Recognition of facial expressions and emotional situations in patients with dementia of the Alzheimer and vascular types

The aim of this study was to investigate the ability of patients with dementia to recognize facial expressions and emotional situations. We evaluated 16 patients with dementia of the Alzheimer type (DAT) and 15 with vascular dementia (VD) for general cognition, discrimination of facial expressions and individual faces, and recognition of facial expressions and emotional situations. VD patients performed significantly worse than DAT patients at recognizing facial emotions, even though there was no difference between them in their general cognition and visuoperceptual abilities. There was no significant difference between them in their ability to recognize emotional situations. The results of this and past studies suggest that caregivers in nursing homes and hospitals need to be aware that VD patients lose the ability to comprehend facial expressions.     

Evidence for a dissociation of structural and semantic knowledge in dementia of the Alzheimer type (DAT)

Object recognition and naming deficits in dementia of the Alzheimer type (DAT) have typically been attributed to deficits in semantic processing, with only a few studies proposing loci of deficits other than semantic. One possible cause of DAT object recognition impairments could involve deficits in processing structural aspects of visually presented items. In this paper, we assess the performance of a group of mild DAT patients on two tasks of structural access, object decision, and the complete/incomplete task (based on part-whole matching task), as well as on a semantic probes task, designed to assess the patients' semantic knowledge of the same items for which structural knowledge had earlier been assessed. The DAT patients were substantially impaired in their performance on tasks of structural access. Further, no evidence for item-to-item consistency in the DAT patients' errors for the structural and semantic tasks was found, raising the possibility that structural and semantic knowledge may become differentially impaired in DAT.     

Recognition of emotion in the frontal and temporal variants of frontotemporal dementia

Recent studies have suggested that the frontal and temporal variants of frontotemporal dementia (fvFTD and tvFTD) are both associated with impairments in emotional processing. However, the degree and type of emotional processing deficits in the two syndromes have not been previously compared. We used the Florida Affect Battery to examine recognition of facial expressions of emotion in fvFTD and tvFTD patients who have no evidence of visual perceptual difficulties for faces. In general, both groups were impaired at recognizing emotions compared with age-matched controls. In tvFTD, this deficit was limited to emotions with a negative valence (sadness, anger, fear), while fvFTD patients showed impairment for positive valence (happiness) as well. These results suggest that damage to frontal lobe regions in FTD may lead to more profound impairment in recognition of emotion than when damage is more limited to the temporal lobe.     

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.     

Sparing of attentional relative to mnemonic function in a subgroup of patients with dementia of the Alzheimer type

Patients with dementia of the Alzheimer type (DAT) received two tests of visual selective attention, together with tests of spatial and visual recognition memory and visuospatial conditional learning previously used to show deficits early in the course of DAT. One set of attentional tests compared visual discrimination learning along intra- and extra-dimensional shifts, using a "total change" design. In the 12 DAT patients capable of attempting the extra-dimensional shift (subgroup 1), performance was equivalent to that of controls. This subgroup was also unimpaired at simple and compound discrimination learning and reversal and an intra-dimensional shift. They were as accurate as controls on a visual search task requiring matching of stimuli on two dimensions with variable numbers of alternatives, but were significantly impaired in the tests of recognition memory and learning. By contrast, the other 13 patients showed marked impairments in the attentional tasks. This subgroup was also significantly worse than subgroup 1 in performance on the visual recognition and conditional learning tasks, and showed greater severity on most of the clinical ratings of dementia. The sparing of attentional shifting in patients early in the course of DAT is contrasted with the impairments previously described in patients with Parkinson's disease with only mild or absent memory loss. The implications of this double dissociation of deficits for understanding the neural bases of the cognitive deficits in these two neurodegenerative diseases are discussed and their significance for the staging of DAT is considered.     

Apolipoprotein E in patients with dementia of the Alzheimer type and vascular dementia

The phenotypes of apolioprotein E (ApoE) in the plasma of patients with dementia of the Alzheimer type (DAT) and vascular dementia (VD) were determined by the isoelectric focusing method. The ApoE mRNA level in the skin fibroblasts was also determined by the Northern blot analysis. As compared with the control subjects, the frequency of the ApoE ε4 allele was significantly higher in the DAT group as well as the VD group, but was not significantly different in the cerebrovascular disease without dementia (CVD) group. The skin fibroblast ApoE mRNA level in the DAT group and the VD group was significantly lower than that in the control group. These findings suggest that the phenotype of ApoE is associated with DAT and VD, and that the lower level of ApoE mRNA may play an important role in the development of DAT as well as VD.     

