Emotional Processing in Healthy Ageing, Mild Cognitive Impairment, and Alzheimer's Disease

Emotional Recognition: A Comparative Study of People with Mild Cognitive Impairment and Alzheimer's Disease Self-Report with Caregiver Perspectives

Objective: This study compared emotional recognition in participants with mild cognitive impairment (MCI) and mild to moderate Alzheimer 's disease (AD) against caregivers' perceptions of these participants' emotional states, while exploring the influence of clinical variables. Methods: We included 141 participants (32 with MCI, 50 with mild AD, and 59 with moderate AD) and their primary caregivers. We employed tasks assessing emotional decoding, identification, and correspondence, along with objective evaluations. Results: Participants across all groups showed significant differences in cognition and functionality. However, emotional recognition abilities did not significantly differ between MCI and mild or moderate AD groups. Most cognitive and neuropsychiatric variables had no significant impact on emotion recognition or social functioning. No differences emerged in patients' self-evaluations of social and emotional functioning. Caregiver assessments revealed significant differences only between the MCI and moderate AD groups. Conclusion: Participants with MCI and AD displayed expected clinical progression while retaining some emotional recognition and social functioning capabilities.

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.

Social cognition in mild cognitive impairment and dementia: A systematic review and meta-analysis

Social cognition is impaired in people with dementia but the differences in social cognitive impairment between mild cognitive impairment (MCI) and dementia and its subtypes remain unclear. We therefore aimed to systematically review and meta-analyze differences in emotion recognition, theory of mind (ToM), and empathy between individuals with MCI and dementia. Across 28 cross-sectional studies (n = 2409), people with MCI had better emotion recognition (Cohen's d = 0.69) and ToM (d = 0.70) than individuals with Alzheimer's disease (AD) dementia, and larger effect sizes were observed for people with frontotemporal dementia (FTD) (emotion recognition (d = 2.09), ToM (d = 1.49), but emotional empathy was higher in AD than in MCI in included studies. Our findings suggest a progressive decline of aspects of social cognition across the MCI-dementia continuum. Longitudinal studies should investigate the diagnostic role of social cognition deficits in MCI progression to dementia, and interventions for social cognition in MCI should be developed and tested. HIGHLIGHTS: First systematic review and meta-analysis comparing social cognition between mild cognitive impairment (MCI) and dementia subtypes. Findings from 28 studies with 2409 participants show people with MCI outperform those with Alzheimer's disease (AD) and frontotemporal dementia (FTD) in emotion recognition and theory of mind. Empathy appears intact in AD dementia, suggesting that this cognitive domain is preserved throughout disease progression. Evaluation of social cognition should be built into dementia assessment as it may hold diagnostic value.

Music moves: Ettlingen dementia study - a pragmatic randomised controlled trial

OBJECTIVES

Due to the limited effectiveness of pharmacological treatment, there is a growing need to explore non-pharmacological psychosocial interventions such as music therapy when treating the behavioural and psychological symptoms of dementia (BPSD).

METHOD

We randomised 57 nursing home residents into individual active music therapy plus standard care (aMT), individual receptive music therapy with tactile sound vibration plus standard care (rMT), or the standard care control group (CG). A trained music therapist provided 12 sessions over 6 weeks. The outcomes (BPSD; depression; quality of life; medical system usage; activities of daily living; music therapy engagement) were measured at baseline (0 week), post-intervention (6 weeks), and follow-up (12 weeks).

RESULTS

The results indicated small beneficial effects for BPSD in aMT and rMT at follow-up, a small beneficial effect for total musical engagement in aMT and rMT, a small negative effect for verbal communication in rMT, and a small beneficial effect for medical usage in the CG.

CONCLUSION

Both aMT and rMT methods showed promise for managing BPSD and increasing engagement during music therapy. rMT may be more suited for advanced stages of dementia. Future studies should evaluate the appropriateness and effectiveness of each intervention according to disease severity.

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.

Category-Sensitive Age-Related Shifts Between Prosodic and Semantic Dominance in Emotion Perception Linked to Cognitive Capacities

PURPOSE

Prior research extensively documented challenges in recognizing verbal and nonverbal emotion among older individuals when compared with younger counterparts. However, the nature of these age-related changes remains unclear. The present study investigated how older and younger adults comprehend four basic emotions (i.e., anger, happiness, neutrality, and sadness) conveyed through verbal (semantic) and nonverbal (facial and prosodic) channels.

METHOD

A total of 73 older adults (43 women, Mage = 70.18 years) and 74 younger adults (37 women, Mage = 22.01 years) partook in a fixed-choice test for recognizing emotions presented visually via facial expressions or auditorily through prosody or semantics.

