Famous landmark identification in amnestic mild cognitive impairment and Alzheimer's disease

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.

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.

Facial expression recognition deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic investigation of effects of phenotypic variant, task modality, geographical region and symptomatic specificity

Deficits in social cognition may be present in frontotemporal dementia (FTD) and Alzheimer's disease (AD). Here, we conduct a qualitative synthesis and meta-analysis of facial expression recognition studies in which we compare the deficits between both disorders. Furthermore, we investigate the specificity of the deficit regarding phenotypic variant, domain-specificity, emotion category, task modality, and geographical region. The results reveal that both FTD and AD are associated with facial expression recognition deficits, that this deficit is more pronounced in FTD compared to AD and that this applies for the behavioral as well as for language FTD-variants, with no difference between the latter two. In both disorders, overall emotion recognition was most frequently impaired, followed by recognition of anger in FTD and by fear in AD. Verbal categorization was the most frequently used task, although matching or intensity rating tasks may be more specific. Studies from Oceania revealed larger deficits. On the other hand, non-emotional control tasks were more impacted by AD than by FTD. The present findings sharpen the social cognitive phenotype of FTD and AD, and support the use of social cognition assessment in late-life neuropsychiatric disorders.

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/.

The Relationship Between Facial Expression and Cognitive Function in Patients With Depression

Objective: Considerable evidence has shown that facial expression recognition ability and cognitive function are impaired in patients with depression. We aimed to investigate the relationship between facial expression recognition and cognitive function in patients with depression.

Methods: A total of 51 participants (i.e., 31 patients with depression and 20 healthy control subjects) underwent facial expression recognition tests, measuring anger, fear, disgust, sadness, happiness, and surprise. The Chinese version of the MATRICS Consensus Cognitive Battery (MCCB), which assesses seven cognitive domains, was used.

Results: When compared with a control group, there were differences in the recognition of the expressions of sadness (p = 0.036), happiness (p = 0.041), and disgust (p = 0.030) in a depression group. In terms of cognitive function, the scores of patients with depression in the Trail Making Test (TMT; p < 0.001), symbol coding (p < 0.001), spatial span (p < 0.001), mazes (p = 0.007), the Brief Visuospatial Memory Test (BVMT; p = 0.001), category fluency (p = 0.029), and continuous performance test (p = 0.001) were lower than those of the control group, and the difference was statistically significant. The accuracy of sadness and disgust expression recognition in patients with depression was significantly positively correlated with cognitive function scores. The deficits in sadness expression recognition were significantly correlated with the TMT (p = 0.001, r = 0.561), symbol coding (p = 0.001, r = 0.596), maze (p = 0.015, r = 0.439), and the BVMT (p = 0.044, r = 0.370). The deficits in disgust expression recognition were significantly correlated with impairments in the TMT (p = 0.005, r = 0.501) and symbol coding (p = 0.001, r = 0.560).

Conclusion: Since cognitive function is impaired in patients with depression, the ability to recognize negative facial expressions declines, which is mainly reflected in processing speed, reasoning, problem-solving, and memory.

Strategies used by people with Alzheimer's disease for outdoor wayfinding: A repeated observational study

This study aimed to describe the wayfinding strategies used during outdoor walks by people with Alzheimer's disease. Inspired by an ethnographic approach, observations and conversations during repeated outdoor walks with five people with Alzheimer's disease living in their own homes were conducted. Data were analyzed using qualitative content analysis. The wayfinding strategies the participants described were: (1) landmarks, (2) used their senses, (3) stopped, looked around, and thought, (4) walking the same way or loop and in familiar areas, and (5) only walked in places and on routes where they could see other people and houses. Using wayfinding strategies might help people with Alzheimer's disease to be independent during outdoor walks, and discussing these strategies with relatives and nursing care staff may help finding people with Alzheimer's disease if lost outdoors. Wayfinding during the winter might be facilitated if temporary and changeable objects are avoided in people with Alzheimer's disease's walking route.

Czech Brain Aging Study (CBAS): prospective multicentre cohort study on risk and protective factors for dementia in the Czech Republic

PURPOSE

Identification of demographic, physical/physiological, lifestyle and genetic factors contributing to the onset of dementia, specifically Alzheimer disease (AD), and implementation of novel methods for early diagnosis are important to alleviate prevalence of dementia globally. The Czech Brain Aging Study (CBAS) is the first large, prospective study to address these issues in Central/Eastern Europe by enrolling non-demented adults aged 55+ years, collecting a variety of personal and biological measures and tracking cognitive function over time.

