Facial expression recognition in Alzheimer's disease: A systematic review

Differential Social Cognitive Performance in Older Adults With Mild Cognitive Impairment and Dementia

OBJECTIVE

To study general and subdomain performance in measures of social cognition in individuals with mild cognitive impairment (MCI), and dementia, and to explore associations between social cognitive and neuropsychological subdomains.

DESIGN

Cross-sectional study of participants from the Sydney Memory and Ageing Study (MAS).

SETTING

Current data was collected in 2016-2018.

PARTICIPANTS

Community-dwelling older adults (n=321) aged 80 years and above, with no history of neurological or psychiatric conditions. Participants had dementia, MCI, or no cognitive impairment (NCI).

MEASURES

Social cognition was indexed using the Reading the Mind in the Eyes Test (RMET), the Interpersonal Reactivity Index - Perspective Taking (IRI-PT) and Empathic Concern (IRI-EC) subscales, and the Emotion Recognition Task (ERT). These subdomain scores were used to make a composite social cognition score. Apathy was measured via the Apathy Evaluation Scale (AES). Neurocognitive function was indexed using the Addenbrooke Cognitive Examination v3 (ACE-3).

RESULTS

Dementia was associated with poorer overall social cognitive composite performance. MCI and dementia participants performed poorer on RMET and recognition of anger, disgust and happiness on ERT. RMET and ERT disgust remained significant after controlling for relevant covariates. Dementia participants performed poorer than MCI and NCI on the IRI-PT, IRI-EC, and AES. AES remained significant after regression. RMET was correlated with ACE-3 Fluency and/or Language in all study groups.

CONCLUSIONS

MCI is associated with poorer scores in specific social cognitive assessments. Dementia is somewhat associated with poorer scores in informant-rated social cognition scales, though this is no longer significant after accounting for apathy.

Deficits in facial emotion recognition and cognitive function among baby boomers

Facial emotion recognition (FER), a key component of social cognition, plays a critical role in social interactions. In the aging process, FER among older adults holds significant potential as a tool for diagnosing cognitive function or enhancing interpersonal relationships. However, research in this area remains limited. This study aims to address this gap by examining the impact of cognitive function on FER among Korean baby boomers aged 60 to 69. Eighty-one participants completed the Korean version of the Montreal Cognitive Assessment (K-MOCA) and FER tasks. Of the participants, 69 % had normal cognition, while 31 % had mild cognitive impairment. Participants with normal cognition were 1.59 times more likely to recognize facial expressions correctly than those with impaired cognition (AOR = 1.59, p < 0.0001). They showed significantly higher odds of recognizing happy (AOR = 9.68), anger (AOR = 2.25), disgust (AOR = 1.95), neutral (AOR = 3.02), and surprise (AOR = 2.27) expressions (p < 0.001). Participants with normal cognition participants also scored higher on overall intensity for every emotion except sadness (p < 0.001). Among the seven domains of the MoCA, three sub-domains-visuospatial/executive function, language, and orientation-showed significant associations with overall FER. These results highlight the diagnostic potential of FER tasks in identifying cognitive disorders and enhancing social skills in clinical and practical settings.

The TIE-93: a Facial Emotion Recognition Test Adapted for Culturally, Linguistically, and Educationally Diverse Alzheimer's Dementia Patients in France

OBJECTIVE

Emotion recognition tests are essential for differential diagnostics when assessing patients with Alzheimer's disease (AD) dementia. However, there remains a lack of emotion recognition tests appropriate for culturally and educationally diverse populations. The aim of this study was to develop an emotion recognition test (the TIE-93) appropriate for these populations. We then examined whether the TIE-93 could reduce emotion recognition performance differences between populations with a native French versus a culturally and educationally diverse background (participants who had immigrated to France). This was assessed by comparing performance between controls of each cultural group. We also assessed the effect of demographic variables on TIE-93 test performance and whether performance in an AD patient group was consistent with the research literature.

METHODS

Fifty-seven patients with AD dementia and 240 healthy controls, from native French and culturally and educationally diverse backgrounds, were included in the study. The TIE-93 is composed of eight panels with photos of actors displaying six basic emotions. Participants were asked to identify which of the six facial expressions displayed matched an oral description of a context.

RESULTS

When comparing French and culturally and educationally diverse controls, Quade's ANCOVA revealed that there remained an effect of culture and education on TIE-93 test performance. Nonetheless, while controlling for years of education, age, sex, and cultural group, patients with AD dementia scored significantly more poorly than controls, specifically for most negative emotions.

CONCLUSION

The TIE-93 represents a first step toward developing appropriate emotion recognition tests for culturally and educationally diverse populations.

Recognition of static and dynamic emotional facial expressions in mild cognitive impairment, healthy elderly and young people

INTRODUCTION

The ability to recognize emotions is essential for social cognition, and its impairment can affect social interactions, contributing to loneliness and the worsening of issues in individuals with mild cognitive impairment (MCI). This study aims to investigate the ability to recognize emotional facial expressions in MCI individuals compared to healthy elderly and young individuals.

METHOD

We evaluated 27 MCI individuals, 31 healthy elderly, and 29 healthy young participants using two tasks: one with static facial expressions (photographs) and another with dynamic ones (video clips).

RESULTS

The younger group recognized all negative emotional expressions better than the other two groups and also performed better on neutral expressions compared to MCI patients. The healthy elderly group outperformed MCI patients in recognizing most expressions, except for happiness and neutral. Additionally, the ability to recognize dynamic expressions was superior to static ones across all groups for several emotions.

DISCUSSION

These results emphasize the importance of assessing the ability to recognize emotional facial expressions within neuropsychological protocols, to help detect this condition early on. Given the pivotal role that emotional facial expressions play in social interactions, these difficulties can contribute to a decline in such interactions and an increase in social isolation.

Emotion regulation in people living with dementia and their spouses: the role of neuropsychiatric symptoms

OBJECTIVES

People with dementia (PwD) and their care partners (CP) may have difficulties in emotion regulation, and individual differences in emotion regulation may be related to PwD's neuropsychiatric symptoms. This study explores whether there is self-awareness of PwD's difficulties in emotion regulation and whether CP's emotion regulation relates to the PwD's neuropsychiatric symptoms, potentially revealing bias or interpersonal effects.

METHOD

We used data from the Wish Outcome Obstacle Plan Study with a sample of 45 PwD and their spousal CP (n = 90 individuals). Multivariate linear regression models were used to investigate the associations between the CP-reported neuropsychiatric symptoms in PwD and self-reports of emotion regulation in both dyad members, net of sociodemographic and health factors. Separate analyses were conducted for each neuropsychiatric subsyndrome and each domain of difficulties in emotion regulation.

