Skip to main content Accessibility help

Assessment of social cognition in patients with multiple sclerosis


We examined the capacity of patients with multiple sclerosis (MS) to attribute mental states to others and to identify cognitive abilities that subserve theory of mind (ToM). In this article, we report findings on 41 out-patients with diagnosed MS who underwent detailed neuropsychological and social-cognitive assessment. They were subdivided into a cognitively intact (n=15) and cognitively impaired (n=26) group according to their neuropsychological test results. Their results were compared with those of 20 age- and education-matched controls. MS patients with cognitive impairments were found to have more difficulties attributing mental states to others than did cognitively intact MS patients and normal controls on two ToM measures; short stories (Happé, Winner, & Brownell, 1998) and video clips (Ouellet, Bédirian, Charbonneau, & Scherzer, 2009). When attention, memory, and working memory were controlled, performance on the WAIS-III Picture Arrangement task accounted for 17.3% of the variance in performance on the video clips task. Performance on a WAIS-III index composed of Similarities and Comprehension subtests, accounted for 7.0% of the variance in performance on the short stories task. These results provide some preliminary information on the effect of MS-related cognitive deficits on the ability to attribute mental states to others. (JINS, 2010, 16, 287–296.)

Corresponding author
*Correspondence and reprint requests to: Peter Scherzer, PhD, Département de psychologie, Université du Québec à Montréal, Case postale 8888, Succursale Centre-ville, Montréal, (Québec), Canada H3C 3P8. E-mail:
Hide All
Achiron, A., & Barak, Y. (2006). Cognitive changes in early MS: A call for common framework. Journal of the Neurological Sciences, 245, 4755.
Amato, M.P., Ponziani, G., Siracusa, G., & Sorbi, S. (2001). Cognitive dysfunction in early-onset multiple sclerosis: A reappraisal after 10 years. Archives of Neurology, 58, 16021606.
Amato, P.M., Zipoli, V., & Portaccio, E. (2006). Multiple sclerosis-related cognitive changes: A review of cross-sectional and longitudinal studies. Journal of the Neurological Sciences, 245, 4146.
Apperly, I.A., Samson, D., Chiavarino, C., & Humphreys, G.W. (2004). Frontal and temporo-parietal lobe contributions to theory of mind: Neuropsychological evidence from a false-belief task with reduced language and executive demands. Journal of Cognitive Neuroscience, 16, 17731784.
Arnett, P.A., Rao, S.M., Bernardin, L., Grafman, J., Yetkin, E.Z., & Lobeck, L. (1994). Relationship between frontal lobe lesions and Wisconsin Card Sorting Test performance in patients with multiple sclerosis. Neurology, 44, 420425.
Baddeley, A.D. (1968). A 3 minute reasoning test based on grammatical transformation. Psychonomic Sciences, 10, 341342.
Baron-Cohen, S., Leslie, A.M., & Frith, U. (1985). Does the autistic child have a ‘theory of mind’? Cognition, 21, 3746.
Baron-Cohen, S., Joliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger Syndrome. Journal of Child Psychology and Psychiatry, 38, 813822.
Beatty, W.W., Goodkin, E.D., Beatty, A.P., & Monson, N. (1989). Frontal lobe dysfunction and memory impairment in patients with chronic progressive multiple sclerosis. Brain and Cognition, 11, 7386.
Benito-Leon, J., Morales, J.M., & Rivera-Navarro, J. (2002). Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients. European Journal of Neurology, 9, 497502.
Bobholz, J.A., & Rao, S.M. (2003). Cognitive dysfunction in multiple sclerosis: A review of recent developments. Current Opinion in Neurology, 16, 283288.
Brassington, J.C., & Marsh, N.V. (1998). Neuropsychological aspects of multiple sclerosis. Neuropsychology Review, 8, 4377.
Carlson, S.M., Moses, L.J., & Breton, C. (2002). How specific is the relation between executive function and theory of mind? Contributions of inhibitory control and working memory. Infant and Child Development, 11, 7392.
Carruthers, P., & Smith, P.K., (Eds.). (1996). Theories of theories of mind. Cambridge: Cambridge University Press.
Cutajar, R., Ferriani, E., Scandellari, C., Sabattini, L., Trocino, C., Marchello, L.P., et al. . (2000). Cognitive function and quality of life in multiple sclerosis patients. Journal of Neurovirology, 6, 186190.
Delis, D., Kaplan, E., & Kramer, J. (2001). Delis-Kaplan executive function scale. San Antonio: Psychological Corporation.
