Skip to main content Accessibility help

Cognitive but Not Affective Theory of Mind Deficits in Progressive MS

  • Katie Lancaster (a1) (a2), Eric M. Stone (a1) and Helen M. Genova (a1) (a2)



Social cognitive deficits are an important consequence of multiple sclerosis (MS), yet our understanding of how these deficits manifest in progressive MS is currently limited. To this end, we examined theory of mind (ToM) ability in a sample of individuals with progressive MS using an ecologically valid virtual assessment tool that allows for delineation of cognitive ToM (inferring thoughts and intentions of others) from affective ToM (inferring emotions of others).

Methods & Results:

We compared 15 individuals with progressive MS and 15 healthy controls on their ToM ability using the Virtual Assessment of Mentalising Ability. We found that, relative to healthy controls, participants with progressive MS were impaired in cognitive ToM, but not in affective ToM. Furthermore, we found that the MS participants’ deficits in cognitive ToM were mediated by their general cognitive ability such that poor cognitive ToM ability in MS was explained by poor performance on tests of memory and processing speed.


Our findings demonstrate that ToM deficits in progressive MS may be limited to cognitive ToM, while affective ToM is conserved. This could be attributable to the MS-related deficits in general cognitive ability, which appear to negatively affect only the cognitive component of ToM.


Corresponding author

Correspondence and reprint requests to: Helen M. Genova, 120 Eagle Rock Avenue, Suite 100, East Hanover, NJ 07936-3147, USA, Ph: 973-324-3890. E-mail:


Hide All
Abu-Akel, A. & Shamay-Tsoory, S. (2011). Neuroanatomical and neurochemical bases of theory of mind. Neuropsychologia, 49(11), 29712984. Doi: 10.1016/J.NEUROPSYCHOLOGIA.2011.07.012 10.1016/j.neuropsychologia.2011.07.012
Baron-cohen, S., Riordan, M.O., Stone, V., Jones, R., & Plaisted, K. (1999). A new test of social sensitivity: detection of faux pas in normal children and children with asperger syndrome. Journal of Autism and Developmental Disorders, 29(5), 407418. Doi: 10.1016/B978-0-12-802169-9.00012-4 10.1023/A:1023035012436
Batista, S., Freitas, S., Afonso, A., Macário, C., Sousa, L., Cunha, L., & Santana, I. (2018). Theory of mind and executive functions are dissociated in multiple sclerosis. Archives of Clinical Neuropsychology, 33(5), 541551. Doi: 10.1093/arclin /acx101 10.1093/arclin/acx101
Benedict, R.H., Amato, M.P., Boringa, J., Brochet, B., Foley, F., Fredrikson, S., Hamalainen, P., Hartung, H., Krupp, L., Penner, I., Reder, A.T. & Langdon, D. (2012). Brief International Cognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurology, 12(1), 55. Doi: 10.1186/1471-2377-12-55 10.1186/1471-2377-12-55
Benedict, R.H.B., Schretlen, D., Groninger, L., Dobraski, M., & Shpritz, B. (1996). Revision of the brief visuospatial memory test: Studies of normal performance, reliability, and validity. Psychological Assessment, 8(2), 145.10.1037/1040-3590.8.2.145
Canty, A.L., Neumann, D.L., Fleming, J., & Shum, D.H.K. (2017). Evaluation of a newly developed measure of theory of mind: the virtual assessment of mentalising ability. Neuropsychological Rehabilitation, 27(5), 834870. Doi: 10.1080/09602011.2015.1052820 10.1080/09602011.2015.1052820
Chalah, M.A. & Ayache, S.S. (2017). Deficits in social cognition: an unveiled signature of multiple sclerosis. Journal of the International Neuropsychological Society, 23(3), 266286. Doi: 10.1017/S1355617716001156 10.1017/S1355617716001156
Ciampi, E., Uribe-San-Martin, R., Vásquez, M., Ruiz-Tagle, A., Labbe, T., Cruz, J.P., Lillo, P., Slachevsky, A., Reyes, D., Reyes, A., & Cárcamo-Rodríguez, C. (2018). Relationship between social cognition and traditional cognitive impairment in progressive multiple sclerosis and possible implicated neuroanatomical regions. Multiple Sclerosis and Related Disorders, 20, 122128. Doi: 10.1016/j.msard.2018.01.013 10.1016/j.msard.2018.01.013
Cotter, J., Firth, J., Enzinger, C., Kontopantelis, E., Yung, A.R., Elliott, R., & Drake, R.J. (2016). Social cognition in multiple sclerosis: a systematic review and meta-analysis. Neurology. Doi: 10.1212/WNL.0000000000003236 10.1212/WNL.0000000000003236
Delis, D., Dean, C., Kramer, J.H., Kaplan, E., & Ober, B. (2000). California verbal learning test, second edition (CVLT-II). Psychological Corporation. San Antonio, TX.
Genova, H.M., Cagna, C.J., Chiaravalloti, N.D., Deluca, J., & Lengenfelder, J. (2015). Dynamic assessment of social cognition in individuals with multiple sclerosis: a pilot study. Journal of the International Neuropsychological Society, 22(1), 8388. Doi: 10.1017/S1355617715001137 10.1017/S1355617715001137
Hauser, S.L., Dawson, D.M., Lehrich, J.R., Beal, M.F., Kevy, S.V., Propper, R.D., … Weiner, H.L. (1983). Intensive immunosuppression in progressive multiple sclerosis. New England Journal of Medicine, 308(4), 173180. Doi: 10.1056/NEJM198301273080401 10.1056/NEJM198301273080401
Henry, A., Bakchine, S., Maarouf, A., Chaunu, M.P., Rumbach, L., Magnin, E., … Montreuil, M. (2015). Facial emotion recognition and faux pas interpretation in multiple sclerosis. Brain Impairment, 16(3), 158172. Doi: 10.1017/BrImp.2015.33 10.1017/BrImp.2015.33
Henry, A., Tourbah, A., Chaunu, M.-P., Bakchine, S., & Montreuil, M. (2017). Social cognition abilities in patients with different multiple sclerosis subtypes. Journal of the International Neuropsychological Society, 23(08), 653664. Doi: 10.1017/S1355617717000510 10.1017/S1355617717000510
Higginson, C.I., Arnett, P.A., & Voss, W.D. (2000). The ecological validity of clinical tests of memory and attention in multiple sclerosis. Archives of Clinical Neuropsychology, 15(3), 185204. Doi: 10.1093/arclin /15.3.185 10.1093/arclin/15.3.185
Isernia, S., Baglio, F., d’Arma, A., Groppo, E., Marchetti, A., & Massaro, D. (2019). Social mind and long-lasting disease: focus on affective and cognitive theory of mind in multiple sclerosis. Frontiers in Psychology, 10, 218. Doi: 10.3389/fpsyg.2019.00218 10.3389/fpsyg.2019.00218
Kollndorfer, K., Krajnik, J., Woitek, R., Freiherr, J., Prayer, D., & Schöpf, V. (2013). Altered likelihood of brain activation in attention and working memory networks in patients with multiple sclerosis: an ALE meta-analysis. Neuroscience & Biobehavioral Reviews, 37(10), 26992708. Doi: 10.1016/J.NEUBIOREV.2013.09.005 10.1016/j.neubiorev.2013.09.005
Mike, A., Strammer, E., Aradi, M., Orsi, G., Perlaki, G., Hajnal, A., … Illes, Z. (2013). Disconnection mechanism and regional cortical atrophy contribute to impaired processing of facial expressions and theory of mind in multiple sclerosis: a structural MRI study. PLoS One, 8(12), e82422. Doi: 10.1371/journal.pone.0082422 10.1371/journal.pone.0082422
Phillips, L.H., Henry, J.D., Scott, C., Summers, F., Whyte, M., & Cook, M. (2011). Specific impairments of emotion perception in multiple sclerosis. Neuropsychology, 25(1), 131136. Doi: 10.1037/a0020752 10.1037/a0020752
Preacher, K.J. & Hayes, A.F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879891. Doi: 10.3758/BRM.40.3.879 10.3758/BRM.40.3.879
Raimo, S., Trojano, L., Pappacena, S., Alaia, R., Spitaleri, D., Grossi, D., & Santangelo, G. (2017). Neuropsychological correlates of theory of mind deficits in patients with multiple sclerosis. Neuropsychology, 31(7), 811821. Doi: 10.1037/neu0000372 10.1037/neu0000372
Roca, M., Manes, F., Gleichgerrcht, E., Ibáñez, A., González de Toledo, M.E., Marenco, V., Bruno, D., Torralva, T., & Sinay, V. (2014). Cognitive but not affective theory of mind deficits in mild relapsing-remitting multiple sclerosis. Cognitive And Behavioral Neurology, 27(1), 2530. Doi: 10.1097/wnn.0000000000000017 10.1097/WNN.0000000000000017
Silva, P.H.R., Spedo, C.T., Barreira, A.A., & Leoni, R.F. (2018). Symbol digit modalities test adaptation for magnetic resonance imaging environment: a systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, 20, 136143. Doi: 10.1016/J.MSARD.2018.01.014 10.1016/j.msard.2018.01.014
Smith, A. (1982). Symbol Digit Modalities Test. 1982. Western Psychological Services, Los Angeles. Western Psychological Services Los Angeles, CA.
Thompson, A.J., Banwell, B.L., Barkhof, F., Carroll, W.M., Coetzee, T., Comi, G., Correale, J., Fazekas, F., Filippi, M., Freedman, M.S., Fujihara, K., Galetta, S.L., Hartung, H.P., Kappos, L., Lublin, F.D., Marrie, R.A., Miller, A.E., Miller, D.H., Montalban, X., Mowry, E.M., Sorensen, P.S., Tintoré, M., Traboulsee, A.L., Trojano, M., Uitdehaag, B.M.J., Vukusic, S., Waubant, E., Weinshenker, B.G., Reingold, S.C., & Cohen, J.A. (2018). Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. The Lancet Neurology, 17(2), 162173. Doi: 10.1016/S1474-4422(17)30470-2 10.1016/S1474-4422(17)30470-2


Cognitive but Not Affective Theory of Mind Deficits in Progressive MS

  • Katie Lancaster (a1) (a2), Eric M. Stone (a1) and Helen M. Genova (a1) (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed