Facial expressions in severely demented patients—a stimulus–response study of four patients with dementia of the Alzheimer type

The ability to exhibit facial expressions was studied in four patients with severe dementia of the Alzheimer type (SDAT), by means of the Facial Action Coding System (FACS) and physiological responses (heart rate, respiration, skin temperature) under pleasant and unpleasant stimulus conditions. Complex facial expressions that could be interpreted as expressions of emotions were not seen. An increase in the number of facial movements and changes in the physiological responses were seen most markedly under the unpleasant stimulus condition. The patients' reactions during the assumed pleasant stimulus conditions indicated comfort. Different reactions were obtained among the patients. The importance of developing further methods to identify and interpret facial movements in nurse-patient relationships is emphasized.     

Neurophysiological responses to music and vibroacoustic stimuli in Rett syndrome

People with Rett syndrome (RTT) have severe communicative difficulties. They have as well an immature brainstem that implies dysfunction of the autonomic nervous system. Music plays an important role in their life, is often used as a motivating tool in a variety of situations and activities, and caregivers are often clear about people with RTTs favourites. The aim of this study was to investigate physiological and emotional responses related to six different musical stimuli in people with RTT. The study included 29 participants with RTT who were referred to the Swedish Rett Center for medical brainstem assessment during the period 2006–2007. 11 children with a typical developmental pattern were used as comparison. A repeated measures design was used, and physiological data were collected from a neurophysiological brainstem assessment. The continuous dependent variables measured were Cardiac Vagal Tone (CVT), Cardiac Sensitivity to Baroreflex (CSB), Mean Arterial Blood Pressure (MAP) and the Coefficient of Variation of Mean Arterial Blood Pressure (MAP-CV). These parameters were used to categorise brainstem responses as parasympathetic (calming) response, sympathetic (activating) response, arousal (alerting) response and unclear response. The results showed that all participants responded to the musical stimuli, but not always in the expected way. It was noticeable that both people with and without RTT responded with an arousal to all musical stimuli to begin with. Even though the initial expressions sometimes changed after some time due to poor control functions of their brainstem, the present results are consistent with the possibility that the RTT participants’ normal responses to music are intact. These findings may explain why music is so important for individuals with RTT throughout life.     

Autonomic response in the perception of disgust and happiness in depersonalization disorder

Patients with depersonalization disorder have shown attenuated responses to emotional unpleasant stimuli, hence supporting the view that depersonalization is characterised by a selective inhibition on the processing of unpleasant emotions. It was the purpose of this study to establish if autonomic responses to facial emotional expressions also show the same blunting effect. The skin conductance responses (SCRs) of 16 patients with chronic DSM-IV depersonalization disorder, 15 normal controls and 15 clinical controls with DSM-IV anxiety disorders were recorded in response to facial expressions of happiness and disgust. Patients with anxiety disorders were found to have greater autonomic responses than patients with depersonalization, in spite of the fact that both groups had similarly high levels of subjective anxiety as measured by anxiety scales. SCR to happy faces did not vary across groups. The findings of this study provide further support to the idea that patients with depersonalization have a selective impairment in the processing of threatening or unpleasant emotional stimuli.     

Amygdala activation at 3T in response to human and avatar facial expressions of emotions

Facial expressions of emotions are important in nonverbal communication. Although numerous neural structures have been identified to be involved in emotional face processing, the amygdala is thought to be a core moderator. While previous studies have relied on facial images of humans, the present study is concerned with the effect of computer-generated (avatar) emotional faces on amygdala activation. Moreover, elicited activation patterns in response to viewing avatar faces are compared with the neuronal responses to human facial expressions of emotions. Twelve healthy subjects (five females) performed facial emotion recognition tasks with optimized 3T event-related fMRI. Robust amygdala activation was apparent in response to both human and avatar emotional faces, but the response was significantly stronger to human faces in face-sensitive structures, i.e. fusiform gyri. We suggest that avatars could be a useful tool in neuroimaging studies of facial expression processing because they elicit amygdala activation similarly to human faces, yet have the advantage of being highly manipulable and fully controllable. However, the finding of differences between human and avatar faces in face-sensitive regions indicates the presence of mechanisms by which human brains can differentiate between them. This mechanism merits further investigation.     

