Tuesday, 19 September 2017

Social cognition in MS

Eur J Neurol. 2017 Sep 12. doi: 10.1111/ene.13457. [Epub ahead of print]

Characterization of social cognition impairment in multiple sclerosis.

Neuhaus M, Bagutti S, Yaldizli Ö, Zwahlen D, Schaub S, Frey B, Fischer-Barnicol B, Burgunder JM, Martory MD, Pöttgen J, Annoni JM, Penner IK.

Abstract
BACKGROUND:

Multiple sclerosis (MS) has been associated with deficits in social cognition. However, little is known about which domains of social cognition are predominantly affected and what other factors are associated with it.

OBJECTIVES:

1) To characterize social cognition deficit in a group of MS outpatients. 2) To relate impairment in social cognition to overall cognitive status, depression and fatigue.

METHODS:

Thirty-five MS patients (mean disease duration 12.9 years, median EDSS 3) and thirty-four healthy controls (HCs) were examined using the German version of the Geneva Social Cognition Scale to measure different domains of social cognition. Standard neuropsychological testing was applied to all patients and to 20 HCs. Patient-reported outcomes included questionnaires for fatigue, depression, anxiety and executive-behavioural disturbances.

RESULTS:

The mean social cognition raw score was lower in the MS patients compared to the HCs (86.5±8.7 vs. 91.2±5.9 p=0.005; d=0.6) and did not correlate with EDSS or disease duration. The difference was driven by facial affect recognition and the understanding of complex social situations (14% and 23% of patients under the cut-off, respectively). The impairment in these two tasks did not correlate with general cognitive performance or depression but with fatigue.

CONCLUSIONS:

The impairment in our group was restricted to high order and affective social cognition tasks and independent of general cognitive performance, EDSS, disease duration and depression. Fatigue correlated with social cognition performance, which might be due to common underlying neuronal networks.


Critiques would have you believe that emotional intelligence (EQ) is fundamental to the survival of the human race, based on pretext that EQ provides the necessary models of cooperation to drive evolution in our favour. In my opinion EQ is overrated; part 'fru fru' and part new-age, a qualitative vision for the emotional chasers, an emergent probability. If the current state of global affairs was anything to go by, and say the EQ of the human race was a business, it would surely be either bankrupt by now, or at least leveraged to the teeth??? Frankly, most of us don't talk for our health...and least of all for show. And, so why care to listen? I believe, for the small things - relationships and such, and may be also for our own sanity.

Social cognition (SC) is defined as 'the processing of information that influences our behavior towards other people'. It is heavily reliant on set of unwritten social rules, and guess work on what others might be feeling, and if you're in the UK an uncanny ability to read between the lines. The cognitive and affective alterations that result from having a neurological disorder are clearly going to affect this.

Neuhaus et al. wanted to study the factors that influence SC performance in MS. In PwMS and controls they tested both the Geneva social cognition scale and the standard neuropsychological battery.

They found SC impairment in 9% of PwMS tested, reaching 24% for facial affect recognition (the ability to detect emotion from facial expressions). There was no association with SC score and EDSS (the level of disability) or disease duration. The global SC score was moderately correlated with verbal memory, visuospatial memory (a visual map for things) and verbal fluency (information retrieval from memory). Although, fatigue and depression scores were higher in MS, there was no correlation between SC and depression. On the other hand, there was a correlation of SC with cognitive fatigue. When the authors controlled for fatigue in their analysis, the differences between PwMS and controls in SC scores were no longer significant, i.e. they disappeared.

It is therefore likely that both fatigue and SC share the same pathophysiological mechanisms, caused by widespread network dysfunction in the intricate brain connections rather than abnormalities in specific brain domains per se. Heldner et al. (Front. Neurol.) found that behavioral changes, including depression, lability, irritability, impatience, apathy, were commoner in MS (with a lifetime prevalence of ~50%), and occurred largely independent of physical disability and cognitive functioning but correlated with both fatigue and depressive symptoms. Clearly, the whole thing is a bit complicated,  but the next time you strike up an important conversation or a relationship, make sure you're well rested!

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