Facial emotion recognition in multiple sclerosis is related to proxy-reported but not self-reported social behavioural functioning in daily life

Aims To investigate how facial emotion recognition in multiple sclerosis (MS) is related to both self and proxy-reported social behavioural functioning in daily life. <br/>Methods People with MS (PwMS; n=250) and healthy controls (HCs; n=81) were included, with an age between 18-70 (M=50.4, SD=11.2 and M=51.5, SD=10.5, respectively). Groups were well-matched with regard to the distributions of age, sex, and education. Facial emotion recognition was assessed using the Ekman 60 faces test (EFT). Social behavioural functioning in daily life was assessed using both a self and proxy rating of the three subscales of the Dysexecutive Questionnaire (DEX) that focus on social conventions, behavioural-emotional self regulation, and awareness of one’s own behaviour. <br/>Results PwMS performed significantly lower than HCs on the total score of the EFT (r=-.20, p&lt;.001). When examining emotions separately, PwMS performed specifically lower on recognising facial expressions of anger (r=-0.17, p=.002), disgust (r=-0.27, p&lt;.001), happiness (r=-0.16, p=.005), and surprise (r=-0.14, p=.01). In the group of PwMS, no associations were found between performance on the EFT and self-reports of social behavioural functioning in daily life. In contrast, a lower EFT total score did relate to more proxy-reported social behavioural problems (r=-.17, p=.008).<br/>Discussion Our results suggest that impairments in facial emotion recognition have a significant impact on social behavioural functioning of PwMS in daily life. The absence of an association between emotion recognition and self-reported social behavioural functioning could indicate a lack of insight into these social difficulties, a phenomenon previously described in other neurological patient groups. <br/>Conclusions These findings emphasize the importance of assessing social cognitive functions in PwMS, to facilitate appropriate support for the possible negative consequences on social behavioural functioning in daily life. As self-awareness of these difficulties may be limited, including proxy-reports in the assessment is crucial to obtain an accurate picture of daily life social behavioural functioning of PwMS. <br/>