Denney, R.D., Lynch, G.S., & Parmenter, A.B. (2008). A 3-year longitudinal study of cognitive impairment in patients with primary progressive multiple sclerosis: Speed matters. Journal of the Neurological Sciences, 267, 129136.
Dziobek, I., Fleck, S., Kalbe, E., Rogers, K., Hassenstab, J., Brand, M., et al. . (2006). Introducing MASC: A movie for the assessment of social cognition. Journal of Autism and Developmental Disorder, 36, 623636.
Feinstein, A. (1999). The clinical neuropsychiatry of multiple sclerosis. New York: Cambridge University Press.
Fischer, J.S., Foley, F.W., Aikens, J.E., Ericson, G.D., Rao, S.M., & Shindell, S. (1994). What do we really know about cognitive dysfunction, affective disorders, and stress in multiple sclerosis? A practitioner’s guide. Neurorehabilitation and Neural Repair, 8, 151164.
Foong, J., Rozewicz, L., Quaghebeur, G., Davie, C.A., Kartsounis, L.D., Thompson, A.J., et al. . (1997). Executive function in multiple sclerosis. The role of frontal lobe pathology. Brain, 120, 1526.
Gilchrist, A.C., & Creed, F.H. (1994). Depression, cognitive impairment and social stress in multiple sclerosis. Journal of Psychosomatic Research, 38, 193201.
Golan, O., Baron-Cohen, S., Hill, J.J., & Golan, Y. (2006). The “Reading the Mind in Films” Task: A study of complex emotion recognition in adults with and without autism spectrum conditions. Society of Autism and Developmental Disorders, 37, 10961106.
Happé, F., Brownell, H., & Winner, E. (1999). Acquired “theory of mind” impairments following stroke. Cognition, 70, 211240.
Happé, F.G.E., Malhi, G.S., & Checkley, S. (2001). Acquired mind-blindness following frontal lobe surgery? A single case study of impaired ‘theory of mind’ in a patient treated with stereotactic anterior capsulotomy. Neuropsychologia, 39, 8390.
Happé, F.G.E., Winner, E., & Brownell, H. (1998). The getting of wisdom: Theory of mind in old age. Developmental Psychology, 34, 358362.
Heavey, L., Phillips, W., Baron-Cohen, S., & Rutter, M. (2000). The Awkward Moments Test: A naturalistic measure of social understanding in autism. Journal of Autism and Developmental Disorder, 30, 225236.
Henry, J.D., Phillips, L.H., Beatty, W.W., McDonald, S., Longley, W.A., Joscelyne, A., et al. . (2009). Evidence for deficits in facial affect recognition and theory of mind in multiple sclerosis. Journal of the International Neuropsychological Society, 15, 277285.
Huijbregts, S.C., Kalkers, N.F., de Sonneville, L.M., de Groot, V., & Polman, C.H. (2006). Cognitive impairment and decline in different MS subtypes. Journal of the Neurological Sciences, 245, 187194.
Kesselring, J., & Klement, U. (2001). Cognitive and affective disturbances in multiple sclerosis. Journal of Neurology, 248, 180183.
Kurtzke, J.F. (1983). Rating neurological impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology, 33, 14441452.
Leslie, A.M. (1987). Pretence and representation in infancy: The origins of theory of mind. Psychological Review, 94, 84106.
Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological assessment (4th ed.). New York: Oxford University Press.
Lieberman, A., & Benson, D.F. (1977). Control of emotional expression in pseudobulbar palsy. A personal experience. Archives of Neurology, 34, 717719.
MacPherson, S.E., Phillips, L.H., & Della Sala, S.D. (2002). Age, executive function and social decision making: A dorsolateral prefrontal theory of cognitive aging. Psychology and Aging, 17, 598609.
Maurer, D., O’Craven, K.M., Le Grand, R., Mondloch, C.J., Springer, M.V., Lewis, T.L., et al. . (2006). Neural correlates of processing facial identity based on features versus their spacing. Neuropsychologia, 145, 14381451.
Maylor, E.A., Moulson, J.M., Muncar, A.M., & Taylor, L.A. (2002). Does performance on theory of mind tasks decline in old age? British Journal of Psychology, 93, 465485.
McDonald, W.I., Compston, A., Edan, G., Goodkin, D., Hartung, H.-P., Lublin, F.D., et al. . (2001). Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the diagnosis of multiple sclerosis. Annals of Neurology, 50, 121127.