Olfactory dysfunction in dementia of Alzheimer's type and vascular dementia

Background: Olfactory function in vascular dementia has not been extensively investigated to date. We studied olfactory function in vascular dementia (VD) and dementia of Alzheimer's type (DAT). Methods: We studied olfactory functioning in 12 patients suffering from dementia of Alzheimer's type, 11 patients with vascular dementia and 30 normal subjects. For these subjects we examined a 12‐item version of the Pennsylvania smell identification test and mini‐mental state examinations. These three groups were matched for age, sex and educational level. Results: Although the dementia scores were comparable in the DAT and VD groups, the smell identifications were low in DAT patients compared with VD patients and normal control subjects. Conclusions: These results suggest that the smell identification test may be useful in differential diagnosis between DAT and VD patients     

Comparison of executive and visuospatial memory function in Huntington''s disease and dementia of Alzheimer type matched for degree of dementia.

Groups of patients with Hungington's disease and probable dementia of Alzheimer type (DAT) matched for level of dementia on the basis of mini mental state examination scores were compared in several tests of visual memory and tests sensitive to frontal lobe dysfunction. Whereas recall of patients with DAT tended to be worse on the Kendrick object learning test, the two groups were equivalent on tests of sensorimotor ability and delayed matching to sample performance. By contrast, the patients with Huntington's disease were significantly worse on tests of pattern and spatial recognition, simultaneous matching to sample, visuospatial paired associates, and on three tests sensitive to frontal lobe dysfunction--namely, the Tower of London test of planning, spatial working memory, and a visual discrimination learning and reversal paradigm. The impairments in these tests, however, did not always qualitatively resemble those seen in patients with frontal lobe damage and may be more characteristic of primary neostriatal deficit. In the visual discrimination paradigm the patients with Hungtington's disease were significantly worse than the patients with DAT at the simple reversal stage, where they displayed significant preservation to the previously rewarded alternative. The results are consistent with the hypothesis that patients with Huntington's disease exhibit deficits in tests sensitive to frontostriatal dysfunction and that this form of intellectual deterioration is qualitatively distinct from that seen in Alzheimer's disease.     

Possible antidepressant dihydroergosine preferentially binds to 5-HT1B receptor sites in the rat hippocampus

Summary Cerebrospinal fluid (CSF) and serum levels of 22 amino acids were studied in 13 patients with dementia of the Alzheimer type (DAT), 13 patients with vascular dementia (VD) and 15 age-matched controls. We found significantly reduced levels of glutamate in CSF samples from DAT patients compared to VD and control subjects, but CSF levels of aspartate were found to be significantly elevated in the two groups of dementia studied. Moreover, CSF concentrations of tyrosine, leucine and phenylalanine were significantly increased in VD patients in comparison with those in DAT patients and control subjects. Our results showed a wide increase in CSF/serum amino acid ratios in DAT and VD groups compared to controls. However, no differences were found in CSF/serum ratios between dementia groups. These changes show evidence for a possible disorder of amino acid metabolism with different patterns in these two dementia types.     

A voxel-based lesion study on facial emotion recognition after penetrating brain injury

The ability to read emotions in the face of another person is an important social skill that can be impaired in subjects with traumatic brain injury (TBI). To determine the brain regions that modulate facial emotion recognition, we conducted a whole-brain analysis using a well-validated facial emotion recognition task and voxel-based lesion symptom mapping (VLSM) in a large sample of patients with focal penetrating TBIs (pTBIs). Our results revealed that individuals with pTBI performed significantly worse than normal controls in recognizing unpleasant emotions. VLSM mapping results showed that impairment in facial emotion recognition was due to damage in a bilateral fronto-temporo-limbic network, including medial prefrontal cortex (PFC), anterior cingulate cortex, left insula and temporal areas. Beside those common areas, damage to the bilateral and anterior regions of PFC led to impairment in recognizing unpleasant emotions, whereas bilateral posterior PFC and left temporal areas led to impairment in recognizing pleasant emotions. Our findings add empirical evidence that the ability to read pleasant and unpleasant emotions in other people''s faces is a complex process involving not only a common network that includes bilateral fronto-temporo-limbic lobes, but also other regions depending on emotional valence.     

Emotion recognition deficits in the elderly

In two studies, healthy elderly adults were poor at recognizing certain emotions. In study one, an emotion face morphed to express a new emotion. The elderly were impaired when recognizing anger and sadness, whereas no differences were found between the two age groups in recognizing fear or happiness, or in a task requiring reasoning about non=emotion stimuli. In study two, the elderly were impaired when judging which of two faces was more angry, sad, or fearful, but they were not impaired when judging other emotions or when judging which of two beakers was more full. The elderly were also impaired when matching emotion sounds to angry, sad, and disgusted faces, but not to other emotions and not when matching non-emotion (e.g., machine) sounds to machines. Elderly deficits were independent of performance on a task requiring basic face processing (gender recognition). Overall, the results provide support for an age-related decline in the recognition of some emotions that is independent of changes in perceptual abilities, processing speed, fluid IQ, basic face processing abilities, and reasoning about non face stimuli. Recognition of emotion stimuli might be mediated by regions of the brain that are independent from those associated with a more general cognitive decline.     