PARTICIPANTS

The CBAS recruitment was initiated in 2011 from memory clinics at Brno and Prague University Hospitals, and by the end of 2018, the study included 1228 participants. Annual follow-ups include collection of socioeconomic, lifestyle and personal history information, neurology, neuropsychology, laboratory, vital sign and brain MRI data. In a subset, biomarker assessment (cerebrospinal fluid (CSF) and amyloid positron emission tomography) and spatial navigation were performed. Participants were 69.7±8.1 years old and had 14.6±3.3 years of education at baseline, and 59% were women. By the end of 2018, 31% finished three and more years of follow-up; 9% converted to dementia. Apolipoprotein E status is available from 95% of the participants. The biological sample bank linked to CBAS database contained CSF, serum and DNA.

FINDINGS TO DATE

Overall, the findings, mainly from cross-sectional analyses, indicate that spatial navigation is a promising marker of early AD and that it can be distinguished from other cognitive functions. Specificity of several standard memory tests for early AD pathology was assessed with implications for clinical practice. The relationship of various lifestyle factors to cognition and brain atrophy was reported.

FUTURE PLANS

Recruitment is ongoing with secured funding. Longitudinal data analyses are currently being conducted. Proposals for collaboration on specific data from the database or biospecimen, as well as collaborations with similar cohort studies to increase sample size, are welcome. Study details are available online (www.cbas.cz).

How pattern information analyses of semantic brain activity elicited in language comprehension could contribute to the early identification of Alzheimer's Disease

Alzheimer's disease (AD) is associated with a loss of semantic knowledge reflecting brain pathophysiology that begins years before dementia. Identifying early signs of pathophysiology induced dysfunction in the neural systems that access and process words' meaning could therefore help forecast dementia. This article reviews pioneering studies demonstrating that abnormal functional Magnetic Resonance Imaging (fMRI) response patterns elicited in semantic tasks reflect both AD-pathophysiology and the hereditary risk of AD, and also can help forecast cognitive decline. However, to bring current semantic task-based fMRI research up to date with new AD research guidelines the relationship with different types of AD-pathophysiology needs to be more thoroughly examined. We shall argue that new analytic techniques and experimental paradigms will be critical for this. Previous work has relied on specialized tests of specific components of semantic knowledge/processing (e.g. famous name recognition) to reveal coarse AD-related changes in activation across broad brain regions. Recent computational advances now enable more detailed tests of the semantic information that is represented within brain regions during more natural language comprehension. These new methods stand to more directly index how pathophysiology alters neural information processing, whilst using language comprehension as the basis for a more comprehensive examination of semantic brain function. We here connect the semantic pattern information analysis literature up with AD research to raise awareness to potential cross-disciplinary research opportunities.

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

Introduction: It is well established that behavioral variant frontotemporal dementia can impair social and emotional function. However, there is no consensus regarding how Alzheimer's disease can affect facial expression recognition. We aim to systematically review all the literature addressing this issue over the last 10 years. Method: We conducted a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for literature was undertaken on 19 September 2017, using Pubmed, SciELO, BIREME, and Thomson Reuters Web of Science electronic databases. The key terms for the search were: Alzheimer's disease, dementia, and facial expression recognition. Results: We screened 173 articles, and 22 of them were selected. The most common methodology involved showing participants photographs of people expressing the six basic emotions-fear, anger, sadness, disgust, surprise, and happiness. Results were ambiguous. Among people with mild Alzheimer's disease, happiness was easier to recognize than the other five basic emotions, with sadness and anger the most difficult to recognize. In addition, the intensity level of the emotions presented seems to be important, and facial expression recognition is related to specific cognitive capacities, including executive function and visuoperceptual abilities. Impairment in facial expression recognition does not appear to be a consistent neuropsychological finding in Alzheimer's disease. Conclusions: The lack of standardized assessment instruments and the heterogeneity of the methods and samples used across studies hamper comparisons. Future researches should investigate facial expression recognition through more ecological and standardized methods.