RESULTS

Increasing severity of neuropsychiatric symptoms was associated with higher difficulties in emotion regulation in PwD (ß = 1.23, p < 0.05), but not with CP's difficulties in emotion regulation. When CP reported more severe neuropsychiatric symptoms in PwD, PwD reported that they had difficulties in accepting emotions, controlling impulses, goal-directed behaviors, and accessing emotion regulation strategies, but not in emotion awareness and clarification. Proxy-reports of hyperactivity and psychosis subsyndromes are significantly related to PwD's self-reported difficulties in emotion regulation.

CONCLUSION

PwD reported difficulties in emotion regulation at the early stage of dementia. Proxy-reported neuropsychiatric symptoms may capture PwD's emotion regulation capability and not be biased by CP's difficulties in emotion regulation.

Effects of Sleep Quality, Acute Sleep Deprivation, and Napping on Facial Emotion Recognition Accuracy and Speed

Objective

To investigate the effects of sleep quality, sleep deprivation, and napping on facial emotion recognition (FER) accuracy and speed.

Methods

This research included a cross-sectional study (102 qualified participants) and a randomized controlled study (26 in the napping group and 24 in the control group). The stimuli for the FER task were obtained from the Chinese Facial Affective Picture System (CFAPS). Four facial expressions (fearful, disgusted, sad, and angry) were used. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale, and Self-Rating Depression Scale were used to measure participants' sleep quality and psychological conditions. In Study 1, FER ability was compared between good and poor sleepers. In Study 2, all participants were sleep-deprived for one night, and completed the FER task before and after sleep deprivation. After different interventions (ie, napping for one hour, or walking around for ten minutes), the participants completed the third FER task.

Results

Study 1: Poor sleepers were able to recognize sad expressions more accurately compared with good sleepers. Study 2: 30-h sleep deprivation had no significant effect on the accuracy (ACC). Napping after sleep deprivation improved the FER ACC of upper-face expressions and marginally significantly improved the FER ACC of disgusted expressions.

Conclusion

Better sleep quality was linked to lower FER accuracy, particularly in recognizing sad expressions, while no significant differences in recognition speed were observed. Additionally, 30 hours of sleep deprivation did not affect FER accuracy, but napping after sleep deprivation improved accuracy for upper-face and marginally for disgusted expressions.

Facial and Emotion Recognition Deficits in Myasthenia Gravis

Myasthenia gravis (MG) is a neuromuscular disease of autoimmune etiology and chronic evolution. In addition to the muscle weakness and fatigue that characterize MG, in some studies patients show an inferior performance in cognitive tasks and difficulties in recognizing basic emotions from facial expressions. However, it remains unclear if these difficulties are due to anxious-depressive symptoms that these patients present or related to cognitive abilities, such as facial recognition. This study had a descriptive cross-sectional design with a sample of 92 participants, 52 patients with MG and 40 healthy controls. The data collection protocol included measures to assess recognition of facial expressions (BRFT), facial emotional expression (FEEL), and levels of anxiety and depression (HADS). The MG group had worse performance than the control group in recognizing "fear" (p = 0.001; r = 0.344), "happiness" (p = 0.000; r = 0.580), "disgust" (p = 0.000; r = 0.399), "surprise" (p = 0.000; r = 0.602), and "anger" (p = 0.007; r = 0.284). Likewise, the MG group also underperformed in facial recognition (p = 0.001; r = 0.338). These difficulties were not related to their levels of anxiety and depression. Alterations were observed both in the recognition of facial emotions and in facial recognition, without being mediated by emotional variables. These difficulties can influence the interpersonal interaction of patients with MG.

Dynamic and/or multimodal assessments for social cognition in neuropsychology: Results from a systematic literature review

Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.

MC-ViViT: Multi-branch Classifier-ViViT to Detect Mild Cognitive Impairment in Older Adults Using Facial Videos

Deep machine learning models including Convolutional Neural Networks (CNN) have been successful in the detection of Mild Cognitive Impairment (MCI) using medical images, questionnaires, and videos. This paper proposes a novel Multi-branch Classifier-Video Vision Transformer (MC-ViViT) model to distinguish MCI from those with normal cognition by analyzing facial features. The data comes from the I-CONECT, a behavioral intervention trial aimed at improving cognitive function by providing frequent video chats. MC-ViViT extracts spatiotemporal features of videos in one branch and augments representations by the MC module. The I-CONECT dataset is challenging as the dataset is imbalanced containing Hard-Easy and Positive-Negative samples, which impedes the performance of MC-ViViT. We propose a loss function for Hard-Easy and Positive-Negative Samples (HP Loss) by combining Focal loss and AD-CORRE loss to address the imbalanced problem. Our experimental results on the I-CONECT dataset show the great potential of MC-ViViT in predicting MCI with a high accuracy of 90.63% accuracy on some of the interview videos.

Disentangling empathy impairment along Alzheimer's disease continuum: From subjective cognitive decline to Alzheimer's dementia

Little is known about empathy changes from the early stages of Alzheimer's Disease (AD) continuum. The aim of this study is to investigate empathy across AD spectrum from Subjective Cognitive Decline (SCD) to Mild Cognitive Impairment (MCI) and AD dementia (AD-d). Forty-five SCD, 83 MCI and 80 AD-d patients were included. Empathy was assessed by Interpersonal Reactivity Index (IRI) (Perspective Taking - PT, Fantasy - FT, Empathic Concern - EC, and Personal Distress - PD), rated by caregivers before (T0) and after (T1) cognitive symptoms' onset. IRI was also administered to SCD patients to have a self-reported empathy evaluation. Facial emotion recognition was assessed by Ekman-60 Faces Test. Twenty-two SCD, 54 MCI and 62 AD-d patients underwent CSF biomarkers analysis and were classified as carriers of AD pathology (AP+) when they were A+/T+ (regardless of N), or non-carriers (AP-) when they were A- (regardless of T and N), or A+/T-/N-, or A+/T-/N+ according to the A/T(N) system. Cerebral FDG-PET SPM analysis was used to explore neural correlates underlying empathy deficits. PD scores significantly increased from T0 to T1 in SCD, MCI and AD-d (p < .001), while PT scores decreased in MCI and in AD-d (p < .001). SCD AP+ showed a greater increase in PD scores over time (ΔPD T0 - T1) than SCD AP- (p < .001). SCD self-reported PT scores were lower than those of general Italian population (14.94 ± 3.94, 95% C.I. [13.68-16.20] vs 17.70 ± 4.36, 95% C.I. [17.30-18.10]). In AD continuum (SCD AP+, MCI AP+, AD-d), a positive correlation was detected between PT-T1 and brain metabolism in left posterior cingulate gyrus, precuneus and right frontal gyri; a negative correlation was found between ΔPT and brain metabolism in bilateral posterior cingulate gyri. PT may be subtly involved since the preclinical phase of AD. Changes over time of PD are influenced by the underlying Alzheimer's pathology and could potentially serve as an early AD neuropsychological marker.