EMOTION RECOGNITION DEFICITS IN THE ELDERLY

In two studies, healthy elderly adults were poor at recognizing certain emotions. In study one, an emotion face morphed to express a new emotion. The elderly were impaired when recognizing anger and sadness, whereas no differences were found between the two age groups in recognizing fear or happiness, or in a task requiring reasoning about non=emotion stimuli. In study two, the elderly were impaired when judging which of two faces was more angry, sad, or fearful, but they were not impaired when judging other emotions or when judging which of two beakers was more full. The elderly were also impaired when matching emotion sounds to angry, sad, and disgusted faces, but not to other emotions and not when matching non-emotion (e.g., machine) sounds to machines. Elderly deficits were independent of performance on a task requiring basic face processing (gender recognition). Overall, the results provide support for an age-related decline in the recognition of some emotions that is independent of changes in perceptual abilities, processing speed, fluid IQ, basic face processing abilities, and reasoning- about non-face stimuli. Recognition of emotion stimuli might be mediated by regions of the brain that are independent from those associated with a more general cognitive decline     

Facial emotion recognition in myotonic dystrophy type 1 correlates with CTG repeat expansion

Objective

To investigate the ability of patients with myotonic dystrophy type 1 to recognise basic facial emotions. We also explored the relationship between facial emotion recognition, neuropsychological data, personality, and CTG repeat expansion data in the DM‐1 group.

Methods

In total, 50 patients with DM‐1 (28 women and 22 men) participated, with 41 healthy controls. Recognition of facial emotional expressions was assessed using photographs of basic emotions. A set of tests measured cognition and personality dimensions, and CTG repeat size was quantified in blood lymphocytes.

Results

Patients with DM‐1 showed impaired recognition of facial emotions compared with controls. A significant negative correlation was found between total score of emotion recognition in a forced choice task and CTG repeat size. Furthermore, specific cognitive functions (vocabulary, visuospatial construction ability, and speed) and personality dimensions (reward dependence and cooperativeness) correlated with scores on the forced choice emotion recognition task.

Conclusion

These findings revealed a CTG repeat dependent facial emotion recognition deficit in the DM‐1 group, which was associated with specific neuropsychological functions. Furthermore, a correlation was found between facial emotional recognition ability and personality dimensions associated with sociability. This adds a new clinically relevant dimension in the cognitive deficits associated with DM‐1.     

Impaired recognition of facial expressions of emotion in Alzheimer's disease

Recognizing facial emotions is an important aspect of interpersonal communication that may be impaired in Alzheimer's disease (AD). The authors examined facial emotion matching, facial emotion labeling, and same--different emotion differentiation in AD patients, healthy elderly volunteers, and elderly, nondemented psychiatric outpatients. Compared with both control groups, AD patients were significantly impaired on all three measures. AD patients were also impaired on a facial identity matching task. Using facial identity matching scores as a covariate provided evidence suggesting the facial emotion processing deficit may be independent of impairment in nonemotional face processing. AD patients also had selective impairment in labeling facial expressions of sadness. The authors conclude that patients with AD have deficits in recognizing facial emotions, which may be independent of their impairment in recognizing nonemotional features of faces.     

Sleep-wake cycles in multi-infarct dementia and dementia of the Alzheimer type

We monitored by actigraphs minute-by-minute activity of 10 patients with multi-infarct dementia (MID), 15 patients with dementia of the Alzheimer type (DAT), and 11 control volunteers for eight consecutive 24-hour periods to assess sleep-wake cycles and sleep quality. MID patients had disrupted sleep-wake cycles associated with decreased sleep quality. In contrast, ambulatory DAT patients maintained a relatively normal sleep-wake cycle that did not differ significantly from controls. There was no correlation between the severity of intellectual deterioration and the degree of sleep-wake cycle disintegration in either group of dementia patients.     

The ‘Reading the Mind in Films’ Task [Child Version]: Complex Emotion and Mental State Recognition in Children with and without Autism Spectrum Conditions

Children with autism spectrum conditions (ASC) have difficulties recognizing others' emotions. Research has mostly focused on basic emotion recognition, devoid of context. This study reports the results of a new task, assessing recognition of complex emotions and mental states in social contexts. An ASC group (n = 23) was compared to a general population control group (n = 24). Children with ASC performed lower than controls on the task. Using task scores, more than 87% of the participants were allocated to their group. This new test quantifies complex emotion and mental state recognition in life-like situations. Our findings reveal that children with ASC have residual difficulties in this aspect of empathy. The use of language-based compensatory strategies for emotion recognition is discussed.     

