Social Cognition inPediatric-Onset MS

Leigh Charvet, Rebecca Cleary, Katherine Vazquez, Livana Koznesoff, Kate Bartolotta, Jeremy

Benhamroum & Lauren Krupp for the

U.S. Network of Pediatric MS Centers

Lourie Center for Pediatric MS, Stony Brook Medicine

Supported by the National MS Society (grant numbers PP2106, 10020073405); NIH (grant number R01NS071463); The Lourie Foundation, Inc.

Social cognition

• Cognitive processes that guide social interaction

• Theory of mind (ToM) is core construct – infer another’s mental state, making attributions to

their knowledge, beliefs, and emotions– affective and cognitive

Social cognitive deficits

• Characterize autism spectrum disorders, frontal lobe injury, schizophrenia

• More recent studies have found often subtle deficits in a wide range of neurodegenerative conditions

Social cognition in adults with MS

• Deficits found in:– Accurate attribution of the mental state of others– Accurate recognition of emotions, intentions

• Cognitively intact participants • Independent from – disease duration– level of neurologic impairment (EDSS)– fatigue and depressed mood

Pilot study objective

• To determine whether pediatric-onset MS is associated with impaired social cognition

• Pediatric-onset (less than 18 years):– Youngest MS subpopulation– Approximately one-third with cognitive

impairment

• Social cognition especially critical for this age group

Participants

• Pediatric-onset MS participants under the age of 21 years– No other primary neurologic, psychiatric or

medical condition– Steroid-free for 30 days or more and

neurologically stable

• Healthy controls participants– Recruited from community

Measures

• Symbol Digit Modalities Test (SDMT) • ToM– False Beliefs Task– Reading the Mind in the Eyes Test– Faux Pas Test

• Parent behavior inventory– Empathizing/Systematizing (EQ-SQ)

False Beliefs TaskStory narrative with cartoon illustration

• First Order: What does character know or believe?• Second Order: What does one character know or believe about another?

Bake Sale, Hollebranse 2007, Perner & Wimmer, 1985

Reading the Mind in the Eyes Test

Baron-Cohen et al., 2001

Faux Pas Test• Narrative vignettes in which a character inadvertently hurts or

offends another Example: James bought Richard a toy airplane for his birthday. A few months later, they were playing with it, and James accidentally dropped it. “Don’t worry” said Richard, “I never liked it anyway. Someone gave it to me for my birthday”. – Detection:

• Did someone say something they shouldn’t have?

– Comprehension: • What did James give Richard for his birthday?

– False Belief: • Did Richard remember James had given him the toy airplane for his birthday?

Baron-Cohen et al., 2001

Empathizing/Systemizing (EQ-SQ) Inventory

• Empathizing Quotient: Interest in the thoughts and feelings of others with appropriate responses

• “My child would not cry or get upset if a character in a film died.”• “My child is quick to notice when people are joking.”

• Systemizing Quotient: Interest in aspects of the world where rules are applied, e.g., mechanical and natural systems

• “My child is interested in the different members of a specific animal category (e.g. dinosaurs, insects, etc).”

• My child enjoys arranging things precisely (e.g. flowers, books, music collections

• Baron-Cohen et al., 2005

Sample characteristics MS (n=28)

mean (±sd) or %(n)

Control (n=32)mean (±sd) or

%(n)

p

Age 16.29 (±3.12)Range: 8 to 20

15.69 (±2.94)Range: 8 to 19

0.45

Female 68(19) 72(23) 0.78

Caucasian 52(14) 81(26) 0.02

Hispanic 50(14) 28(9) 0.11

Maternal Education

5.48 (±1.89) 7.07 (±1.24) 0.001

WASI FSIQ 103.29 (±12.67) 108.06 (±13.82) 0.21

Clinical characteristics of MS participants

EDSS at testing Median: 1.0 0.0 to 4.0

Disease duration Mean: 33.86 (±30.11) months

1 – 97 months

Total Relapses 2.46 ± 2.44 0 – 9 relapsesRelapse Rate 0.90 ± 0.91 per

year0 – 3.50 per year

Performances on ToM tasks

Measure MS n=28mean (±sd)

Control n=32mean (±sd)

p

Eyes Test 19.73 (±3.19) 21.75 (±2.49) 0.008

Faux Pas Test Total 8.68 (±0.91) 9.24 (±0.69) 0.009

False Beliefs Task * 2.57 (±0.81) 2.88 (±0.34) 0.06

*MS n=21

Item sub-analyses• Faux Pas Test: –MS participants’ performed lower on the false

beliefs component• Identification of faux pas p=0.19• Story comprehension p=0.25• False beliefs p=0.008

• False Beliefs task:–MS group made more errors for both first and

second order items– Approached significance for more errors on

second order item (p=0.08)

ToM and relation to demographic factors

• MS group more racially diverse with lower maternal educational attainment

• Controlling for these and other factors (age, estimated IQ, gender, or ethnicity) did not alter pattern of results

ToM and relation to MS clinical features

• Total ToM performance – Total number of relapses (r=-0.39, ns)– Disease duration (r=-0.27, ns)– EDSS (r=-0.17, ns)– Relapse rate (r=0.13, ns)

Relation to information processing speed (SDMT)

• SDMT z-scoresMS= - 0.26 (±1.74) vs. HCs= 0.44 (±1.19), p=0.08

• SDMT impairment– 10 (38%) in MS vs. 2 (6%) in HC group

• SDMT with ToM total score, r=0.35, p=0.01• Controlling for SDMT, MS participants’ ToM

performance remained lower than controls (p=0.05)

EQ-SQ Inventory

• MS n=18 vs. HC n=16• Mean EQ: 40.28 ±5.94 vs. 40.69 ±8.51 (ns)• Mean SQ= 23.94 ± 8.29 vs. 23.69 ± 5.77 (ns)• Not related to ToM performance (in either

group)

Summary

• Relative to healthy controls, pediatric-onset MS participants performed worse on study ToM measures– Poorer facial recognition of affective state– Poorer ability to identify beliefs and knowledge of others

• Not explained by demographic factors• Not clearly linked with disease activity • Lower SDMT performance was predictive of ToM, but did not

fully account for the MS group’s deficit• The EQ-SQ inventory did not distinguish the two groups

Limitations

• Cross-sectional pilot study• Only preliminary measures of ToM• Additional measures of cognitive functioning

needed– Executive functioning

• Real-world measures of actual social functioning

Conclusions• ToM deficits may occur in pediatric-onset MS• Consistent with findings in adult MS samples • Deficits are subtle and clinical significance is

unclear• May underlie functional difficulties that would

otherwise go undetected• Youngest may be most vulnerable to long-term

consequences of even subtle deficits