Longitudinal changes in social cognition in early relapsing-remitting multiple sclerosis over two years

Longitudinal studies examining social cognition in multiple sclerosis remain under-investigated, especially in early disease stages. This study investigated changes in social cognition over a two-year follow-up period in individuals with early relapsing-remitting multiple sclerosis (RRMS). Twenty-four participants with early RRMS and 23 matched healthy controls were included. Participants completed clinical and neuropsychological evaluations, assessments of depression, anxiety, fatigue, and quality of life (QoL), and social cognition tasks evaluating emotion recognition (Emotion Recognition Task), affective theory of mind (Reading the Mind in the Eyes Test), and cognitive theory of mind (Faux Pas Test). Longitudinal analyses revealed modest declines in both affective and cognitive theory of mind performance over follow-up, while emotion recognition remained stable. Cognitive theory of mind and emotion recognition were associated with other cognitive domains, whereas affective theory of mind showed no significant cognitive correlations. Poorer cognitive theory of mind performance was associated with lower global and mental QoL, and mental QoL was independently associated with cognitive theory of mind performance. In conclusion, social cognition, particularly theory of mind, showed modest worsening over time in individuals with early-stage RRMS despite low physical disability. These findings suggest that subtle social cognition deficits may emerge early in the disease and may be associated with poorer mental quality of life. Incorporating social cognition assessment into routine neuropsychological evaluation from the early stages of MS may allow early identification of deficits and inform targeted interventions to improve psychosocial outcomes.