described as the brain's social cognitive center. During perform‐ ance of various sociocognitive tasks for mental state attribution, common areas of increased activation in the medial prefrontal gyrus and the temporoparietal junctions are registered bilaterally, while the area of the medial prefrontal cortex (the paracingulate cortex) is the only region uniquely activated by the performance of ToM.

Most MRI studies of patients with MS found a correlation between the cognitive and/or affective disorders, on the one hand, and lesion localization, total lesion load, or cerebral atrophy, on the other. A significant correlation was also reported between

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abnormal activities in specific cortical zones on fMRI, on the one hand, and clinical manifestation, conventional MRI findings and behavioral changes, on the other. Altered patterns of brain activity were found in all clinical phenotypes of MS, including when cognitive abilities were intact and/or restored, social cognitive dysfunction in MS actually affects all stages of the disease and all types of clinical course. The cortical plastic changes are a dynamic phenomenon that can be modulated by external factors. This phenomenon would facilitate the mapping of individual strategies for adequate treatment and rehabilitation of each patient.

**Keywords:** social cognition, multiple sclerosis, empathy, theory of mind, mentaliza‐ tion, emotional perception, faux pas, disability, social brain, imaging studies

### **1. Introduction**

Multiple sclerosis (MS) is a chronic inflammatory autoimmune degenerative disease of the central nervous system (CNS) leading to both physical and neuropsychological disability. These two types of impairment may occur simultaneously or independently [1]. Until now the focus of scientific research has predominantly been on the physical disablement in patients with MS and its impact on their quality of life. Over the last few decades, researchers have shown an increasing interest in mood disorders, behavior and cognition in this disease.

Cognitive impairments in MS are heterogeneous [2] and their rate varies between 43% and 70% [3–5]. They are in an independent form of disability and make the performance of routine daily activities difficult, sometimes impossible. Up to now studies have mostly been conducted on impairments in the main cognitive domains such as memory, attention and executive functions. A less studied aspect of cognition is social cognition, which is not a uniform theoretical construct. It includes emotion perception, prosody, empathy, theory of mind (ToM) and assessment of mood [6, 7]. Findings in MS show disturbance not only in emotion recog‐ nition from facial expressions but in the whole area of general emotion processing. The connection between cognitive decline and impaired social cognitive skills in MS remains debatable.

Social cognitive dysfunction in MS actually affects all stages of the disease and all types of clinical course. Such disturbances are reported even in clinically isolated syndrome (CIS). Relatively, little is known about the evolution of cognitive deficits in MS, especially about those manifested in the early stages of the disease [8].

The frequency of social cognition impairments and the nature of pathological changes in the brain in patients with MS are reasonable grounds for seeking a relationship between deterio‐ rated mentalization and findings from imaging/functional brain studies. Studies looking for a correlation between cognitive decline and MRI changes (lesion volume, lesion load, cortical thinning) are still at an early stage. This also applies to studies seeking to detect functional changes in specific brain areas responsible for the performance of relevant sociocognitive tasks. Additional data from future research in this field are needed for better understanding of social cognition impairments [9].

In addition to progressive physical disability, social cognitive impairments are a reason for job loss in 24–80% of patients with MS [10, 11], increased divorce rate, dissolution of partnerships [12] and social communication difficulties. Furthermore, these disturbances restrict the career development and social life of patients. This calls for a multidisciplinary approach in research and concurrent assessment of the physical, neuropsychological and social aspects of disability in MS.

The main objective is to evaluate the frequency and degree of social cognition impairments in patients with MS based on systematic analysis of advanced scientific research and to outline scientific trends in the field.