Processing of subliminal facial expressions of emotion: A behavioral and fMRI study

The recognition of emotional facial expressions is an important means to adjust behavior in social interactions. As facial expressions widely differ in their duration and degree of expressiveness, they often manifest with short and transient expressions below the level of awareness. In this combined behavioral and fMRI study, we aimed at examining whether or not consciously accessible (subliminal) emotional facial expressions influence empathic judgments and which brain activations are related to it. We hypothesized that subliminal facial expressions of emotions masked with neutral expressions of the same faces induce an empathic processing similar to consciously accessible (supraliminal) facial expressions. Our behavioral data in 23 healthy subjects showed that subliminal emotional facial expressions of 40 ms duration affect the judgments of the subsequent neutral facial expressions. In the fMRI study in 12 healthy subjects it was found that both, supra- and subliminal emotional facial expressions shared a widespread network of brain areas including the fusiform gyrus, the temporo-parietal junction, and the inferior, dorsolateral, and medial frontal cortex. Compared with subliminal facial expressions, supraliminal facial expressions led to a greater activation of left occipital and fusiform face areas. We conclude that masked subliminal emotional information is suited to trigger processing in brain areas which have been implicated in empathy and, thereby in social encounters     

Lateralisation effect in comprehension of emotional facial expression: A comparison between EEG alpha band power and behavioural inhibition (BIS) and activation (BAS) systems

Asymmetry in comprehension of facial expression of emotions was explored in the present study by analysing alpha band variation within the right and left cortical sides. Second, the behavioural activation system (BAS) and behavioural inhibition system (BIS) were considered as an explicative factor to verify the effect of a motivational/emotional variable on alpha activity. A total of 19 participants looked at an ample range of facial expressions of emotions (anger, fear, surprise, disgust, happiness, sadness, and neutral) in random order. The results demonstrated that anterior frontal sites were more active than central and parietal sites in response to facial stimuli. Moreover, right and left side responses varied as a function of emotional types, with an increased right frontal activity for negative, aversive emotions vs an increased left response for positive emotion. Finally, whereas higher BIS participants generated more right hemisphere activation for some negative emotions (such as fear, anger, surprise, and disgust), BAS participants were more responsive to positive emotion (happiness) within the left hemisphere. Motivational significance of facial expressions was considered to elucidate cortical differences in participants' responses to emotional types.     

Posed emotional expression in unilateral brain damaged patients

The facial expressions of six basic emotions were posed by two groups of right (N = 23) and left (N = 34) brain damaged patients and by a control group of normal subjects (N = 28). The posed expressions were examined by means of the Facial Action Coding System (FACS) which provides analytical and objective scoring, as by a subjective scale of appropriateness of expression. Results indicated no difference between controls and patients with a lesion in the right or left hemisphere. These findings are inconsistent with the hypothesis that the right hemisphere plays a specific role in the control of posed facial expression. No relationship was observed between posed emotional expressions and facial paralysis or the presence of oral apraxia.     

Deliberate emotional expressions of socially anxious children and their mothers

The aim of the present study was to investigate whether socially anxious children show deficits in their deliberate facial expression of emotions. To test for potential mother-child transmission effects, the mothers' facial expressions were also assessed. Fifty socially anxious and 25 socially nonanxious children (8-12 years) and their mothers participated in a facial expression posing task. The expressions produced were coded using Ekman and Friesen's (1978) Facial Action Coding System (FACS). In addition, naive raters rated their quality of emotion. FACS analyses indicated that socially anxious children show a reduced general facial activity, have a more restricted facial repertoire and differ qualitatively from controls in their facial expression of emotions. Similarly, the global ratings indicated that the socially anxious children's posed facial expressions are less accurate. For the mothers no differences between groups were found when global ratings were used. However, the FACS data demonstrate that the facial expressions of mothers of socially anxious children are less intense compared to controls. It is possible that the decreased intensity of the mothers' facial expressiveness makes it more difficult for the socially anxious children to learn adequate facial expressions.     

