Dynamic emotion recognition and authenticity detection in multiple sclerosis: preliminary cognitive, behavioral, and neuroimaging evidence

BACKGROUND: Facial emotion recognition (FER) is affected in multiple sclerosis (MS), impacting interpersonal functioning. Standard FER tests utilize static/posed stimuli, lacking in ecological validity. In this pilot study, we used the Emotion Authenticity Recognition (EAR) test, featuring both genuine/posed dynamic expressions, to assess FER in an MS sample, also investigating behavioral/neuroimaging correlates. METHODS: A group of 54 MS patients (36 F; age = 41.4 ± 11.0, education = 14.7 ± 2.8) and a matched age/sex/education sample of 54 healthy controls (HCs) completed the EAR test, which provides two indices: Emotion Recognition (ER) and Emotion Authenticity (EA). Associations were explored with clinical/neuropsychological/self-report/MRI data. Structural 3T-MRI was analyzed using Voxel-Based Morphometry (VBM) for regional gray matter volumes. RESULTS: No significant differences were found with standard t-tests for ER and EA between MS and HCs. Bayesian independent t-tests revealed moderate evidence for no group difference in ER (BF10 = 0.210, % error = 0.029) and anecdotal evidence in favor of the null hypothesis for EA (BF10 = 0.658, % error = 0.017). In MS, ER correlated with age (r = -0.50, p < 0.001), disease duration (R = -0.30, p = 0.030), education (R = 0.34, p = 0.012), and with domain-specific/global cognitive functioning (all r indexes among 0.3 - 0.5). EA was lower in patients with severe cognitive impairment (r = 0.47, p < 0.001) and associated with empathy (R = 0.29, p = 0.037). ER was associated with bilateral widespread cortical regions and cerebellum, while EA with fronto-temporal cortices and amygdala. CONCLUSIONS: Despite no statistically significant differences observed compared to HCs, EAR in MS reflected age, cognition, and brain damage: this test captures subtle alterations, underscoring the value of dynamic and genuineness-based measures in MS assessment. These preliminary findings warrant further investigation into emotion-cognition interactions in MS.