Effect of distance education courses held in different environments on emotions of the instructor

In this study, the emotional states of the instructors who teach by distance education and the effect of the environment in which they give the lesson on their emotions were examined. Computer-aided "Facial Action Coding System" method was used to measure emotion values from facial images. Through the software developed by the researchers using the Microsoft Face Recognition API, 43292 facial images taken from five trainers during their training were analysed and seven basic emotions representing facial expressions were obtained numerically. As a result of the analysis, it was found that the emotions of the instructors that can be described as negative in the lessons held in the e-studio environment generally increased at the beginning of the lesson, decreased in the following minutes and increased again at the end of the lesson; On the other hand, it was determined that positive emotions decreased at the beginning of the lesson and increased later. In the home environment, while the emotions that can be described as negative at the beginning decreased, positive emotions increased. A significant difference was determined between home and e-studio environment in all emotions except anger. One of the emotions with a difference in value between the two environments is happiness, and it has been determined that happiness has higher values in the home environment. It has been determined that other emotions are experienced more in the e-studio environment. It is thought that the results of the study will contribute to the mental states of the instructors who teach through distance education and to the efficiency of distance education.

Facial Expression Recognition of Emotional Situations in Mild and Moderate Alzheimer's Disease

Background: Recognizing emotional situations may be impaired in people with Alzheimer's disease (AD). Purpose: We examined differences in the comprehension of an emotional situation in healthy older controls (HOC) and individuals with mild and moderate AD. Research Design: cross-sectional study. Study Sample: We assessed a convenience sample of 115 participants in 3 contexts: understanding the situation, ability to name the congruent emotion, and choice of the correct face in 4 emotional situations (sadness, surprise, anger, happiness). Data Colection: Chi-square and Mann-Whitney U tests were used for comparison between groups separated by CDR 1 and 2. Chi-square and Kruskal-Wallis tests were also used for comparison between groups separated by CDR 0, 1, and 2, with a pairwise comparisons analysis. Results: We found that the ability to understand, name, and choose the proper emotion is not linked and depends on the portrayed emotion. Conclusions: The findings suggest an interaction between emotional processing and cognitive functioning. Therefore, knowledge of an emotional condition and the connection to a specific facial choice most likely involve 2 degraded areas of knowledge, resulting in even higher odds of inaccuracy.

Facial emotion recognition is associated with executive functions and depression scores, but not staging of dementia, in mild-to-moderate Alzheimer's disease

BACKGROUND

Although deficits in facial emotion recognition (FER) significantly affect interpersonal communication and social functioning, there is no consensus on how FER affects Alzheimer's disease (AD). In this study, we aimed to investigate the clinical and neuropsychological factors affecting the possible deficits in the FER abilities of patients with AD.

METHODS

This cross-sectional study included 37 patients with mild [clinical dementia rating (CDR) scale score = 1] or moderate (CDR = 2) AD, in whom vascular dementia and depression were excluded, and 24 cognitively normal (CDR = 0) subjects. FER ability was determined using the facial emotion identification test (FEIT) and facial emotion discrimination test (FEDT). All participants underwent mini-mental state examination (MMSE), frontal assessment battery (FAB), and geriatric depression scale (GDS). The neuropsychiatric inventory-clinician rating scale (NPI-C), Katz index of independence in activities of daily living, and Lawton instrumental activities of daily living were also administered to patients with AD.

RESULTS

The FEIT and FEDT total scores showed that patients with mild and moderate AD had significant FER deficits compared to healthy controls. However, no significant difference was observed between patients with mild and moderate AD in the FEIT and FEDT total scores. FEIT and FEDT scores were not correlated with the MMSE and NPI-C total and subscales scores in patients with AD. Linear regression indicated that FEIT and FEDT total scores were significantly related to age and FAB scores. The GDS score negatively moderated the relationship between FAB and FEDT.

CONCLUSIONS

This study demonstrated a decreased FER ability in patients with AD. The critical point in FER deficits is the presence of dementia, not the dementia stage, in AD. It has been determined that executive functions and depression (even at a subsyndromal level), which have limited knowledge, are associated with FER abilities.

Facial emotion expressivity in patients with Parkinson's and Alzheimer's disease

Parkinson's disease (PD) and Alzheimer's disease (AD) are neurodegenerative disorders with some overlapping clinical features. Hypomimia (reduced facial expressivity) is a prominent sign of PD and it is also present in AD. However, no study has experimentally assessed hypomimia in AD and compared facial expressivity between PD and AD patients. We compared facial emotion expressivity in patients with PD, AD, and healthy controls (HCs). Twenty-four PD patients, 24 AD patients and 24 HCs were videotaped during neutral facial expressions and while posing six facial emotions (anger, surprise, disgust, fear, happiness, and sadness). Fifteen raters were asked to evaluate the videos using MDS-UPDRS-III (item 3.2) and to identify the corresponding emotion from a seven-forced-choice response format. We measured the percentage of accuracy, the reaction time (RT), and the confidence level (CL) in the perceived accuracy of the raters' responses. We found the highest MDS-UPDRS 3.2 scores in PD, and higher in AD than HCs. When evaluating the posed expression captures, raters identified a lower percentage of correct answers in the PD and AD groups than HCs. There was no difference in raters' response accuracy between the PD and AD. No difference was observed in RT and CL data between groups. Hypomimia in patients correlated positively with the global MDS-UPDRS-III and negatively with Mini Mental State Examination scores. PD and AD patients have a similar pattern of reduced facial emotion expressivity compared to controls. These findings hold potential pathophysiological and clinical implications.

Diagnosis Framework for Probable Alzheimer's Disease and Mild Cognitive Impairment Based on Multi-Dimensional Emotion Features

BACKGROUND

Emotion and cognition are intercorrelated. Impaired emotion is common in populations with Alzheimer's disease (AD) and mild cognitive impairment (MCI), showing promises as an early detection approach.

OBJECTIVE

We aim to develop a novel automatic classification tool based on emotion features and machine learning.

METHODS

Older adults aged 60 years or over were recruited among residents in the long-term care facilities and the community. Participants included healthy control participants with normal cognition (HC, n = 26), patients with MCI (n = 23), and patients with probable AD (n = 30). Participants watched emotional film clips while multi-dimensional emotion data were collected, including mental features of Self-Assessment Manikin (SAM), physiological features of electrodermal activity (EDA), and facial expressions. Emotional features of EDA and facial expression were abstracted by using continuous decomposition analysis and EomNet, respectively. Bidirectional long short-term memory (Bi-LSTM) was used to train classification model. Hybrid fusion was used, including early feature fusion and late decision fusion. Data from 79 participants were utilized into deep machine learning analysis and hybrid fusion method.