Normal recognition of emotional similarity between facial expressions following bilateral amygdala damage.

Bilateral damage to the amygdala in humans has been previously linked to two deficits in recognizing emotion in facial expressions: recognition of individual basic emotions, especially fear, and recognition of similarity among emotional expressions. Although several studies have examined recognition of individual emotions following amygdala damage, only one subject has been examined on recognition of similarity. To assess the extent to which deficits in recognizing similarity among facial expressions might be a general consequence of amygdala damage, we examined this ability in two subjects with complete bilateral amygdala damage. Both subjects had previously demonstrated entirely normal recognition of individual facial emotions. Here we report that these two patients also are intact in their ability to recognize similarity between emotional expressions. These results indicate that, like the recognition of individual basic emotions in facial expressions, the recognition of similarity among emotional expressions does not have an absolute dependence on the amygdala.     

Automated Facial Action Coding System for dynamic analysis of facial expressions in neuropsychiatric disorders

Facial expression is widely used to evaluate emotional impairment in neuropsychiatric disorders. Ekman and Friesen's Facial Action Coding System (FACS) encodes movements of individual facial muscles from distinct momentary changes in facial appearance. Unlike facial expression ratings based on categorization of expressions into prototypical emotions (happiness, sadness, anger, fear, disgust, etc.), FACS can encode ambiguous and subtle expressions, and therefore is potentially more suitable for analyzing the small differences in facial affect. However, FACS rating requires extensive training, and is time consuming and subjective thus prone to bias. To overcome these limitations, we developed an automated FACS based on advanced computer science technology. The system automatically tracks faces in a video, extracts geometric and texture features, and produces temporal profiles of each facial muscle movement. These profiles are quantified to compute frequencies of single and combined Action Units (AUs) in videos, and they can facilitate a statistical study of large populations in disorders known to impact facial expression. We derived quantitative measures of flat and inappropriate facial affect automatically from temporal AU profiles. Applicability of the automated FACS was illustrated in a pilot study, by applying it to data of videos from eight schizophrenia patients and controls. We created temporal AU profiles that provided rich information on the dynamics of facial muscle movements for each subject. The quantitative measures of flatness and inappropriateness showed clear differences between patients and the controls, highlighting their potential in automatic and objective quantification of symptom severity.     

Neural activities associated with emotion recognition observed in men and women

Previous studies have suggested that men and women process emotional stimuli differently. In this study, we examined if there would be any consistency in regions of activation in men and women when processing stimuli portraying happy or sad emotions presented in the form of facial expressions, scenes, and words. A blocked design BOLD functional magnetic resonance imaging paradigm was employed to monitor the neural activities of male and female healthy volunteers while they were presented with the experimental stimuli. The imaging data revealed that the right insula and left thalamus were consistently activated for men, but not women, during emotion recognition of all forms of stimuli studied. To further understand the imaging data acquired, we conducted the protocol analysis method to identify the cognitive processes engaged while the men and women were viewing the emotional stimuli and deciding whether they were happy or sad. The findings suggest that men rely on the recall of past emotional experiences to evaluate current emotional experiences. This may explain why the insula, a structure important for self-induced or internally generated recalled emotions, was consistently activated in men while processing emotional stimuli. Our findings suggest possible gender-related neural responses to emotional stimuli.     

Perception of emotions on happy/sad chimeric faces in Alzheimer disease: relationship with cognitive functions

AIMS: To investigate the ability to recognize facial emotions in patients with Alzheimer disease (AD). Happiness and sadness, fundamental emotions that are easily recognized across cultures, were evaluated. Results were further analyzed in relation to demographic, clinical, and neuropsychologic characteristics. METHODS: A test exploring recognition of facial emotions using chimeric faces based on Jaynes' happy and sad faces was administered to 71 patients with probable AD. RESULTS: The ability to identify positive and negative facial emotions was largely preserved in AD subjects. Impaired recognition of facial emotions was found in 27%. Poor test performance was associated with low scores on constructional praxis and nonverbal memory tasks. CONCLUSIONS: Decoding of emotional facial expressions seems to be differently affected in relation to patients' neuropsychologic profile, as poor test performance closely correlated with nonverbal cognitive impairment. This emotion-discrimination disorder likely characterizes the behavior of a subset of AD patients with predominant right-hemisphere dysfunction. A preserved ability to process the emotional features of faces may have an important role in the management of demented patients, and suggests the use of nonverbal communication as an integrative/alternative system. The simple test used in our study may be a useful clinical tool to explore emotional behavior in demented subjects.     

