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

The Story behind the Mask: A Narrative Review on Hypomimia in Parkinson's Disease

Facial movements are crucial for social and emotional interaction and well-being. Reduced facial expressions (i.e., hypomimia) is a common feature in patients with Parkinson's disease (PD) and previous studies linked this manifestation to both motor symptoms of the disease and altered emotion recognition and processing. Nevertheless, research on facial motor impairment in PD has been rather scarce and only a limited number of clinical evaluation tools are available, often suffering from poor validation processes and high inter- and intra-rater variability. In recent years, the availability of technology-enhanced quantification methods of facial movements, such as automated video analysis and machine learning application, led to increasing interest in studying hypomimia in PD. In this narrative review, we summarize the current knowledge on pathophysiological hypotheses at the basis of hypomimia in PD, with particular focus on the association between reduced facial expressions and emotional processing and analyze the current evaluation tools and management strategies for this symptom, as well as future research perspectives.

Gender Differences in Facial Emotion Recognition Among Adolescents Depression with Non-Suicidal Self-Injury

Objective

Despite the perception that healthy female are superior at emotional identification, it remains unclear whether gender-specific differences exist in adolescent depression and whether such specific differences in emotional recognition are associated with the most salient feature of adolescent depression---non-suicidal self-injury (NSSI).

Methods

In this study, 1428 adolescents (1136 females and 292 males) with depression and NSSI were examined using the Facial Emotion Recognition Task, Patient Health Questionnaire-9 (PHQ-9), and Functional Assessment of Self-mutilation questionnaire (FASM). This study was grouped by gender. Data were analyzed using the descriptive statistics, independent sample t-test, chi-square test, non-parametric test (Mann-Whitney U-test), Spearman correlation and Multiple linear regression analysis.

Results

Depressed females reported a significantly greater frequency of self-injurious behaviour and more severe depressive symptoms than males. Face emotion recognition was also significantly more accurate in females and was positively correlated with levels of self-injury and depression, whereas no such correlations were found in males. Among depressed adolescents, face emotion recognition is better in females and is associated with self-injurious behaviour.

Conclusion

This study found that the greater susceptibility to depression and NSSI among adolescent females may stem in part from superior recognition and sensitivity to the negative emotions of others.

Facial Expressions Track Depressive Symptoms in Old Age

Facial expressions play a crucial role in the diagnosis of mental illnesses characterized by mood changes. The Facial Action Coding System (FACS) is a comprehensive framework that systematically categorizes and captures even subtle changes in facial appearance, enabling the examination of emotional expressions. In this study, we investigated the association between facial expressions and depressive symptoms in a sample of 59 older adults without cognitive impairment. Utilizing the FACS and the Korean version of the Beck Depression Inventory-II, we analyzed both "posed" and "spontaneous" facial expressions across six basic emotions: happiness, sadness, fear, anger, surprise, and disgust. Through principal component analysis, we summarized 17 action units across these emotion conditions. Subsequently, multiple regression analyses were performed to identify specific facial expression features that explain depressive symptoms. Our findings revealed several distinct features of posed and spontaneous facial expressions. Specifically, among older adults with higher depressive symptoms, a posed face exhibited a downward and inward pull at the corner of the mouth, indicative of sadness. In contrast, a spontaneous face displayed raised and narrowed inner brows, which was associated with more severe depressive symptoms in older adults. These findings suggest that facial expressions can provide valuable insights into assessing depressive symptoms in older adults.

A method for diagnosing depression: Facial expression mimicry is evaluated by facial expression recognition

BACKGROUND

Considerable evidence has shown that facial expression mimicry is impaired in patients with depression. We aimed to evaluate voluntary expression mimicry by facial expression recognition for diagnosing depression.

METHODS

A total of 168 participants performed voluntary expression mimicry task, posing anger, disgust, fear, happiness, neutrality, sadness, and surprise. 9 healthy raters performed facial expression recognition task through the observer scoring method, and evaluated seven expressions imitated by participants. Emotional scores were calculated to measure any differences between two groups of participants and provided a basis for clinical diagnosis of depression.

