The achievement of ToM skills during development is fundamental, by supporting a functional and rich social life, impacting people’s well being ( Thomas et al., 2017). Recent ToM models represent the multi-domain nature of this social ability, by separating a cognitive component underlying the understanding of thoughts, dispositions, and motivations, from an affective part, responsible for the comprehension of emotions ( Shamay-Tsoory et al., 2009, 2010 Sebastian et al., 2012). Among these, theory of mind (ToM) represents a core component referring to the ability to understand others’ states of mind, such as thoughts, emotions and dispositions driving behavior ( Call and Tomasello, 2008). Socio-cognitive abilities constitute a complex set of interconnected and interdependent processes indispensable for social interactions ( Happé and Frith, 2014). The results suggest that aberrant intrinsic and extrinsic connectivity constitutes a crucial neural mechanism underlying ToM deficit in MS. Finally, a correlation between cognitive ToM and intrinsic FC was detected in ACC and dorsal striatum, belonging to the limbic–paralimbic network, likely explaining the behavioral deficit in MS. A trend of aberrant intrinsic connectivity in MS within the anterior cingulate cortex (ACC) was also reported. A disconnection between limbic–paralimbic network and prefrontal execution loops was observed. Lower ToM performance was registered for MS both in cognitive and affective ToM, significantly associated with processing speed. Correlation with psychosocial scores was also investigated. A neuroanatomical ToM model was constructed deriving 11 bilateral ROIs and then between and within-functional connectivity (FCs) were assessed to test for group differences.
In total, 37 MS patients (23 females, mean age = 54.08 ± 11.37 years, median Expanded Disability Status Scale = 6.00) underwent an MRI and a neuro-psychosocial examination and were compared with 20 sex-age-education matched healthy subjects. To investigate the neural underpinning of theory of mind (ToM) deficit in multiple sclerosis (MS), a region of interest (ROI)-based resting-state fMRI study was proposed. Although neural hubs of mentalizing are acknowledged, the brain mechanisms underlying mentalizing deficit, characterizing different neurological conditions, are still a matter of debate.