Dysfunctional facial emotional expression and comprehension in a patient with corticobasal degeneration

Patients with corticobasal degeneration (CBD) frequently develop orofacial apraxia but little is known about CBD's influence on emotional facial processing. We describe a patient who developed a facial apraxia including an impaired ability to voluntarily generate facial expressions with relative sparing of spontaneous emotional faces. Her ability to interpret the facial expressions of others was also severely impaired. Despite these deficits, the patient had normal affect and normal speech, including expressive and receptive emotional prosody. As patients with corticobasal degeneration are known to manifest both orofacial apraxia and visuospatial dysfunction this patient's expressive and receptive deficits may be independent manifestations of the same underlying disease process. Alternatively, these functions may share a common neuroanatomic substrate that degenerates with CBD.     

Neural responses to happy,fearful and angry faces of varying identities in 5- and 7-month-old infants

The processing of facial emotion is an important social skill that develops throughout infancy and early childhood. Here we investigate the neural underpinnings of the ability to process facial emotion across changes in facial identity in cross-sectional groups of 5- and 7-month-old infants. We simultaneously measured neural metabolic, behavioral, and autonomic responses to happy, fearful, and angry faces of different female models using functional near-infrared spectroscopy (fNIRS), eye-tracking, and heart rate measures. We observed significant neural activation to these facial emotions in a distributed set of frontal and temporal brain regions, and longer looking to the mouth region of angry faces compared to happy and fearful faces. No differences in looking behavior or neural activations were observed between 5- and 7-month-olds, although several exploratory, age-independent associations between neural activations and looking behavior were noted. Overall, these findings suggest more developmental stability than previously thought in responses to emotional facial expressions of varying identities between 5- and 7-months of age.     

Differential judgement of static facial expressions of emotions in three cultures

Judging facial expressions of emotions has important clinical value in the assessment of psychiatric patients. Judging facial emotional expressions in foreign patients however, is not always easy. Controversy has existed in previous reports on cultural differences in identifying static facial expressions of emotions. While it has been argued that emotional expressions on the face are universally recognized, experimental data obtained were not necessarily totally supportive. Using the data reported in the literature, our previous pilot study showed that the Japanese interpreted many emotional expressions differently from USA viewers of the same emotions. In order to explore such discrepancies further, we conducted the same experiments on Chinese subjects residing in Beijing. The data showed that, similar to the Japanese viewers, Chinese viewers also judged many static facial emotional expressions differently from USA viewers. The combined results of the Chinese and the Japanese experiments suggest a major cross-cultural difference between American and Asian viewers in identifying some static facial emotional expressions, particularly when the posed emotion has negative connotations. The results have important implications for cross-cultural communications when facial emotional expressions are presented as static images.     

Dysfunctional Facial Emotional Expression and Comprehension in a Patient with Corticobasal Degeneration

Patients with corticobasal degeneration (CBD) frequently develop orofacial apraxia but little is known about CBD's influence on emotional facial processing. We describe a patient who developed a facial apraxia including an impaired ability to voluntarily generate facial expressions with relative sparing of spontaneous emotional faces. Her ability to interpret the facial expressions of others was also severely impaired. Despite these deficits, the patient had normal affect and normal speech, including expressive and receptive emotional prosody. As patients with corticobasal degeneration are known to manifest both orofacial apraxia and visuospatial dysfunction this patient's expressive and receptive deficits may be independent manifestations of the same underlying disease process. Alternatively, these functions may share a common neuroanatomic substrate that degenerates with CBD.     

