Abstract
Successful socialization requires the ability of understanding of others’ mental states. This ability called as mentalization (Theory of Mind) may become deficient and contribute to everyday life difficulties in multiple sclerosis. We aimed to explore the impact of brain pathology on mentalization performance in multiple sclerosis. Mentalization performance of 49 patients with multiple sclerosis was compared to 24 age- and gender matched healthy controls. T1- and T2-weighted three-dimensional brain MRI images were acquired at 3Tesla from patients with multiple sclerosis and 18 gender- and age matched healthy controls. We assessed overall brain cortical thickness in patients with multiple sclerosis and the scanned healthy controls, and measured the total and regional T1 and T2 white matter lesion volumes in patients with multiple sclerosis. Performances in tests of recognition of mental states and emotions from facial expressions and eye gazes correlated with both total T1-lesion load and regional T1-lesion load of association fiber tracts interconnecting cortical regions related to visual and emotion processing (genu and splenium of corpus callosum, right inferior longitudinal fasciculus, right inferior fronto-occipital fasciculus, uncinate fasciculus). Both of these tests showed correlations with specific cortical areas involved in emotion recognition from facial expressions (right and left fusiform face area, frontal eye filed), processing of emotions (right entorhinal cortex) and socially relevant information (left temporal pole). Thus, both disconnection mechanism due to white matter lesions and cortical thinning of specific brain areas may result in cognitive deficit in multiple sclerosis affecting emotion and mental state processing from facial expressions and contributing to everyday and social life difficulties of these patients.
Highlights
Cognitive decline is a common clinical manifestation of multiple sclerosis (MS) with an estimated prevalence between 40–65% [1,2]
Mentalization ability was evaluated by tests of emotion recognition from facial expressions (Faces test), mental state decoding from eye gazes (Eyes test), and reasoning about mental states from verbal stories (Faux pas test)
We have found that poorer Faces test and Eyes test performances were related to regional T1-weighted WM lesion volume (rT1LV) of association fiber tracts interconnecting cortical regions related to visual and emotion processing
Summary
Cognitive decline is a common clinical manifestation of multiple sclerosis (MS) with an estimated prevalence between 40–65% [1,2]. Loss of employment status, restricted social activities, and difficulties in inter-personal relationships frequently occur during the disease [5]. Such functional limitations may relate to deficits of social cognition. Social cognition is a human ability of making inferences about mental states of other people. A few studies have investigated social cognitive abilities of patients with MS These studies have demonstrated deficits both in facial emotion recognition and cognitive inferences about complex mental states of others [8,9,10,11,12,13,14,15,16]
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