RESULTS

By combining multiple emotion features, the model's performance of AUC value was highest in classification between HC and probable AD (AUC = 0.92), intermediate between MCI and probable AD (AUC = 0.88), and lowest between HC and MCI (AUC = 0.82).

CONCLUSIONS

Our method demonstrated an excellent predictive power to differentiate HC/MCI/AD by fusion of multiple emotion features. The proposed model provides a cost-effective and automated method that can assist in detecting probable AD and MCI from normal aging.

The importance of social behavior in nonhuman primate studies of aging: A mini-review

Social behavior plays an important role in supporting both psychological and physical health across the lifespan. People's social lives change as they age, and the nature of these changes differ based on whether people are on healthy aging trajectories or are experiencing neurodegenerative diseases that cause dementia, such as Alzheimer's disease and Parkinson's disease. Nonhuman primate models of aging have provided a base of knowledge comparing aging trajectories in health and disease, but these studies rarely emphasize social behavior changes as a consequence of the aging process. What data exist hold particular value, as negative effects of disease and aging on social behavior are likely to have disproportionate impacts on quality of life. In this mini review, we examine the literature on nonhuman primate models of aging with a focus on social behavior, in the context of both health and disease. We propose that adopting a greater focus on social behavior outcomes in nonhuman primates will improve our understanding of the intersection of health, aging and sociality in humans.

A Longitudinal Evaluation of the Pattern of Social Cognition Impairment in Brazilians With Alzheimer's Disease

BACKGROUND

Social cognition (SC) impairments contribute to the dependence of people with Alzheimer disease (AD), influencing their functional disability and the burden on family members and caregivers. Our objective was to longitudinally investigate the relationship between SC and cognitive and clinical variables in persons with AD and their caregivers. We also evaluated the different SC predictors from 3 perspectives: people with AD, caregivers of people with AD, and discrepancy analysis.

METHODS

In all, 137 dyads (people with AD and their caregivers) underwent 2 assessments: at baseline (M1) and after 1 year (M2). During follow-up, 58 dyads were excluded, and the study was thus concluded with 79.

RESULTS

Longitudinal analysis of the people with AD showed that while some cognitive functions declined (which is consistent with disease progression), SC impairments showed a more stable pattern. Another interesting result was related to SC predictors. For people with AD, SC was associated with cognition at both time points. For caregivers, besides cognition, other predictors included reduced functional abilities and quality of life in people with AD. These results are consistent with the discrepancy predictors.

CONCLUSION

The stable pattern in SC functioning over 12 months in AD suggests that this neurocognitive domain may be influenced more by emotional processing than by cognitive impairment. In addition, the SC predictors showed that the investigation of different points of view enables a more global understanding, contributing to better and more targeted treatment for the patient.

Thinking versus feeling: How interoception and cognition influence emotion recognition in behavioural-variant frontotemporal dementia, Alzheimer's disease, and Parkinson's disease

Disease-specific mechanisms underlying emotion recognition difficulties in behavioural-variant frontotemporal dementia (bvFTD), Alzheimer's disease (AD), and Parkinson's disease (PD) are unknown. Interoceptive accuracy, accurately detecting internal cues (e.g., one's heart beating), and cognitive abilities are candidate mechanisms underlying emotion recognition. One hundred and sixty-eight participants (52 bvFTD; 41 AD; 24 PD; 51 controls) were recruited. Emotion recognition was measured via the Facial Affect Selection Task or the Mini-Social and Emotional Assessment Emotion Recognition Task. Interoception was assessed with a heartbeat detection task. Participants pressed a button each time they: 1) felt their heartbeat (Interoception); or 2) heard a recorded heartbeat (Exteroception-control). Cognition was measured via the Addenbrooke's Cognitive Examination-III or the Montreal Cognitive Assessment. Voxel-based morphometry analyses identified neural correlates associated with emotion recognition and interoceptive accuracy. All patient groups showed worse emotion recognition and cognition than controls (all P's ≤ .008). Only the bvFTD showed worse interoceptive accuracy than controls (P < .001). Regression analyses revealed that in bvFTD worse interoceptive accuracy predicted worse emotion recognition (P = .008). Whereas worse cognition predicted worse emotion recognition overall (P < .001). Neuroimaging analyses revealed that the insula, orbitofrontal cortex, and amygdala were involved in emotion recognition and interoceptive accuracy in bvFTD. Here, we provide evidence for disease-specific mechanisms for emotion recognition difficulties. In bvFTD, emotion recognition impairment is driven by inaccurate perception of the internal milieu. Whereas, in AD and PD, cognitive impairment likely underlies emotion recognition deficits. The current study furthers our theoretical understanding of emotion and highlights the need for targeted interventions.

Insomnia and impacts on facial expression recognition accuracy, intensity and speed: A meta-analysis

Facial expressions provide nonverbal cues that are important for delivering and interpreting human emotions. Previous studies have shown that the ability to interpret facial emotions correctly could be partially impaired in sleep-deprived people. People with insomnia might also suffer from sleep loss, so we assumed that facial expression recognition ability might also be impaired in people with insomnia. Despite a growing body of research exploring insomnia's potential impacts on facial expression recognition, conflicting results have been reported, and no systematic review of this research body has been conducted. In this study, after screening 1100 records identified through database searches, six articles examining insomnia and facial expression recognition ability were included in a quantitative synthesis. The main outcomes were classification accuracy (ACC), reaction time (RT), and intensity rating-the three most studied facial expression processing variables. Subgroup analysis was performed to identify altered perceptions according to the facial expressions of four emotions-happiness, sadness, fear, and anger-used to examine insomnia and emotion recognition. The pooled standard mean differences (SMDs) and corresponding 95% confidence intervals (CIs) demonstrated that facial expression recognition among people with insomnia was less accurate (SMD = -0.30; 95% CI: -0.46, -0.14) and slower (SMD = 0.67; 95% CI: 0.18, -1.15) compared to good sleepers. The classification ACC of fearful expression was lower in the insomnia group (SMD = -0.66; 95% CI: -1.02, -0.30). This meta-analysis was registered using PROSPERO.

