Cognitively preserved MS patients demonstrate functional differences in processing neutral and emotional faces

Abstract

The ability to recognize emotional facial expressions is crucial to adequate social behavior. Previous studies have suggested deficits in emotion recognition in multiple sclerosis (MS). These deficits were accompanied by several confounders including cognitive or visual impairments, disease duration, and depression. In our study we used functional MRI (fMRI) to test for potential early adaptive changes in only mildly disabled MS patients performing an emotion recognition task including the facial expressions of the emotions anger, fear and disgust. Fifteen relapsing-remitting MS patients with a median Expanded Disability Status Scale (EDSS) score of 2 (range: 0-3.5) and 15 healthy controls (HC) matched for age, gender, and education underwent behavioral (BERT: behavioral emotion recognition test; BRB-N: Brief Repeatable Battery for neuropsychological tests, WCST: Wisconsin Card Sorting Test) and clinical assessments (BDI: Beck Depression Inventory). Conventional MRI at 3.0T served to assess whole-brain volume, white matter, gray matter, cerebrospinal fluid, and T2-lesion load; during fMRI, participants were confronted with neutral, scrambled, angry, disgusted, and fearful faces, and houses. In the absence of differences in cognitive performance and in the ability to accurately recognize distinct emotional facial expressions, MS patients demonstrated excess fMRI activations during facial recognition compared to HC. These differences concerned the posterior cingulate cortex (PCC) and precuneus for anger and disgust contrasted to neutral faces, and the occipital fusiform gyri and the anterior CC for neutral faces versus houses. This study provides first evidence for excess activation during processing of higher order visual stimuli of emotional content in the absence of emotional, visual or cognitive behavior abnormalities already in earlier stages of MS.

Social cognition in multiple sclerosis

“…The limited structural and functional imaging evidence among patients with MS to date suggests that social cognitive deficits may be due to abnormalities in the neural circuitry that underlie these processes. [43][44][45][46] However, further analyses, particularly for ToM, are warranted to improve our understanding of social cognitive decline. Similarly, the relationship between social cognitive and neurocognitive deficits in MS remains unclear and would benefit from longitudinal evaluation.…”

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

“…In a study of Jehna, EDSS scores did not correlate significantly with scores from emotion recognition tests or with results from FST in MS subjects (sample of 20 patients: CIS n = 12, RRMS = 7, SPMS = 1) [80]. Results from other recent studies indicate that the severity of the disease (respectively the degree of physical disability) does not correlate with the degree of impaired emotion recognition or with the psychological and social aspects of the quality of life [71,88]. Therefore, some researchers consider social cognition as a separate domain of cognition which could independently affect the quality of life of the individual, in particular, that of patients with MS. Based on the extensive review of the literature available, we can conclude that social cognition impairments in these patients require further in-depth research.…”

“…This worsens the processing of emotions and the decoding of mental states from facial expressions. Functional MRI study, conducted by Jehna et al, provides evidence of altered functional brain processing in the posterior cingulate cortex and precuneus during emotion recognition in subjects with MS (sample of 15 patients and 15 healthy individuals) [88]. Abnormalities in face encoding and recognition vary in different stages of MS.…”

“…These differences were found relatively early in the course of the disease, even in the absence of behavioral differences between subjects and controls. Since the functional changes registered in the occipital areas of patients with MS during recognition of nonemotional faces are usually associated with face processing, the authors explain the excessive activation of the posterior cingulate and precuneus during emotion processing as an additional attentive requirement [88].…”

Yet a Lot to Consider Regarding Cognition in Multiple Sclerosis

“…Yet another promising trail, that deserves to be followed, is the recent demonstration of significant impairment of social cognition abilities (emotion processing, theory of mind…) in MS patients, even at early stages [4]. Such results indicate that assessment of social cognition should be systematically assessed in addition to traditional evaluation of higher brain functions.…”