Visual exploration of emotional facial expressions in Parkinson's disease

Parkinson's disease (PD) is associated with impairments in facial emotion recognition as well as visual and executive dysfunction. We investigated whether facial emotion categorization impairments in PD are attributable to visual scanning abnormalities by recording the eye movements of 16 non-demented PD and 20 healthy control (HC) participants during an emotion recognition task. We examined the influence of several factors that can affect visual scanning, including oculomotor, basic visual, and cognitive abilities (executive function). Increases in the number and duration of fixations in the top regions of surprise facial expressions were related to increases in recognition accuracy for this emotion in PD participants with left-sided motor-symptom onset. Compared to HC men, HC women spent less time fixating on fearful expressions. PD participants displayed oculomotor abnormalities (antisaccades), but these were unrelated to scanning patterns. Performance on visual measures (acuity, contrast sensitivity) correlated with scanning patterns in the PD group only. Poorer executive function was associated with longer fixation times in PD and with a greater number of fixations in HC. Our findings indicate a specific relation between facial emotion categorization impairments and scanning of facial expressions in PD. Furthermore, PD and HC participants’ scanning behaviors during an emotion categorization task were driven by different perceptual processes and cognitive strategies. Our results underscore the need to consider differences in perceptual and cognitive abilities in studies of visual scanning, particularly when examining this ability in patient populations for which both vision and cognition are impaired.     

Deficits in decoding emotional facial expressions in Parkinson's disease

INTRODUCTION: The basal ganglia have numerous connections not only with the motor cortex but also with the prefrontal and limbic cortical areas. Therefore, basal ganglia lesions can disturb motor function but also cognitive function and emotion processing. The aim of the present study was to assess the consequences of Parkinson's disease (PD) on ability to decode emotional facial expressions (EFEs)-a method commonly used to investigate non-verbal emotion processing. METHODS: Eighteen PD patients participated in the study, together with 18 healthy subjects strictly matched with respect to age, education and sex. The patients were early in the course of the disease and had not yet received any antiparkinsonian treatment. Decoding of EFEs was assessed using a standardized, quantitative task where the expressions were of moderate intensity, i.e. quite similar to those experienced in everyday life. A set of tests also assessed executive function. Visuospatial perception, depression and anxiety were measured. RESULTS: Early in the course of the disease, untreated PD patients were significantly impaired in decoding EFEs, as well as in executive function. The deficits were significantly interrelated, although neither was significantly related to severity of the motor symptoms. Visuospatial perception was not impaired, and the patients' impairment was related neither to their depression nor to their anxiety score. The PD patients' impairment in decoding EFEs was related to a systematic response bias. CONCLUSION: Early in the course of PD, non-verbal emotional information processing is disturbed. This suggests that in PD, nigrostriatal dopaminergic depletion leads not only to motor and cognitive disturbances but also to emotional information processing deficits. The observed correlation pattern does not enable adoption of a clear-cut position in the debate over totally or partially segregated functional organization of the basal ganglia circuits.     

Fear recognition is impaired by subthalamic nucleus stimulation in Parkinson's disease

Behavioural disturbances such as disorders of mood, apathy or indifference are often observed in Parkinson's disease (PD) patients with chronic high frequency deep brain stimulation of subthalamic nucleus (STN DBS). Neuropsychological modifications causing these adverse events induced by STN DBS remain unknown, even if limbic disturbances are hypothesised. The limbic system supports neural circuits processing emotional information. The aim of this work is to evaluate changes of emotional recognition in PD patients induced by STN DBS. Thirty PD patients were assessed using a computerised paradigm of recognition of emotional facial expressions [Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists Press], 15 before STN DBS and 15 after. The two patients groups were compared to a group of 15 healthy control subjects. One series of 55 pictures of emotional facial expressions was presented to each patient. Patients had to classify the pictures according to seven basic emotions (happiness, sadness, fear, surprise, disgust, anger and no emotion). The intact ability to percept faces was firstly assured using the Benton Recognition Test. Recognition of fear expressions was significantly and selectively reduced in the post-operative group in comparison to both pre-operative and control groups. Our results demonstrate for the first time a selective reduction of recognition of facial expressions of fear by STN DBS. This impairment could be the first neuropsychological marker of a more general limbic dysfunction, thought to be responsible for the behavioural disorders reported after STN DBS.     