Older adults' emotion recognition: No auditory-visual benefit for less clear expressions

The ability to recognise emotion from faces or voices appears to decline with advancing age. However, some studies have shown that emotion recognition of auditory-visual (AV) expressions is largely unaffected by age, i.e., older adults get a larger benefit from AV presentation than younger adults resulting in similar AV recognition levels. An issue with these studies is that they used well-recognised emotional expressions that are unlikely to generalise to real-life settings. To examine if an AV emotion recognition benefit generalizes across well and less well recognised stimuli, we conducted an emotion recognition study using expressions that had clear or unclear emotion information for both modalities, or clear visual, but unclear auditory information. Older (n = 30) and younger (n = 30) participants were tested on stimuli of anger, happiness, sadness, surprise, and disgust (expressed in spoken sentences) in auditory-only (AO), visual-only (VO), or AV format. Participants were required to respond by choosing one of 5 emotion options. Younger adults were more accurate in recognising emotions than older adults except for clear VO expressions. Younger adults showed an AV benefit even when unimodal recognition was poor. No such AV benefit was found for older adults; indeed, AV was worse than VO recognition when AO recognition was poor. Analyses of confusion responses indicated that older adults generated more confusion responses that were common between AO and VO conditions, than younger adults. We propose that older adults' poorer AV performance may be due to a combination of weak auditory emotion recognition and response uncertainty that resulted in a higher cognitive load.

Theory of Mind and social functioning among neuropsychiatric disorders: A transdiagnostic study

Social dysfunction is commonly present in neuropsychiatric disorders of schizophrenia (SZ) and Alzheimer's disease (AD). Theory of Mind (ToM) deficits have been linked to social dysfunction in disease-specific studies. Nevertheless, it remains unclear how ToM is related to social functioning across these disorders, and which factors contribute to this relationship. We investigated transdiagnostic associations between ToM and social functioning among SZ/AD patients and healthy controls, and explored to what extent these associations relate to information processing speed or facial emotion recognition capacity. A total of 163 participants were included (SZ: n=56, AD: n=50 and age-matched controls: n=57). Social functioning was assessed with the Social Functioning Scale (SFS) and the De Jong-Gierveld Loneliness Scale (LON). ToM was measured with the Hinting Task. Information processing speed was measured by the Digit Symbol Substitution Test (DSST) and facial emotion recognition capacity by the facial emotion recognition task (FERT). Case-control deficits in Hinting Task performance were larger in AD (rrb = -0.57) compared to SZ (rrb = -0.35). Poorer Hinting Task performance was transdiagnostically associated with the SFS (βHinting-Task = 1.20, p<0.01) and LON (βHinting-Task = -0.27, p<0.05). DSST, but not FERT, reduced the association between the SFS and Hinting Task performance, however the association remained significant (βHinting-Task = 0.95, p<0.05). DSST and FERT performances did not change the association between LON and Hinting Task performance. Taken together, ToM deficits are transdiagnostically associated with social dysfunction and this is partly related to reduced information processing speed.

Impaired Facial Emotion Recognition and Gaze Direction Detection in Mild Alzheimer's Disease: Results from the PACO Study

BACKGROUND

Facial emotion recognition (FER) and gaze direction (GD) identification are core components of social cognition, possibly impaired in many psychiatric or neurological conditions. Regarding Alzheimer's disease (AD), current knowledge is controversial.

OBJECTIVE

The aim of this study was to explore FER and GD identification in mild AD compared to healthy controls.

METHODS

180 participants with mild AD drawn from the PACO study and 74 healthy elderly controls were enrolled. Participants were asked to complete three socio-cognitive tasks: face sex identification, recognition of facial emotions (fear, happiness, anger, disgust) expressed at different intensities, and GD discrimination. Multivariate analyses were conducted to compare AD participants and healthy controls.

RESULTS

Sex recognition was preserved. GD determination for subtle deviations was impaired in AD. Recognition of prototypically expressed facial emotions was preserved while recognition of degraded facial emotions was impacted in AD participants compared to controls. Use of multivariate analysis suggested significant alteration of low-expressed fear and disgust recognition in the AD group.

CONCLUSION

Our results showed emotion recognition and GD identification in patients with early-stage AD compared to elderly controls. These impairments could be the object of specific therapeutic interventions such as social cognition remediation or raising awareness of primary caregivers to improve the quality of life of patients with early AD.

Progression of socio-cognitive impairment from healthy aging to Alzheimer's Dementia: A systematic Review and Meta-Analysis

BACKGROUND

Trajectories of decline across different socio-cognitive domains in healthy older adults and in pathological aging conditions have not been investigated. This was addressed in the present systematic review and meta-analysis.

METHODS

MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched for studies investigating social cognition across four domains (Theory of Mind, ToM; emotion recognition, ER; Social-decision making, SD; visual perspective taking, VPT) in healthy older individuals, individuals with subjective and mild cognitive impairment (SCD, MCI) and Alzheimer's disease (AD). Random-effects meta-analyses were conducted.

RESULTS

Of 8,137 screened studies, 132 studies were included in the review. ToM and ER showed a clear progression of impairment from normal aging to AD. Differential patterns of decline were identified for different types of ToM and ER.

CONCLUSION

This systematic review identified progression of impairment of specific socio-cognitive abilities, which is the necessary pre-requisite for developing targeted interventions. We identified a lack of research on socio-cognitive decline in different populations (e.g., middle age, SCD and MCI-subtypes) and domains (SDM, VPT).

REGISTRATION

CRD42020191607, https://www.crd.york.ac.uk/prospero/.

Large-Scale Functional Networks, Cognition and Brain Structures Supporting Social Cognition and Theory of Mind Performance in Prodromal to Mild Alzheimer's Disease

Impairment of social cognition (SC) skills such as recognition and attribution of intentions and affective states of others (Theory of Mind, ToM) has been evidenced in Alzheimer’s Disease (AD). This study investigated the neuropsychological, neuroanatomical and brain-functional underpinnings of SC processing to obtain an understanding of the social neurophenotype in early probable AD. Forty-six patients with mild cognitive impairment and mild probable AD underwent SC assessment including emotion recognition (Ekman-60-faces task) and cognitive and affective ToM (Reading-the-Mind-in-the-Eyes test and Story-based Empathy task). Linear models tested the association between SC scores and neuropsychological measures, grey matter maps and large-scale functional networks activity. The executive domain had the most predominant association with SC scores in the cognitive profile. Grey matter volume of the anterior cingulate, orbitofrontal, temporoparietal junction (TPJ), superior temporal, and cerebellar cortices were associated with ToM. Social cognition scores were associated with lower connectivity of the default-mode network with the prefrontal cortex. The right fronto-parietal network displayed higher inter-network connectivity in the right TPJ and insula while the salience network showed lower inter-network connectivity with the left TPJ and insula. Connectivity coupling alterations of executive-attentional networks may support default mode social-cognitive-associated decline through the recruitment of frontal executive mechanisms.