Emotional perception deficits in amyotrophic lateral sclerosis.

OBJECTIVE: Cognitive deficits associated with frontal lobe dysfunction can occur in amyotrophic lateral sclerosis (ALS), particularly in individuals with bulbar ALS who can also suffer pathologic emotional lability. Because frontal pathophysiology can alter emotional perception, we examined whether emotional perception deficits occur in ALS, and whether they are related to depressive or dementia symptoms. METHODS: Bulbar ALS participants (n=13) and age-matched healthy normal controls (n=12) completed standardized tests of facial emotional and prosodic recognition, the Geriatric Depression Scale, and the Mini-Mental State Examination. Participants identified the basic emotion (happy, sad, angry, afraid, surprised, disgusted) that matched 39 facial expressions and 28 taped, semantically neutral, intoned sentences. RESULTS: ALS patients performed significantly worse than controls on facial recognition but not on prosodic recognition. Eight of 13 patients (62%) scored below the 95% confidence interval of controls in recognizing facial emotions, and 3 of these patients (23% overall) also scored lower in prosody recognition. Among the 8 patients with emotional perceptual impairment, one-half did not have depressive, or memory or cognitive symptoms on screening, whereas the remainder showed dementia symptoms alone or together with depressive symptoms. CONCLUSIONS: Emotional recognition deficits occur in bulbar ALS, particularly with emotional facial expressions, and can arise independent of depressive and dementia symptoms or comorbid with depression and dementia. These findings expand the scope of cognitive dysfunction detected in ALS, and bolsters the view of ALS as a multisystem disorder involving cognitive and also motor deficits.     

Emotion recognition in Huntington's disease and frontotemporal dementia

A well-documented feature of Huntington's disease (HD) is disproportionate impairment in the ability to recognise the emotional expression of disgust. However, this finding has been challenged by studies that report no differential disgust impairment and attribute apparent differences across emotions to task difficulty. The present study sought to shed light on disparities in findings through a comparative study of emotion recognition in HD and frontotemporal dementia (FTD). Ten HD, 12 FTD patients and 12 healthy controls were administered 10 tasks assessing facial and vocal recognition of emotions and comprehension of emotion terms. The findings were not consistent with either the 'selective disgust impairment' or 'task difficulty' view. Both HD and FTD groups were impaired compared to controls, deficits in HD being less severe. Impairments in FTD were elicited for all emotions whereas in HD they were demonstrated predominantly for negative emotions of fear, disgust and anger. Consistency in performance, despite varying task demands, excluded an explanation in terms of item difficulty, and was in keeping with the notion of distinct neural substrates for processing of negative emotions. Contrary to the notion of disproportionate disgust impairment, the most severe deficits in HD were elicited for anger, a finding that may have relevance for the poor anger control that is the hallmark of HD. The data raise the possibility that linguistic influences and conceptual complexities of the emotion of disgust may contribute to the variable finding of selective disgust impairment in HD.     

Facial emotion recognition impairment in chronic temporal lobe epilepsy

Purpose:   To evaluate facial emotion recognition (FER) in a cohort of 176 patients with chronic temporal lobe epilepsy (TLE).
Methods:   FER was tested by matching facial expressions with the verbal labels for the following basic emotions: happiness, sadness, fear, disgust, and anger. Emotion recognition performances were analyzed in medial (n = 140) and lateral (n = 36) TLE groups. Fifty healthy subjects served as controls. The clinical and neuroradiologic variables potentially affecting the ability to recognize facial expressions were taken into account.
Results:   The medial TLE (MTLE) group showed impaired FER (86% correct recognition) compared to both the lateral TLE patients (FER = 93.5%) and the controls (FER = 96.4%), with 42% of MTLE patients recording rates of FER that were lower [by at least 2 standard deviations (SDs)] than the control mean. The MTLE group was impaired compared to the healthy controls in the recognition of all basic facial expressions except happiness. The patients with bilateral MTLE were the most severely impaired, followed by the right and then the left MTLE patients. FER was not affected by type of lesion, number of antiepileptic drugs (AEDs), aura semiology, or gender. Conversely, the early onset of seizures/epilepsy was related to FER deficits. These deficits were already established in young adulthood, with no evidence of progression in older MTLE patients.
Conclusion:   These results on a large cohort of TLE patients demonstrate that emotion recognition deficits are common in MTLE patients and widespread across negative emotions. We confirm that early onset seizures with right or bilateral medial temporal dysfunction lead to severe deficits in recognizing facial expressions of emotions.