Social cognition in neuromyelitis optica spectrum disorder compared with relapsing-remitting multiple sclerosis and healthy controls

Social cognition (SC)—the ability to perceive and interpret social information—is often impaired in neurological disorders such as multiple sclerosis (MS). However, its status in neuromyelitis optica spectrum disorder (NMOSD), a distinct autoimmune demyelinating disease, remains unclear. In this cross-sectional study, 107 participants (32 NMOSD, 38 RRMS, 37 HC) completed the Reading the Mind in the Eyes Test (RMET), Empathy Quotient (EQ), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale (MFIS), Kessler Psychological Distress Scale (K10), and Wechsler Adult Intelligence Scale (WAIS-R). Group comparisons were analyzed using ANOVA and ANCOVA with covariate adjustment. NMOSD participants had lower RMET scores than HCs (16.81 ± 4.29 vs. 19.35 ± 3.49, p = 0.02), but this difference was not significant after adjustment ( p = 0.45). Empathy did not differ among groups initially (NMOSD: 41.97 ± 10.769, RRMS: 38.29 ± 9.03, Control: 42.05 ± 9.39, p = 0.17); however, adjusted analyses revealed lower empathy in RRMS compared to NMOSD ( p = 0.03). IQ was significantly lower in NMOSD compared to RRMS and HC (NMOSD:76.68 ± 43.17, RRMS:109.71 ± 29.23, Control:120.14 ± 31.27, p < 0.0001). RRMS is associated with lower adjusted EQ scores in RRMS than in NMOSD, whereas the initial difference in affective theory-of-mind performance between NMOSD and healthy controls was not retained after covariate adjustment. SC impairments may differ between demyelinating disorders, warranting longitudinal and neuroimaging studies. Not applicable.