Social Cognition in Patients with Amnestic Mild Cognitive Impairment and Mild Dementia of the Alzheimer Type

BACKGROUND

Social cognition (SC) is a core criterion for neurocognitive disorders. However, findings in patients with amnestic mild cognitive impairment (aMCI) and dementia of the Alzheimer type (DAT) are inconsistent.

OBJECTIVE

We report assessments of emotion recognition (ER), affective and cognitive theory of mind (ToM) in young (YC) and older controls (OC) compared to aMCI and DAT.

METHODS

28 aMCI, 30 DAT, 30 YC, and 29 OC received tests of SC and a comprehensive neuropsychological assessment. Analysis of covariance was used to determine group differences. Multiple regression models were applied to identify predictors for each SC task.

RESULTS

In controls, OC performed worse in ER and both ToM tasks compared to YC except for one subtest. No significant differences were found between OC and patients concerning ER and affective ToM. In cognitive ToM, differences between OC and patients depended on content and cognitive load with significant impairment in DAT compared to OC. A cognitive composite score predicted SC in OC, but not in patients. Associations of SC with single cognitive domains were found in all groups with language and complex attention as best predictors. Not all variance of SC performance was explained by variance in cognitive domains.

CONCLUSION

Lower performance on SC tasks in OC versus YC was confirmed, although not all tasks were equally affected. With progressive cognitive impairment, cognitive ToM is more impaired than ER or affective ToM. SC seems to be at least partly independent of other cognitive domains, justifying its inclusion in batteries for dementia diagnostic.

Emotion regulation and decision-making in persons with dementia: A scoping review

BACKGROUND AND OBJECTIVES

Emotion is integral to decision-making, and emotion regulation is associated with improved well-being in older age. Persons with dementia are likely to experience impairments in emotion regulation processes that can potentially contribute to differential decision-making and well-being outcomes. To promote the development of theoretical models of well-being in dementia, we review the quantitative evidence concerning the associations between emotion regulation and decision-making in dementia.

METHODS

Scoping review.

RESULTS

Seven studies of persons with dementia met our criteria. In persons with frontotemporal lobar degeneration, emotion regulation processes that precede the emotional experience were associated with decision-making in a moral (but not uncertainty) context. Independent of type of dementia, evidence concerning the associations between emotion regulation processes that occur after emotion is experienced and decision-making was mixed and drew on different methodologies. No studies relating to the associations between decision-making in dementia and several emotion regulation processes and strategies were found.

CONCLUSIONS

In this review, we sought to clarify the concept of everyday decision-making in dementia and map the current state of evidence concerning its associations with emotion regulation. Our findings show that emotion regulation processes are associated with decision-making in dementia, depending on type of decision-making assessment and emotional experience. We outline the gaps in the literature to set a research agenda for promoting our understanding of how emotion regulation processes can shape the various decisions that are made by persons with dementia on a daily basis.

Decline in Emotional Face Recognition Among Elderly People May Reflect Mild Cognitive Impairment

Background

As with cognitive function, the ability to recognize emotions changes with age. In the literature regarding the relationship between recognition of emotion and cognitive function during aging, the effects of predictors such as aging, emotional state, and cognitive domains on emotion recognition are unclear. This study was performed to clarify the cognitive functions underlying recognition of emotional facial expressions, and to evaluate the effects of depressive mood on recognition of emotion in elderly subjects, as well as to reproduce the effects of aging on the recognition of emotional facial expressions.

Materials and Methods

A total of 26 young (mean age = 20.9 years) and 30 elderly subjects (71.6 years) participated in the study. All subjects participated in face perception, face matching, emotion matching, and emotion selection tasks. In addition, elderly subjects were administered a multicomponent cognitive test: the Neurobehavioral Cognitive Status Examination (Cognistat) and the Geriatric Depression Scale-Short Version. We analyzed these factors using multiple linear regression.

Results

There were no significant differences between the two groups in the face perception task, but in the face matching, emotion matching, and emotion selection tasks, elderly subjects showed significantly poorer performance. Among elderly subjects, multiple regression analyses showed that performance on the emotion matching task was predicted by age, emotional status, and cognitive function, but paradoxical relationships were observed between recognition of emotional faces and some verbal functions. In addition, 47% of elderly participants showed cognitive decline in one or more domains, although all of them had total Cognistat scores above the cutoff.

Conclusion

It might be crucial to consider preclinical pathological changes such as mild cognitive impairment when testing for age effects in elderly populations.

Dimensional and Discrete Emotional Reactivity in Alzheimer's Disease: Film Clips as a Research Tool in Dementia

BACKGROUND

No studies have been conducted to date on the dimensional and discrete classification of emotions to study the emotional reactivity of older adults with Alzheimer's disease (AD). Additionally, the presentation of film clips with affective content is currently one of the most effective and widely used Mood Induction Procedures (MIPS). However, it has been scarcely used in AD patients.

OBJECTIVE

Based on the dimensional and discrete models of emotion, this study examines the emotional reactivity of older adults with AD, using a popular set of film clips to induce emotions.

METHODS

We compared the responses of older adults aged over 65-years with mild to moderate AD (n = 15) and a healthy comparison group (n = 17) to six target emotions: disgust, fear, anger, sadness, amusement, and tenderness.

RESULTS

The results showed significant differences in the reactivity of fear, anger, and sadness between AD patients and healthy comparison group. However, the responses of the two groups to positive film clips were similar. Only in the amusement clip did the AD participants show a higher intensity response.

CONCLUSION

These findings suggest that the characteristic loss of cognitive abilities in AD is related to a reduction in the ability to react to emotional stimuli, especially negative ones. However, these abilities seem to be preserved when it comes to positive emotions. Future research is necessary to investigate whether the positivity effect is present in AD patients.

Identity preserving multi-pose facial expression recognition using fine tuned VGG on the latent space vector of generative adversarial network

Facial expression is the crucial component for human beings to express their mental state and it has become one of the prominent areas of research in computer vision. However, the task becomes challenging when the given facial image is non-frontal. The influence of poses on facial images is alleviated using an encoder of a generative adversarial network capable of learning pose invariant representations. State-of-art results for image generation are achieved using styleGAN architecture. An efficient model is proposed to embed the given image into the latent vector space of styleGAN. The encoder extracts high-level features of the facial image and encodes them into the latent space. Rigorous analysis of semantics hidden in the latent space of styleGAN is performed. Based on the analysis, the facial image is synthesized, and facial expressions are recognized using an expression recognition neural network. The original image is recovered from the features encoded in the latent space. Semantic editing operations like face rotation, style transfer, face aging, image morphing and expression transfer can be performed on the image obtained from the image generated using the features encoded latent space of styleGAN. L2 feature-wise loss is applied to warrant the quality of the rebuilt image. The facial image is then fed into the attribute classifier to extract high-level features, and the features are concatenated to perform facial expression classification. Evaluations are performed on the generated results to demonstrate that state-of-art results are achieved using the proposed method.

