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Social Cognition in Pediatric-Onset MS, AAN, 2014

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Social Cognition in Pediatric-Onset MS, AAN, 2014

  1. 1. Social Cognition in Pediatric-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.
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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)
  8. 8. False Beliefs Task Story 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
  9. 9. Reading the Mind in the Eyes Test Baron-Cohen et al., 2001
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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 relapses Relapse Rate 0.90 ± 0.91 per year 0 – 3.50 per year
  14. 14. Performances on ToM tasks Measure MS n=28 mean (±sd) Control n=32 mean (±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
  15. 15. 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)
  16. 16. 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
  17. 17. 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)
  18. 18. Relation to information processing speed (SDMT) • SDMT z-scores MS= - 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)
  19. 19. 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)
  20. 20. 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
  21. 21. 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
  22. 22. 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

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