Problems with Facial Mimicry Might Contribute to Emotion Recognition Impairment in Parkinson's Disease

Children with facial differences experience deficits in emotion skills

Children with facial differences, such as repaired cleft lip and palate (CLP), may present with reduced capacity for sensorimotor simulation, particularly in the form of facial mimicry. This study examined whether facial mimicry, emotion recognition, and empathy skills are reduced in children with CLP when compared with sex/age-matched controls. A case-control design was utilized. Forty-five children between the ages of 8 and 12 with CLP, and 45 age/sex-matched controls were recruited. Participants completed a facial mimicry task, and facial movements were tracked and quantified using OpenFace. Participants also completed picture and context-based emotion recognition tasks. Picture-based assessment involved identifying emotions from the Dynamic FACES database. Context-based assessment consisted of identifying how a child might feel in various situations. Finally, participants and their parents completed the Empathy Questionnaire for Children and Adolescents (EmQue-CA). Children with CLP presented with significantly reduced facial mimicry (p = .017), picture-based (p < .001), and context-based emotion recognition scores (p < .001) when compared with controls. Better facial mimicry was associated with better picture-based emotion recognition scores in the control group only (r = .22, p < .01). Children with CLP also had significantly lower child and parent-proxy EmQue-CA scores (p < .001). Greater facial mimicry significantly predicted better parent-proxy EmQue-CA scores (p = .016) but did not predict child scores. Children with CLP presented with reduced facial mimicry, poorer emotion recognition, and empathy skills. These findings have a broader relevance as they suggest children with facial differences may present with reduced facial mimicry and/or deficits in emotion recognition. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Evaluating the Impact of BoNT-A Injections on Facial Expressions: A Deep Learning Analysis

BACKGROUND

Botulinum toxin type A (BoNT-A) injections are widely administered for facial rejuvenation, but their effects on facial expressions remain unclear.

OBJECTIVES

In this study, we aimed to objectively measure the impact of BoNT-A injections on facial expressions with deep learning techniques.

METHODS

One hundred eighty patients age 25 to 60 years who underwent BoNT-A application to the upper face were included. Patients were photographed with neutral, happy, surprised, and angry expressions before and 14 days after the procedure. A convolutional neural network (CNN)-based facial emotion recognition (FER) system analyzed 1440 photographs with a hybrid data set of clinical images and the Karolinska Directed Emotional Faces (KDEF) data set.

RESULTS

The CNN model accurately predicted 90.15% of the test images. Significant decreases in the recognition of angry and surprised expressions were observed postinjection (P < .05), with no significant changes in happy or neutral expressions (P > .05). Angry expressions were often misclassified as neutral or happy (P < .05), and surprised expressions were more likely to be perceived as neutral (P < .05).

CONCLUSIONS

Deep learning can effectively assess the impact of BoNT-A injections on facial expressions, providing more standardized data than traditional surveys. BoNT-A may reduce the expression of anger and surprise, potentially leading to a more positive facial appearance and emotional state. Further studies are needed to understand the broader implications of these changes.

LEVEL OF EVIDENCE: 4 (THERAPEUTIC)

On the Role of Sensorimotor Experience in Facial Expression Perception

Humans recognize the facial expressions of others rapidly and effortlessly. Although much is known about how we perceive expressions, the role of facial experience in shaping this remarkable ability remains unclear. Is our perception of expressions linked to how we ourselves make facial expressions? Are we better at recognizing other's facial expressions if we are experts at making the same expressions ourselves? And if we could not make facial expressions at all, would it impact our ability to recognize others' facial expressions? The current article aims to examine these questions by explicating the link between facial experience and facial expression recognition. It includes a comprehensive appraisal of the related literature and examines three main theories that posit a connection between making and recognizing facial expressions. First, recent studies in individuals with Moebius syndrome support the role of facial ability (i.e., the ability to move one's face to make facial expressions) in facial expression recognition. Second, motor simulation theory suggests that humans recognize others' facial expressions by covertly mimicking the observed expression (without overt motor action) and that this facial mimicry helps us identify and feel the associated emotion. Finally, the facial feedback hypothesis provides a framework for enhanced emotional experience via proprioceptive feedback from facial muscles when mimicking a viewed facial expression. Evidence for and against these theories is presented as well as some considerations and outstanding questions for future research studies investigating the role of facial experience in facial expression perception.