Metacognition of emotion recognition across neurodegenerative diseases

Metacognition (monitoring) of emotion recognition is fundamental for social interactions. Correct recognition of and confidence in the emotional meaning inferred from others' faces are fundamental for guiding and adjusting interpersonal behavior. Yet, although emotion recognition impairments are well documented across neurodegenerative diseases, the role of metacognition in this domain remains poorly understood. Here, we evaluate multimodal neurocognitive markers of metacognition in 83 subjects, encompassing patients with behavioral variant frontotemporal dementia [bvFTD, n = 18], Alzheimer's disease [AD, n = 27], and demographically-matched controls (n = 38). Participants performed a classical facial emotion recognition task and, after each trial, they rated their confidence in their performance. We examined two measures of metacognition: (i) calibration: how well confidence tracks accuracy; and (ii) a metacognitive index (MI) capturing the magnitude of the difference between confidence and accuracy. Then, whole-brain grey matter volume and fMRI-derived resting-state functional connectivity were analyzed to track associations with metacognition. Results showed that metacognition deficits were linked to basic emotion recognition. Metacognition of negative emotions was compromised in patients, especially disgust in bvFTD as well as sadness in AD. Metacognition impairments were associated with reduced volume of fronto-temporo-insular and subcortical areas in bvFTD and fronto-parietal regions in AD. Metacognition deficits were associated with disconnection of large-scale fronto-posterior networks for both groups. This study reveals a link between emotion recognition and metacognition in neurodegenerative diseases. The characterization of metacognitive impairments in bvFTD and AD would be relevant for understanding patients' daily life changes in social behavior.

Face Recognition Deficits in a Patient With Alzheimer's Disease: Amnesia or Agnosia? The Importance of Electrophysiological Markers for Differential Diagnosis

Face recognition deficits are frequently reported in Alzheimer's disease (AD) and often attributed to memory impairment. However, it has been hypothesized that failure in identifying familiar people could also be due to deficits in higher-level perceptual processes, since there is evidence showing a reduced inversion effect for faces but not for cars in AD. To address the involvement of these higher processes, we investigated event-related potential (ERP) neural correlates of faces in a patient with AD showing a face recognition deficit. Eight healthy participants were tested as a control group. Participants performed different tasks following the stimulus presentation. In experiment 1, they should indicate whether the stimulus was either a face or a house or a scrambled image. In experiments 2 and 3, they should discriminate between upright and inverted faces (in experiment 2, stimuli were faces with neutral or fearful expressions, while in experiment 3, stimuli were famous or unfamiliar faces). Electrophysiological results reveal that the typical face-specific modulation of the N170 component, which is thought to reflect the structural encoding of faces, was not present in patient MCG, despite being affected by the emotional content of the face implicitly processed by MCG. Conversely, the N400 component, which is thought to reflect the recruitment of the memory trace of the face identity, was found to be implicitly modulated in MCG. These results may identify a possible role for gnosic processes in face recognition deficits in AD and suggest the importance of adopting an integrated approach to the AD diagnosis while considering electrophysiological markers.

Emotion recognition of morphed facial expressions in presymptomatic and symptomatic frontotemporal dementia, and Alzheimer's dementia

BACKGROUND

The emotion recognition task (ERT) was developed to overcome shortcomings of static emotion recognition paradigms, by identifying more subtle deficits in emotion recognition across different intensity levels. In this study, we used the ERT to investigate emotion recognition deficits across the frontotemporal (FTD) and Alzheimer's Dementia (AD) spectrum.

METHODS

With the ERT, we assessed the recognition of facial emotional expressions (anger-disgust-fear-happiness-sadness-surprise) across four intensities (40-60-80-100%) in patients with behavioural variant FTD (bvFTD; n = 32), and AD (n = 32), presymptomatic FTD mutation carriers (n = 47) and controls (n = 49). We examined group differences using multilevel linear regression with age, sex and education level as covariates, and performed post hoc analyses on presymptomatic (MAPT, GRN and C9orf72) mutation carriers. Classification abilities were investigated by means of logistic regression.

RESULTS

Lowest ERT total scores were found in patients with bvFTD and AD, whereas equal highest performance was found in presymptomatic mutation carriers and controls. For all emotions, significantly lower subscores were found in patients with bvFTD than in presymptomatic mutation carriers and in controls (highest p value = 0.025). Patients with bvFTD performed lower than patients with AD on anger (p = 0.005) and a trend towards significance was found for a lower performance on happiness (p = 0.065). Task performance increased with higher emotional intensity, and classification was better at the lowest than at the highest intensity. C9orf72 mutation carriers performed worse on recognizing anger at the lowest intensity than GRN mutation carriers (p = 0.047) and controls (p = 0.038). The ERT differentiated between patients with bvFTD and controls, and between patients with AD and controls (both p < 0.001).

DISCUSSION

Our results demonstrate emotion recognition deficits in both bvFTD and AD, and suggest the presence of subtle emotion recognition changes in presymptomatic C9orf72-FTD. This highlights the importance of incorporating emotion recognition paradigms into standard neuropsychological assessment for early differential diagnosis, and as clinical endpoints in upcoming therapeutic trials.

Facial expression recognition in mild cognitive impairment and dementia: is the preservation of happiness recognition hypothesis true?

AIM

Social cognition encompasses facial expression recognition (FER), theory of mind, and empathy. Although studies examining FER in large numbers of patients with mild cognitive impairment (MCI) or dementia are rare, relative preservation of happiness recognition in dementia was reported in some studies. In this study, we examined performance on FER tests and its relationship to clinical demographics and other cognitive function test scores in patients with cognitive decline.

METHODS

The present study administered an FER test and several cognitive tests to outpatients at a memory clinic. The FER test presents four facial expressions (happiness, surprise, anger, and sadness). A total of 187 patients were placed in one of the three groups based on their cognitive status: dementia group (n = 63), MCI group (n = 92), and normal cognition group (n = 32).

RESULTS

The total scores on the FER test significantly differed among the three groups (normal > MCI > dementia). In the recognition of happiness and surprise, the dementia group had significantly lower scores than the normal cognition group. There were no significant differences in the recognition of anger and sadness scores among the three groups. The FER scores for happiness and surprise were primarily related to executive function scores, but the FER scores for anger and sadness were primarily related to age.

CONCLUSIONS

We note the difference in recognition of causative factors among the four emotions (happiness, surprise, anger, sadness). Our study raises serious doubts about the preservation of happiness recognition hypothesis in dementia based on FER tests.