Montreuil, M., & Lyon-Caen, O. (1993). Troubles thymiques et relations entre alexithymie et dysfonctionnement interhémisphérique dans la sclérose en plaques. Revue de Neuropsychologie, 3, 287302.
Ouellet, J., Bédirian, V., Charbonneau, S., & Scherzer, P.B. (2002). La cognition sociale chez les personnes âgées: proposition d’une mesure écologique. Trois-Rivières: Poster presented at the 25th Annual Meeting of the Société québécoise pour la recherche en psychologie (SQRP).
Pelosi, L., Geesken, J.M., Holly, M., Hayward, M., & Blumhardt, L.D. (1997). Working memory impairment in early multiple sclerosis: Evidence from an event-related potential study of patients with clinically isolated myelopathy. Brain, 120, 20392058.
Potagas, C., Giogkaraki, E., Koutsis, G., Mandellos, D., Tsirempolou, E., Sfagos, C., et al. . (2008). Cognitive impairment in different MS subtypes and clinically isolated syndromes. Journal of the Neurological Sciences, 267, 100106.
Rao, S.M. (1996). White matter disease and dementia. Brain and Cognition, 31, 250268.
Rao, S.M., Grafman, J., DiGiulio, D., Mittenberg, W., Bernardin, L., Leo, G.J., et al. . (1993). Memory dysfunction in multiple sclerosis: Its relation to working memory, semantic encoding, and implicit learning. Neuropsychology, 7, 364374.
Rao, S.M., Leo, G.J., Bernardin, L., & Unverzagt, F. (1991a). Cognitive dysfunction in multiple sclerosis. I. Frequency, patterns, and prediction. Neurology, 41, 685691.
Rao, S.M., Leo, J., Ellington, L., Naurtz, T., Bernardin, I., & Unverzagt, F. (1991b). Cognitive dysfunction in multiple sclerosis II: Impact on employment and social functioning. Neurology, 41, 692696.
Roeyers, H., Buysse, A., Ponnet, K., & Pichal, B. (2001). Advancing advanced mind-reading tests: Empathic accuracy in adults with a pervasive developmental disorder. Journal of Child Psychology and Psychiatry and Allied Disciplines, 42, 271278.
Rowe, A.D., Bullock, P.R., Polkey, C.E., & Morris, R.G. (2001). Theory of mind impairments and their relationship to executive functioning following frontal lobe excisions. Brain, 24, 600616.
Ruby, M., & Decety, J. (2003). What you believe versus what you think they believe: A neuroimaging study of conceptual perspective-taking. European Journal of Neuroscience, 17, 24752480.
Sartori, E., & Edan, G. (2006). Assessment of cognitive dysfunction in multiple sclerosis. Journal of the Neurological Sciences, 245, 169175.
Saxe, R., & Kanwisher, N. (2003). People thinking about thinking people: The role of the temporo-parietal junction in “theory of mind”. Neuroimage, 19, 18351842.
Saxe, R., & Powell, L.J. (2006). It’s the thought that counts: Specific brain regions for one component of theory of mind. Psychological Science, 17, 692699.
Saxe, R., & Wexler, A. (2005). Making sense of another mind: The role of the right temporo-parietal junction. Neuropsychologia, 43, 13911399.
Schiffer, R.B. (1990). Affective disturbance in multiple sclerosis: Disturbances of affect. In Rao, S.M. (Ed.), Neurobehavioral aspects of multiple sclerosis (pp. 186195). Oxford: Oxford University Press.
Schiffer, R.B., & Caine, E.D. (1991). The interaction between depressive affective disorder and neuropsychological test performance in multiple sclerosis patients. Journal of Neuropsychiatry and Clinical Neuroscience, 3, 2832.
Siegert, R.J., & Abernethy, D.A. (2005). Depression in multiple sclerosis: A review. Journal of Neurology, Neurosurgery, and Psychiatry, 76, 469475.
Sommer, M., Döhnel, K., Sodian, B., Meinhardt, J., Thoermer, J.C., & Hajak, G. (2007). Neural correlates of true and false belief reasoning. Neuroimage, 35, 13781384.
Stone, V.E., Baron-Cohen, S., & Knight, R.T. (1998). Frontal lobe contribution to theory of mind. Journal of Cognitive Neuroscience, 10, 640656.
Stuss, D.T., Gallup, G.G., & Alexander, M.P. (2001). The frontal lobes are necessary for ‘theory of mind’. Brain, 124, 279286.
Sullivan, S., & Ruffman, T. (2004). Social understanding: How does it fare with advancing years? British Journal of Psychology, 95, 118.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



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