Temporal cognition in multiple sclerosis: naturalistic evidence of impaired temporal memory and future simulation

Background: Cognitive impairment in multiple sclerosis (MS) extends beyond classical domains such as processing speed and memory, yet temporal aspects of cognition remain underexplored. Temporal cognition, including time perception, memory for time and future-oriented thinking are essential for structuring experience and guiding everyday behaviour. Objectives/Aims: To assess temporal cognition in MS across present-, past- and future-oriented processes using a naturalistic, ecologically grounded paradigm. Methods: Thirty-one people with MS (PwMS; age 39±10 years; education 16.2±3 years; disease duration 10.5±11 years; EDSS 2.5±1.5) and forty-five matched healthy controls viewed a full television episode and subsequently completed a battery assessing temporal order reconstruction, recency discrimination, temporal distance estimation and interval reproduction. Future-oriented thinking was assessed using questionnaires. Results: PwMS showed reduced recency accuracy (p = 0.011), larger errors in the temporal reconstruction task (p < 0.001) and greater duration estimation errors (p < 0.001). Performance on interval reproduction did not differ between groups for regular intervals (p = 0.495) and showed a trend towards reduced accuracy in PwMS for irregular intervals (p = 0.077). Future-oriented thinking showed preserved perception of one’s own future (p = 0.172) and reduced performance in projecting oneself into the future in PwMS (p = 0.032). Conclusion: PwMS show consistent impairments across key components of temporal cognition, particularly affecting temporal memory and future self-projection, while more basic timing abilities remain relatively preserved. This pattern is consistent with disruption of distributed networks supporting temporal integration, episodic reconstruction and future simulation. These findings highlight temporal cognition as a clinically relevant and previously overlooked dimension of cognitive dysfunction in MS that may not be captured by standard cognitive measures, with potential implications for more sensitive assessment and targeted interventions.