Focusing on Emotional and Social Intelligence Stimulation of People With Dementia by Playing a Serious Game—Proof of Concept Study

Context: Dementia is one of the top five chronic diseases, which has an overwhelming impact on patients' life quality, family, and caregivers. Currently, research relating to people with dementia (PwD) focuses on the deterioration of cognitive abilities. A more innovative approach, and the one taken by this paper, is focusing on methods to maintain and improve functionality, communication and quality of life of PwD by building on remaining capacities in the yet unexplored domain of emotional and social intelligence (ESI). The use of serious games for PwD (SG4D) aimed at building social and emotional capacity is a budding field of research.

Objectives: Proof of concept that the, low cost, easy to deploy SG4D, called “My Brain Works” (MBW), co-designed with PwD, enhances ESI, based on the Bar-On ESI model.

Methods: 27 PwD, clients at MELABEV dementia day center, participated in a mixed methods 12 weeks pilot, proof of concept study using a tablet SG4D co-designed with PwD. Quantitative performance data was collected automatically by the tablet during game sessions. In this paper we focus on the analysis of the qualitative and quantitative data related to ESI, observed by 10 different researchers, during each game session.

Results: Quantitative data revealed: both the PwD with high and low MoCA scores had similar average ESI scores. Qualitative analysis revealed that the PwD demonstrated 9 sub-components of the Bar-On ESI Model.

Conclusion: While there is no drug to stop cognitive decline associated with dementia, interventions related to ESI, on the other hand, may improve functioning and quality of life. Despite declines in cognitive abilities, our study shows that a tablet based SG4D can stimulate their ESI and evoke responses in self-awareness, empathy, social and communication capacities. Using SG4D to exercise and maintain social skills is an area that may be promising in the future and may help counter the negative effects of social isolation and loneliness. Such games, while not focusing on cognitive improvement, may also impact on cognitive functioning and help bridge the gap between caregiver and PwD. More research is needed with larger sample sizes.

Social cognition and social functioning in patients with amnestic mild cognitive impairment or Alzheimer's dementia

The aim of the present study was to examine social cognition and social functioning in a group of amnestic mild cognitive impairment (aMCI) and Alzheimer’s dementia (AD) patients. Thirty one people with aMCI, 29 individuals with AD, and 45 healthy older adults participated in the study. Facial expressions of happiness, anger, fear, disgust, and surprise presented in different intensities had to be labelled. Mentalizing was assessed using first‐order belief theory of mind (ToM) stories and everyday social functioning by the Inventory of Interpersonal Situations (IIS), completed by an informant. aMCI patients were impaired in recognizing the emotions anger, disgust, and fear, while AD patients were impaired in recognizing the emotions anger, disgust, and surprise. More importantly, no significant differences between aMCI and AD patients were found on overall emotion recognition. Both the aMCI and AD patients were impaired on the ToM task, but no differences between the aMCI and AD patients were found. On everyday social functioning, only the AD patients showed impairments. No associations between the IIS and ToM were found, but the IIS and emotion perception were significantly correlated. Regression analysis taking all potentially confounding variables into account showed that only mood, but not the social‐cognitive task performance or any other cognitive variable, predicted social functioning. aMCI and AD patients demonstrated impairments in mentalizing and facial emotion perception, and showed decrements in everyday social functioning. Informing caregivers about these deficits may help them to understand deficits in social cognition that may be present already in the MCI stage of Alzheimer’s disease.

Altered phobic reactions in frontotemporal dementia: A behavioural and neuroanatomical analysis

INTRODUCTION

Abnormal behavioural and physiological reactivity to emotional stimuli is a hallmark of frontotemporal dementia (FTD), particularly the behavioural variant (bvFTD). As part of this repertoire, altered phobic responses have been reported in some patients with FTD but are poorly characterised.

METHODS

We collected data (based on caregiver reports) concerning the prevalence and nature of any behavioural changes related to specific phobias in a cohort of patients representing canonical syndromes of FTD and Alzheimer's disease (AD), relative to healthy older controls. Neuroanatomical correlates of altered phobic reactivity were assessed using voxel-based morphometry.

RESULTS

46 patients with bvFTD, 20 with semantic variant primary progressive aphasia, 25 with non-fluent variant primary progressive aphasia, 29 with AD and 55 healthy age-matched individuals participated. Changes in specific phobia were significantly more prevalent in the combined FTD cohort (15.4% of cases) and in the bvFTD group (17.4%) compared both to healthy controls (3.6%) and patients with AD (3.5%). Attenuation of phobic reactivity was reported for individuals in all participant groups, however new phobias developed only in the FTD cohort. Altered phobic reactivity was significantly associated with relative preservation of grey matter in left posterior middle temporal gyrus, right temporo-occipital junction and right anterior cingulate gyrus, brain regions previously implicated in contextual decoding, salience processing and reward valuation.

CONCLUSION

Altered phobic reactivity is a relatively common issue in patients with FTD, particularly bvFTD. This novel paradigm of strong fear experience has broad implications: clinically, for diagnosis and patient well-being; and neurobiologically, for our understanding of the pathophysiology of aversive sensory signal processing in FTD and the neural mechanisms of fear more generally.

Conflict monitoring on an emotional Stroop task. Comparison of healthy older adults and patients with major neurocognitive disorders due to probable AD

INTRODUCTION

The conflict monitoring system exerts an influence on centers responsible for cognitive control, causing them to intervene more strongly in processing when conflict occurs. These mechanisms are usually investigated through specific tasks where there is an inherent interference elicited by the congruency or incongruency between the stimuli and responses, such as the Stroop task. In studies of emotional conflict, one hypothesis related to the dorsal anterior cingulate cortex (ACC) is that it serves, in part, to signal the appearance of conflicts, thus triggering compensatory adjustments. This study aims to verify whether the conflict monitoring hypothesis is confirmed in a group with Alzheimer's disease and, therefore, whether they exhibit a reduction in their reaction times.

METHOD

A group of healthy older adults (HOA) and a group with Major Neurocognitive Disorders due to probable AD were evaluated to test the conflict monitoring hypothesis with an emotional Stroop task.

RESULTS

A significant interaction was obtained on the word and faces blocks. In the HOA group, a reduction in reaction times was observed, whereas in the AD groups, no reduction in reaction times was obtained.

CONCLUSIONS

Whereas in HOA the conflict monitoring hypothesis is confirmed, in the Major Neurocognitive Disorders due to probable AD group there is no reduction in their reaction times on the high conflict resolution trials (incongruent trials that follow incongruent trials) due to their difficulty in making compensatory adjustments to cognitive control that help them to reduce conflict and improve their success rate.