Facial expressions and identities recognition in Parkinson disease

Parkinson's Disease (PD) is associated with motor and non-motor symptoms. Among the latter are deficits in matching, identification, and recognition of emotional facial expressions. On one hand, this deficit has been attributed to a dysfunction in emotion processing. Another explanation (which does not exclude the former) links this deficit with reduced facial expressiveness in these patients, which prevents them from properly understanding or embodying emotions. To disentangle the specific contribution of emotion comprehension and that of facial expression processing in PD's observed deficit with emotions we performed two experiments on non-emotional facial expressions. In Experiment 1, a group of PD patients and a group of Healthy Controls (HC) underwent a task of non-emotional expression recognition in faces of different identity and a task of identity recognition in faces with different expression. No differences were observed between the two groups in accuracies. In Experiment 2, PD patients and Healthy Controls underwent a task where they had to recognize the identity of faces encoded through a non-emotional facial expression, through a rigid head movement, or as neutral. Again, no group differences were observed. In none of the two experiments hypomimia scores had a specific effect on expression processing. We conclude that in PD patients the observed impairment with emotional expressions is likely due to a specific deficit for emotions to a greater extent than for facial expressivity processing.

The impact of deep brain stimulation of the subthalamic nucleus on facial emotion recognition in patients with Parkinson's disease

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is successful in patients with advanced Parkinson's disease (PD) but may worsen cognitive outcome, including facial emotion recognition (FER). Data-analyses on 59 consecutive PD patients with complete pre- and postoperative assessments, using a sensitive FER test, showed no changes in FER 1 year after STN-DBS surgery, both after group and individual analyses. These findings do however not exclude the impact of FER in and on itself on the outcome after STN-DBS.

Facial emotion recognition in individuals with mild cognitive impairment: An exploratory study

Understanding facial emotions is fundamental to interact in social environments and modify behavior accordingly. Neurodegenerative processes can progressively transform affective responses and affect social competence. This exploratory study examined the neurocognitive correlates of face recognition, in individuals with two mild cognitive impairment (MCI) etiologies (prodromal to dementia - MCI, or consequent to Parkinson's disease - PD-MCI). Performance on the identification and memorization of neutral and emotional facial expressions was assessed in 31 individuals with MCI, 26 with PD-MCI, and 30 healthy controls (HC). Individuals with MCI exhibited selective impairment in recognizing faces expressing fear, along with difficulties in remembering both neutral and emotional faces. Conversely, individuals with PD-MCI showed no differences compared with the HC in either emotion recognition or memory. In MCI, no significant association emerged between the memory for facial expressions and cognitive difficulties. In PD-MCI, regression analyses showed significant associations with higher-level cognitive functions in the emotional memory task, suggesting the presence of compensatory mechanisms. In a subset of participants, voxel-based morphometry revealed that the performance on emotional tasks correlated with regional changes in gray matter volume. The performance in the matching of negative expressions was predicted by volumetric changes in brain areas engaged in face and emotional processing, in particular increased volume in thalamic nuclei and atrophy in the right parietal cortex. Future studies should leverage on neuroimaging data to determine whether differences in emotional recognition are mediated by pathology-specific atrophic patterns.

Facial muscle movements in patients with Parkinson's disease undergoing phonation tests

PURPOSE

Parkinson's disease (PD) is a serious neurodegenerative disease affecting the elderly. In general, the locomotion deficit, which seriously affects the daily life of patients with PD, usually occurs at a later stage. The mask face symptom meanwhile progressively worsens. However, facial muscle disorders and changes involved in the freezing mask are unclear.

METHOD

In this study, we recruited 35 patients with PD and 26 age- and sex-balanced controls to undergo phonation tests, while the built-in camera on the laptop recorded their facial expressions during the whole pronunciation process. Furthermore, FaceReader (version 7.0; Noldus Information Technology, Wageningen, Netherlands) was used to analyze changes in PD facial landmark movement and region movement.

RESULTS

The two-tailed Student's t-test showed that the changes in facial landmark movement among 49 landmarks were significantly lower in patients with PD than in the control group (P < 0.05). The data on facial region movement revealed that the eyes and upper lip of patients with PD differed significantly from those in the control group.