Biased processing of neutral facial expressions is associated with depressive symptoms and suicide ideation in individuals at risk for major depression due to affective temperaments

Background

To elucidate whether abnormal facial emotion processing represents a vulnerability factor for major depression, some studies have explored deficits in emotion processing in individuals at familial risk for depression. Nevertheless, these studies have provided mixed results. However, no studies on facial emotion processing have been conducted in at-risk samples with early or attenuated signs of depression, such as individuals with affective temperaments who are characterized by subclinical depressive moods, cognitions, and behaviors that resemble those that occur in patients with major depression.

Methods

Presence and severity of depressive symptoms, affective temperaments, death wishes, suicidal ideation, and suicide planning were explored in 231 participants with a mean age 39.9 years (SD = 14.57). Participants also completed an emotion recognition task with 80 emotional face stimuli expressing fear, angry, sad, happy, and neutral facial expressions.

Results

Participants with higher scores on affective temperamental dimensions containing a depressive component, compared to those with lower scores, reported more depressive symptoms, death wishes, suicide ideation and planning, and an increased tendency to interpret neutral facial expressions as emotional facial expressions; in particular, neutral facial expressions were interpreted more negatively, mostly as sad facial expressions. However, there were no group differences in identification and discrimination of facial expressions of happiness, sadness, fear, and anger.

Conclusions

A negative bias in interpretation of neutral facial expressions, but not accuracy deficits in recognizing emotional facial expressions, may represent a vulnerability factor for major depression. However, further research is needed.     

Amygdala damage impairs emotion recognition from scenes only when they contain facial expressions

Bilateral damage to the human amygdala impairs recognition of negatively valenced emotions from facial expressions, but it is unclear if this finding generalizes to richer visual stimuli that contain cues in addition to faces. We investigated this issue in 4 subjects with bilateral amygdala damage, 23 with unilateral amygdala damage, 22 brain-damaged controls and 16 normal individuals. Subjects were shown two blocks of complex social scenes; all stimuli in the two blocks were identical, except that the first block had all facial expressions in the image erased. While control subjects were more accurate in recognizing emotions when facial expressions were present, subjects with bilateral amygdala damage did not show the same benefit for negative emotions, often performing equivalently across the two conditions. Most striking, subjects with bilateral amygdala damage were more accurate in recognizing scenes showing anger with faces erased than with faces present, an effect resulting in part from highly abnormal recognition of certain angry facial expressions. All four subjects with bilateral amygdala damage were impaired in recognizing angry faces shown in isolation, and frequently mistook expressions of anger for smiles, a mistake never made by any control subject. Bilateral amygdala damage thus disproportionately impairs recognition of certain emotions from complex visual stimuli when subjects utilize information from facial expressions.     

Autonomic imbalance is associated with reduced facial recognition in somatoform disorders

Objectives

Somatoform disorders are characterized by the presence of multiple somatic symptoms. While the accuracy of perceiving bodily signal (interoceptive awareness) is only sparely investigated in somatoform disorders, recent research has associated autonomic imbalance with cognitive and emotional difficulties in stress-related diseases. This study aimed to investigate how sympathovagal reactivity interacts with performance in recognizing emotions in faces (facial recognition task).

Methods

Using a facial recognition and appraisal task, skin conductance levels (SCLs), heart rate (HR) and heart rate variability (HRV) were assessed in 26 somatoform patients and compared to healthy controls. Interoceptive awareness was assessed by a heartbeat detection task.

Results

We found evidence for a sympathovagal imbalance in somatoform disorders characterized by low parasympathetic reactivity during emotional tasks and increased sympathetic activation during baseline. Somatoform patients exhibited a reduced recognition performance for neutral and sad emotional expressions only. Possible confounding variables such as alexithymia, anxiety or depression were taken into account. Interoceptive awareness was reduced in somatoform patients.

Conclusions

Our data demonstrate an imbalance in sympathovagal activation in somatoform disorders associated with decreased parasympathetic activation. This might account for difficulties in processing of sad and neutral facial expressions in somatoform patients which might be a pathogenic mechanism for increased everyday vulnerability.