RESULTS

The results confirmed age-related decline in recognizing emotions across all channels except for identifying happy facial expressions. Furthermore, the two age groups demonstrated both commonalities and disparities in their inclinations toward specific channels. While both groups displayed a shared dominance of visual facial cues over auditory emotional signals, older adults indicated a preference for semantics, whereas younger adults displayed a preference for prosody in auditory emotion perception. Notably, the dominance effects observed in older adults for visual and semantic cues were less pronounced for sadness and anger compared to other emotions. These challenges in emotion recognition and the shifts in channel preferences among older adults were correlated with their general cognitive capabilities.

CONCLUSION

Together, the findings underscore that age-related obstacles in perceiving emotions and alterations in channel dominance, which vary by emotional category, are significantly intertwined with overall cognitive functioning.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27307251.

Deficits of Facial Emotion Recognition in Elderly Individuals with Mild Cognitive Impairment

INTRODUCTION

The study of facial emotion recognition is under-explored in subjects with mild cognitive impairment (MCI). We investigated whether deficits in facial emotion recognition are present in patients with MCI. We also analyzed the relationship between facial emotion recognition and different domains of cognitive function.

METHODS

This study included 300 participants aged 60 years or older with cognitive decline. We evaluated 181 MCI and 119 non-MCI subjects using the Seoul Neuropsychological Screening Battery-Core (SNSB-C) and facial emotion recognition task using six facial expressions (anger, disgust, fear, happiness, sadness and surprise). A Generalized Linear Model (GLM) was used to assess the association between cognitive performance and accuracy of facial emotion recognition and to compare facial emotion recognition in the MCI group based on the impairment of five different domains of cognitive function. The model was adjusted for age, sex, years of education, and depressive symptoms.

RESULTS

Patients with MCI had a lower score for accurately recognizing total facial emotion (0.48 vs. 0.53; ρ = 0.0003) and surprise (0.73 vs. 0.81; ρ = 0.0215) when compared to cognitively healthy subjects. We also discovered that frontal/executive function domain (Digit Symbol Coding [DSC, 0.38 vs. 0.49; p < 0.0001], Controlled Oral Word Association Test [COWAT, 0.42 vs. 0.49; p = 0.0001], Korean-Trail Making Test [K-TMT, 0.37 vs. 0.48; p = 0.0073], Korean-Color Word Stroop Test [K-CWST, 0.43 vs. 0.49; p = 0.0219]) and language domain (Korean-Boston Naming Test [S-K-BNT, 0.46 vs. 0.47; p = 0.003]) were statistically associated with the deficits of facial emotion recognition in patients with MCI.

CONCLUSION

We observed a significant association between deficits in facial emotion recognition and cognitive impairment in elderly individuals.

Age-related reduction in anxiety and neural encoding of negative emotional memory

Introduction

Older adults experience less anxiety. We examined how memory of negative emotional images varied with age and may reflect age-related differences in anxiety.

Methods

Fifty-one adults, age 22-80 years, underwent imaging with a memory task where negative and neutral images were displayed pseudo-randomly. They were queried post-scan about the images inter-mixed with an equal number of images never displayed. Sensitivity (d') and reporting bias (Z-score of false alarm rate; Z[FAR]) were quantified with signal detection theory.

Results

Age was negatively correlated with both Spielberg State Trait Anxiety Inventory (STAI) state score and d' (negative - neutral) and positively with Z[FAR] (negative - neutral). However, STAI score and d' or Z[FAR] (negative - neutral) were not significantly correlated. In whole-brain regression, STAI score was correlated with higher activity of the right middle/superior temporal gyri/temporal parietal junction (MTG/STG/TPJ) for "negative correct - incorrect" - "neutral correct - incorrect" trials. Further, the MTG/STG/TPJ activity (β) was also negatively correlated with age. Mediation analyses supported a complete mediation model of age → less anxiety → less MTG/STG/TPJ β.

Discussion

Together, the findings demonstrated age-related changes in negative emotional memory and how age-related reduction in anxiety is reflected in diminished temporoparietal cortical activities during encoding of negative emotional memory.

Exploring longitudinal changes in implicit awareness of dementia: An investigation of the emotional Stroop effect in healthy ageing and mild dementia

The aim of the study was to investigate responses to dementia-relevant words in healthy older people and to investigate changes in response over 20-months in people with early-stage dementia. An emotional Stroop task, using colour-naming dementia-relevant words, was used as an indicator of implicit awareness of dementia. Overall, 24 people with dementia and 24 healthy older people completed an emotional Stroop task (T1). People with dementia completed the same task again after 12 (T2) and 20 (T3) months. For people with dementia emotional Stroop performance was contrasted with ratings of explicit awareness based on a detailed interview at T1 and at T2. For healthy older people and people with dementia response times to dementia-relevant words were significantly longer than those for neutral words. The effect was absent for people with dementia at T3. This decline in the emotional Stroop effect was not associated with cognitive decline as measured by the MMSE. Ratings of explicit awareness showed no significant change over time. There was no association between explicit awareness and implicit awareness. Implicit awareness of the condition is evident in early-stage dementia and can be elicited even where there is reduced explicit awareness. The emotional Stroop effect for dementia-relevant words in people with dementia appears to decline over time, independently of changes in MMSE score, suggesting that implicit awareness fades as time progresses.

