Time efficiency in mental state reasoning of people with multiple sclerosis: The double-sided affective and cognitive Theory of Mind disturbances

<b>Objective:</b> Theory of Mind (ToM) disturbances are recognized as a hallmark of several neurological conditions including multiple sclerosis (MS). People with MS show lower ToM competencies compared to healthy controls (HC) from the earliest stages of the disease. However, the nature of this disturbance is still under investigation. The aims of this study were 1) to explore ToM competencies in people with MS using a single task (the Yoni-48) considering both accuracy and time efficiency according to a multi-level (first- and second-order) and multi-component (affective and cognitive) approach, and 2) to investigate the relationship between ToM and other neurocognitive functions in people with MS. <b>Method:</b> Seventy-seven participants underwent an individual evaluation session to investigate their ToM profile and associated neurocognitive domains (short-term and working memory, and executive functioning). <b>Results:</b> As expected, the comparison between the two groups (MS vs HC) on ToM performance showed a selective decline of accuracy for the second-order level (Cohen's d = 0.46) and the affective (Cohen's d = 0.57) components of ToM, and a pathological reduction in ToM time efficiency in people with MS (Cohen's d > 0.50). Moreover, a link between executive function, memory, and ToM was found. Our results highlight a double-sided selective decline of high levels and affective components of ToM in people with MS, and a broad involvement of time efficiency. <b>Conclusions:</b> These findings provide insights into the contribution of efficiency and automaticity of mental state reasoning in this pathology, suggesting the role of compensation strategies in maintaining adequate performance during social interactions.