CONCLUSION

Patients with PD had defects in facial landmark movement and regional movement when producing a single syllable, double syllable, and multiple syllables, which may be related to reduced facial expressions in patients with PD.

Deficits in Emotion Recognition and Theory of Mind in Parkinson's Disease Patients With and Without Cognitive Impairments

Background

Emotion recognition and social deficits have been previously reported in Parkinson's disease (PD). However, the extent of these impairments is still unclear and social cognition is excluded from the cognitive domains considered in the current criteria for PD mild cognitive impairment (MCI). This study aims to analyze emotion recognition, affective and cognitive theory of mind in early PD patients classified according to Level II MCI criteria, and to evaluate the prevalence of socio-cognitive deficits in this sample.

Methods

We enrolled 45 participants with PD, classified as cognitively unimpaired (CU; n = 32) or MCI (n = 13) based on a standard neuropsychological assessment. Social cognitive skills were evaluated through validated tests for emotion recognition (i.e., Ekman 60-faces test, Ek60 Test) and mental states attribution (Story-based Empathy Task, SET) and compared to a group of 45 healthy controls (HC). Between-group differences in social tasks were performed, as well as correlation analyses to assess the relationship between social, cognitive, and clinical variables. Finally, the number of patients with social cognitive impairments in both MCI and CU subgroups was computed based on Italian normative data.

Results

Statistical comparison revealed significant differences among groups in the Ek60 test, with MCI obtaining significantly lower scores than HC and CU, especially for negative emotions. Significant differences were detected also in the SET, with lower performance in emotion and intention attribution for both PD groups compared to HC. A significant correlation emerged between the Ek60 test and emotion attribution. Nine patients showed poor performance at social tasks, five of them being classified as PD-CU.

Discussion

Parkinson's disease cognitive profile was characterized by emotion recognition and attribution deficits. These results, as well as the detection of CU patients with isolated socio-cognitive impairments, underline the importance of assessing social cognition in PD as a possible early marker of cognitive decline.

Efficacy of Facial Exercises in Facial Expression Categorization in Schizophrenia

Embodied cognition theories suggest that observation of facial expression induces the same pattern of muscle activation, and that this contributes to emotion recognition. Consequently, the inability to form facial expressions would affect emotional understanding. Patients with schizophrenia show a reduced ability to express and perceive facial emotions. We assumed that a physical training specifically developed to mobilize facial muscles could improve the ability to perform facial movements, and, consequently, spontaneous mimicry and facial expression recognition. Twenty-four inpatient participants with schizophrenia were randomly assigned to the experimental and control group. At the beginning and at the end of the study, both groups were submitted to a facial expression categorization test and their data compared. The experimental group underwent a training period during which the lip muscles, and the muscles around the eyes were mobilized through the execution of transitive actions. Participants were trained three times a week for five weeks. Results showed a positive impact of the physical training in the recognition of others’ facial emotions, specifically for the responses of “fear”, the emotion for which the recognition deficit in the test is most severe. This evidence suggests that a specific deficit of the sensorimotor system may result in a specific cognitive deficit.

Social Symptoms of Parkinson's Disease

Parkinson's disease (PD) is typically well recognized by its characteristic motor symptoms (e.g., bradykinesia, rigidity, and tremor). The cognitive symptoms of PD are increasingly being acknowledged by clinicians and researchers alike. However, PD also involves a host of emotional and communicative changes which can cause major disruptions to social functioning. These incude problems producing emotional facial expressions (i.e., facial masking) and emotional speech (i.e., dysarthria), as well as difficulties recognizing the verbal and nonverbal emotional cues of others. These social symptoms of PD can result in severe negative social consequences, including stigma, dehumanization, and loneliness, which might affect quality of life to an even greater extent than more well-recognized motor or cognitive symptoms. It is, therefore, imperative that researchers and clinicans become aware of these potential social symptoms and their negative effects, in order to properly investigate and manage the socioemotional aspects of PD. This narrative review provides an examination of the current research surrounding some of the most common social symptoms of PD and their related social consequences and argues that proactively and adequately addressing these issues might improve disease outcomes.