title: Social cognition in multiple sclerosis: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To quantify the magnitude of deficits in theory of mind (ToM) and facial emotion recognition among patients with multiple sclerosis (MS) relative to healthy controls.
  
  
  METHODS
  An electronic database search of Ovid MEDLINE, PsycINFO, and Embase was conducted from inception to April 1, 2016. Eligible studies were original research articles published in peer-reviewed journals that examined ToM or facial emotion recognition among patients with a diagnosis of MS and a healthy control comparison group. Data were independently extracted by 2 authors. Effect sizes were calculated using Hedges g.
  
  
  RESULTS
  Twenty-one eligible studies were identified assessing ToM (12 studies) and/or facial emotion recognition (13 studies) among 722 patients with MS and 635 controls. Deficits in both ToM (g = -0.71, 95% confidence interval [CI] -0.88 to -0.55, p < 0.001) and facial emotion recognition (g = -0.64, 95% CI -0.81 to -0.47, p < 0.001) were identified among patients with MS relative to healthy controls. The largest deficits were observed for visual ToM tasks and for the recognition of negative facial emotional expressions. Older age predicted larger emotion recognition deficits. Other cognitive domains were inconsistently associated with social cognitive performance.
  
  
  CONCLUSIONS
  Social cognitive deficits are an overlooked but potentially important aspect of cognitive impairment in MS with potential prognostic significance for social functioning and quality of life. Further research is required to clarify the longitudinal course of social cognitive dysfunction, its association with MS disease characteristics and neurocognitive impairment, and the MS-specific neurologic damage underlying these deficits.
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria. jack.cotter@manchester.ac.uk.
authors.forename: Jack
authors.initials: J
authors.lastname: Cotter
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
authors.forename: Joseph
authors.initials: J
authors.lastname: Firth
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Enzinger
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Elliott
authors.affiliation: From the Institute of Brain, Behaviour and Mental Health (J.C., J.F., A.R.Y., R.E., R.J.D.) and Farr Institute for Health Informatics Research (E.K.), University of Manchester, UK; and Research Unit for Neuronal Repair and Plasticity (C.E.), Department of Neurology, Medical University of Graz, Austria.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Drake
mesh_terms: D003071:Cognition; D003072:Cognition Disorders / Q000150:complications; D000066499:Facial Recognition; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications / Q000523:psychology*; D012938:Social Perception; D056345:Theory of Mind