Association between emotion recognition and cognitive functioning in multiple sclerosis: a multilevel correlational meta-analysis

Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease marked by both cognitive and socio-cognitive impairments, including difficulties in recognizing emotions. While deficits in processing speed, executive functions, and episodic memory are well known, growing evidence also points to impairments in emotion-recognition, particularly for negative emotions such as fear, sadness, or disgust. However, the extent to which these socio-cognitive difficulties are linked to broader cognitive dysfunction remains unclear, as individual studies report inconsistent findings. This meta-analysis synthesized data from 23 independent studies (k = 774 correlations) using multilevel random-effects models to quantify the association between emotion-recognition and cognitive functioning in MS. Overall, results revealed small to moderate associations between emotion-recognition and cognitive performance, with stronger effects for negative emotions and for total emotion scores. Processing speed and executive functions exhibited broad associations, while episodic memory effects were more emotion-specific. At the subdomain level, working memory and verbal fluency emerged as key correlates. However, substantial heterogeneity across studies should be noted. Additional meta-regressions indicated that higher disability and anxiety were associated with stronger emotion-cognition links, whereas longer disease duration and depression predicted weaker associations. These findings indicate that emotion-recognition deficits in MS seem partially connected to neurocognitive dysfunctions.Trial registration: The preregistered review protocol can be accessed at https://doi.org/10.17605/OSF.IO/3VNA4 .