Gender-Specific Degeneration of Dementia-Related Subcortical Structures Throughout the Lifespan

Age-related changes in brain structure are a question of interest to a broad field of research. Structural decline has been consistently, but not unambiguously, linked to functional consequences, including cognitive impairment and dementia. One of the areas considered of crucial importance throughout this process is the medial temporal lobe, and primarily the hippocampal region. Gender also has a considerable effect on volume deterioration of subcortical grey matter (GM) structures, such as the hippocampus. The influence of age×gender interaction on disproportionate GM volume changes might be mediated by hormonal effects on the brain. Hippocampal volume loss appears to become accelerated in the postmenopausal period. This decline might have significant influences on neuroplasticity in the CA1 region of the hippocampus highly vulnerable to pathological influences. Additionally, menopause has been associated with critical pathobiochemical changes involved in neurodegeneration. The micro- and macrostructural alterations and consequent functional deterioration of critical hippocampal regions might result in clinical cognitive impairment-especially if there already is a decline in the cognitive reserve capacity. Several lines of potential vulnerability factors appear to interact in the menopausal period eventually leading to cognitive decline, mild cognitive impairment, or Alzheimer's disease. This focused review aims to delineate the influence of unmodifiable risk factors of neurodegenerative processes, i.e., age and gender, on critical subcortical GM structures in the light of brain derived estrogen effects. The menopausal period appears to be of key importance for the risk of cognitive decline representing a time of special vulnerability for molecular, structural, and functional influences and offering only a narrow window for potential protective effects.

Naming unique entities in the semantic variant of primary progressive aphasia and Alzheimer's disease: Towards a better understanding of the semantic impairment

While the semantic variant of primary progressive aphasia (svPPA) is characterized by a predominant semantic memory impairment, episodic memory impairments are the clinical hallmark of Alzheimer's disease (AD). However, AD patients also present with semantic deficits, which are more severe for semantically unique entities (e.g. a famous person) than for common concepts (e.g. a beaver). Previous studies in these patient populations have largely focused on famous-person naming. Therefore, we aimed to evaluate if these impairments also extend to other semantically unique entities such as famous places and famous logos. In this study, 13 AD patients, 9 svPPA patients, and 12 cognitively unimpaired elderly subjects (CTRL) were tested with a picture-naming test of non-unique entities (Boston Naming Test) and three experimental tests of semantically unique entities assessing naming of famous persons, places, and logos. Both clinical groups were overall more impaired at naming semantically unique entities than non-unique entities. Naming impairments in AD and svPPA extended to the other types of semantically unique entities, since a CTRL>AD>svPPA pattern was found on the performance of all naming tests. Naming famous places and famous persons appeared to be most impaired in svPPA, and both specific and general semantic knowledge for these entities were affected in these patients. Although AD patients were most significantly impaired on famous-person naming, only their specific semantic knowledge was impaired, while general knowledge was preserved. Post-hoc neuroimaging analyses also showed that famous-person naming impairments in AD correlated with atrophy in the temporo-parietal junction, a region functionally associated with lexical access. In line with previous studies, svPPA patients' impairment in both naming and semantic knowledge suggest a more profound semantic impairment, while naming impairments in AD may arise to a greater extent from impaired lexical access, even though semantic impairment for specific knowledge is also present. These results highlight the critical importance of developing and using a variety of semantically-unique-entity naming tests in neuropsychological assessments of patients with neurodegenerative diseases, which may unveil different patterns of lexical-semantic deficits.

Feature Binding Deficits in Subjective Cognitive Decline and in Mild Cognitive Impairment

BACKGROUND

Feature binding is a sensitive and specific cognitive marker for Alzheimer's disease (AD). Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are clinical categories associated with an increased risk for AD.

OBJECTIVE

To investigate whether the SCD and MCI group are impaired with regard to feature binding.

METHODS

The feature binding test was administered to memory clinic patients with either SCD (n = 19, mean MMSE: 29.2) or with MCI (n = 23, mean MMSE: 26.5), and to a group of healthy controls (HC, n = 23, mean MMSE: 29.0). Participants were assessed with the CERAD Plus neuropsychological test battery. Cognitive performance of the three groups was compared by ANCOVA with age, gender and education as covariates and planned contrasts.

RESULTS

Groups differed in the binding condition. Planned contrasts showed significant differences in adjusted means between HC and SCD (p = 0.003), as well as between HC and MCI (p <  0.0001).

DISCUSSION

The feature binding task detects subtle cognitive impairments in participants with SCD, who are unimpaired in traditional neuropsychological testing. This corroborates the use of feature binding tests in preclinical AD studies and suggests that specific cognitive deficits can be found in SCD. Future studies incorporating AD biomarkers and longitudinal follow-up are needed to further establish the clinical utility of feature binding.