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.

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.

Amygdala activity and amygdala-hippocampus connectivity: Metabolic diseases, dementia, and neuropsychiatric issues

With rapid aging of the population worldwide, the number of people with dementia is dramatically increasing. Some studies have emphasized that metabolic syndrome, which includes obesity and diabetes, leads to increased risks of dementia and cognitive decline. Factors such as insulin resistance, hyperglycemia, high blood pressure, dyslipidemia, and central obesity in metabolic syndrome are associated with synaptic failure, neuroinflammation, and imbalanced neurotransmitter levels, leading to the progression of dementia. Due to the positive correlation between diabetes and dementia, some studies have called it "type 3 diabetes". Recently, the number of patients with cognitive decline due to metabolic imbalances has considerably increased. In addition, recent studies have reported that neuropsychiatric issues such as anxiety, depressive behavior, and impaired attention are common factors in patients with metabolic disease and those with dementia. In the central nervous system (CNS), the amygdala is a central region that regulates emotional memory, mood disorders, anxiety, attention, and cognitive function. The connectivity of the amygdala with other brain regions, such as the hippocampus, and the activity of the amygdala contribute to diverse neuropathological and neuropsychiatric issues. Thus, this review summarizes the significant consequences of the critical roles of amygdala connectivity in both metabolic syndromes and dementia. Further studies on amygdala function in metabolic imbalance-related dementia are needed to treat neuropsychiatric problems in patients with this type of dementia.

The role of emotional instability in borderline personality disorder: a systematic review

BACKGROUND

The emotional regulation process plays a pivotal role in daily-life functioning, modulating goal-directed and adaptive behavior. Conversely, altering this cognitive function can disrupt self-regulation and bring emotional dysregulation. Emotional instability could represent a core characteristic of BPD, also modulating the BPD symptom's onset. This systematic review aims to summarize the existing literature reporting the role of emotional instability in BPD to better define the role of the impairment of the emotional processes in the onset of the cognitive and behavioral symptoms of this complex mental disorder.

METHODS

MEDLINE, Scopus and Web of Science were independently searched for relevant studies. Eligible studies had to be identifiable through database searching, published and accessible. This systematic review was conducted according to PRISMA guidelines. The search period was from 2012 to 14 September 2022.

RESULTS

A pool of 120 studies was identified, out of which 11 met the selection criteria and were included. Overall, the studies confirm a relationship between emotional instability and borderline personality disorder.

CONCLUSIONS

The evidences retrieved seem to point out the role of the emotional impairment not only in worsening of the disorder, but could also be one of the risk factors for its onset.

Emotion recognition and processing in patients with mild cognitive impairment: A systematic review

The purpose of this study was to investigate emotion recognition and processing in patients with mild cognitive impairment (MCI) in order to update the state of current literature on this important but undervalued topic. We identified 15 papers published between 2012 and 2022 that meet the inclusion criteria. Paper search, selection, and extraction followed the PRISMA guidelines. We used a narrative synthesis approach in order to report a summary of the main findings taken from all papers. The results collected are still ambiguous: some studies did not find any differences between MCI and healthy controls (HC) groups in emotion recognition and processing, and other results reported emotion-specific deficits in emotion recognition regarding MCI patients (both regarding negative and neutral emotions). It is essential to underline that these findings could not be generalized to the whole MCI population due to the heterogeneous use of measures and composition of the sample. This does not allow us to make a comprehensive comparison between the results. Our suggestion for future research is to align the results using the same type of tests and emotion recognition assessment.

Emotion Processing Dysfunction in Alzheimer's Disease: An Overview of Behavioral Findings, Systems Neural Correlates, and Underlying Neural Biology

We described behavioral studies to highlight emotional processing deficits in Alzheimer's disease (AD). The findings suggest prominent deficit in recognizing negative emotions, pronounced effect of positive emotion on enhancing memory, and a critical role of cognitive deficits in manifesting emotional processing dysfunction in AD. We reviewed imaging studies to highlight morphometric and functional markers of hippocampal circuit dysfunction in emotional processing deficits. Despite amygdala reactivity to emotional stimuli, hippocampal dysfunction conduces to deficits in emotional memory. Finally, the reviewed studies implicating major neurotransmitter systems in anxiety and depression in AD supported altered cholinergic and noradrenergic signaling in AD emotional disorders. Overall, the studies showed altered emotions early in the course of illness and suggest the need of multimodal imaging for further investigations. Particularly, longitudinal studies with multiple behavioral paradigms translatable between preclinical and clinical models would provide data to elucidate the time course and underlying neurobiology of emotion processing dysfunction in AD.