**2. Methods**

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

**Keywords:** social cognition, multiple sclerosis, empathy, theory of mind, mentaliza‐

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

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

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

tion, emotional perception, faux pas, disability, social brain, imaging studies

treatment and rehabilitation of each patient.

manifested in the early stages of the disease [8].

cognition impairments [9].

**1. Introduction**

228 Trending Topics in Multiple Sclerosis

debatable.

We conducted advanced search based on the following key words in different combinations: "social cognition", "multiple sclerosis", "empathy", "theory of mind (ToM)", "faux pas", "mentalization", "emotional perception", "disability", "social brain" and "imaging studies". The selection was made by two independent reviewers who retrieved relevant scientific works (original articles, book chapters, systematic reviews) published in English from electronic database (PubMed, MEDLINE). The search period was unrestricted. The following inclusion criteria were determined: (1) subjects, suffering from multiple sclerosis; (2) assessment of social cognition abilities; and (3) brain imaging findings and impaired social cognition. Case report articles were excluded. A relationship between social cognition skills, physical disability and duration of the disease was searched. We also checked up the bibliography of the related sources and included the relevant articles. We also checked up the bibliography of the related sources and included the relevant articles. We selected six books, seven book chapters, 43 scientific reviews, 86 original articles, one thesis, two conference papers and one manual regarding social cognition and/or MS. Finally, we retrieved two book chapters, 10 scientific reviews, 32 research studies, one thesis and two conference papers on the current topic "social cognition" in MS. Meta‐analysis was not suitable for summarizing of the results due to methodological heterogeneity between reviewed studies. Quantitative assessment of the relevant data was conducted. Different points of views, as well as controversies within the scientific field, were presented. We highlighted key results, determined importance of social cognition impairments for quality of life in patients with MS and outlined a framework of research trends.