RESULTS

Compared with the control group, the depression group had lower accuracy in imitating happiness. Compared with the control group, the depression group imitated a higher neutrality bias for sadness, surprise, happiness and disgust, while sadness and surprise had a lower happiness bias; for imitating happiness, the depression group showed higher anger, disgust, fear, neutrality, and surprise bias; for imitating neutrality, the depression group showed higher sadness bias, and lower happiness bias. Compared with the control group, the raters had a higher reaction time to recognize the happiness imitated by depression group, and it was positively correlated with severity of depression. The severity of depression was also negatively correlated with accuracy in imitating happiness, and positively correlated with neutrality bias of imitating surprise.

LIMITATIONS

The ecological effectiveness of static stimulus materials is lower than that of dynamic stimuli. Without synchronized functional imaging, there is no way to link brain activation patterns.

CONCLUSION

The ability of patients with depression to voluntarily imitate facial expressions declines, which is mainly reflected in accuracy, bias and recognizability. Our experiment has discovered deficits in these aspects of patients with depression, which will be used as a method for diagnosising depression.

The alternate-form reliability study of six variants of the Brief Visual-Spatial Memory Test-Revised and the Hopkins Verbal Learning Test-Revised

Introduction

The revised Hopkins Verbal Learning Test-Revised (HVLT-R) and the Brief Visual-Spatial Memory Test-Revised (BVMT-R) are two widely used test involving verbal and visual learning and memory. In the two tests, six different versions are assembled, respectively, to prevent learning effects. Currently, no researchers have compared the six versions of the two tests. Thus, their usefulness in clinical studies requiring multiple follow-ups is limited. In this work, we confirm the equivalence of six HVLT-R and BVMT-R versions.

Methods

20 people completed all six HVLT-R and BVMT-R versions, while 120 people were randomly assigned to complete one of the six versions of each test. The Intelligence Quotient (IQ) level is measured using the short version of the Wechsler Adult Intelligence test. R4.2.0 is used for statistical analysis. The K-Related sample test (a non-parametric test) is used to observe the differences in test scores among the 20 subjects. The one-way Analysis of Variance (ANOVA) test is utilized to analyze the differences in test scores among the 120 subjects. The scores on different versions are compared using two similar sample tests. The HVLT-R Total Learning, the HVLT-R Delayed Recall, the BVMT-R Total Learning, and the BVMT-R Delayed Recall are indexes for comparison. Version and test scores are used as research factors, while different versions are used as research levels.

Results

The results suggest that HVLT-R and BVMT-R versions 3, 5 and 6 are equally difficult, and relatively easy compared to versions 1, 2 and 4. HVLT-R versions 3, 5, and 6 show good reliability and can be used interchangeably when testing word learning ability or short-term memory; BVMT-R Versions 3, 5, and 6 show acceptable reliability and can be can be used interchangeably.

Discussion

In the study of multiple follow-ups, it is a must to avoid discrepant versions and choose other equivalent versions. The results from this study could be used as a guide for upcoming studies and clinical applications in China.

Behavioral and electrophysiological analyses of self-referential neural processing in major depressive disorder

Cognitive theories suggest that patients with major depressive disorder (MDD) constantly negatively evaluate their self-referential information. Unlike Westerners with an independent self, self-representation is strongly influenced by cultural differences; the Chinese self may include others (interdependent self). This study uses a self-referential effect task combined with event-related potentials (ERP), and 34 patients with MDD and 54 healthy controls (HC) were asked to judge whether an adjective was suitable for describing the self, mother, or a public person, followed by an unexpected recognition task. They were required to judge whether a word was presented during the encoding phase. The results reveal that during the encoding phase, for both self- and mother-referential adjectives, patients with MDD endorsed fewer positive adjectives and more negative adjectives than the HCs. During the recognition phase, both groups showed a typical task effect (self = mother > other), while patients recognized more self-referential adjectives than the HCs. ERP data reveal that patients with MDD show larger P2 amplitudes during the encoding stage than healthy individuals. During the recognition phase, negative adjectives evoked larger P2 amplitudes in patients than in HCs under the self-referential condition. These findings shed important light on the information processes that may contribute to our understanding of depression and may offer implications for clinical interventions.