Understanding facial emotion perception in Parkinson's disease: the role of configural processing

Parkinson's disease (PD) has been frequently associated with facial emotion recognition impairments, which could adversely affect the social functioning of those patients. Facial emotion recognition requires processing of the spatial relations between facial features, known as the facial configuration. Few studies, however, have investigated this ability in people with PD. We hypothesized that facial emotion recognition impairments in patients with PD could be accounted for by a deficit in configural processing. To assess this hypothesis, three tasks were proposed to 10 patients with PD and 10 healthy controls (HC): (i) a facial emotion recognition task with upright faces, (ii) a similar task with upside-down faces, to explore the face inversion effect, and (iii) a configural task to assess participants’ abilities to detect configural modifications made on a horizontal or vertical axis. The results showed that when compared with the HC group, the PD group had impaired facial emotion recognition, in particular for faces expressing anger and fear, and exhibited reduced face inversion effect for these emotions. More importantly, the PD group's performance on the configural task to detect vertical modifications was lower than the HC group's. Taken together, these results suggest the presence of a configural processing alteration in patients with PD, especially for vertical, second-order information. Furthermore, configural performance was positively correlated with emotion recognition for anger, disgust, and fear, suggesting that facial emotion recognition could be related, at least partially, to configural processing.     

精神分裂症患者面孔情绪认知特点及其影响因素研究

目的探讨精神分裂症患者面孔情绪认知的特点及其影响因素。方法采用中国人面孔情绪测验(CFET)对121例精神分裂症患者进行测试,与76名正常对照比较,同时作阳性症状量表(SAPS)和阴性症状量表(SANS)评定。结果患者组6种基本情绪认知正确数均显著低于对照组,远隔错误数均显著高于对照组。回归分析显示,患者情绪认知障碍与年龄、用药情况、病程、住院次数及SAPS和SANS总评分无关,而受教育年限与情绪认知正确数和远隔错误数评分及多项不同情绪认知评分相关。SAPS阳性思维形式障碍因子分与CFET正确数总分呈负相关,而与CFET远隔错误数总分呈正相关,同时与惊、悲、怒情绪认知评分呈相关。SANS的注意障碍因子分与CFET正确数总分呈负相关,而与CFET远隔错误数总分呈正相关。结论精神分裂症患者存在广泛的情绪认知障碍并与某些症状相关,提示情绪认知障碍可能与疾病病理生理过程有关。     

Diminished sensitivity and specificity at recognising facial emotional expressions of varying intensity underlie emotion-specific recognition deficits in autism spectrum disorders

BackgroundA plethora of research on facial emotion recognition in autism spectrum disorders (ASD) exists and reported deficits in ASD compared to controls, particularly for negative basic emotions. However, these studies have largely used static high intensity stimuli. The current study investigated facial emotion recognition across three levels of expression intensity from videos, looking at accuracy rates to investigate impairments in facial emotion recognition and error patterns (’confusions’) to explore potential underlying factors.MethodTwelve individuals with ASD (9 M/3F; M(age) = 17.3) and 12 matched controls (9 M/3F; M(age) = 16.9) completed a facial emotion recognition task including 9 emotion categories (anger, disgust, fear, sadness, surprise, happiness, contempt, embarrassment, pride) and neutral, each expressed by 12 encoders at low, intermediate, and high intensity.ResultsA facial emotion recognition deficit was found overall for the ASD group compared to controls, as well as deficits in recognising individual negative emotions at varying expression intensities. Compared to controls, the ASD group showed significantly more, albeit typical, confusions between emotion categories (at high intensity), and significantly more confusions of emotions as ‘neutral’ (at low intensity).ConclusionsThe facial emotion recognition deficits identified in ASD, particularly for negative emotions, are in line with previous studies using other types of stimuli. Error analysis showed that individuals with ASD had difficulties detecting emotional information in the face (sensitivity) at low intensity, and correctly identifying emotional information (specificity) at high intensity. These results suggest different underlying mechanisms for the facial emotion recognition deficits at low vs high expression intensity.     

Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder

Patients with borderline personality disorder (BPD) exhibit impairment in labeling of facial emotional expressions. However, it is not clear whether these deficits affect the whole domain of basic emotions, are valence-specific, or specific to individual emotions. Whether BPD patients' errors in a facial emotion recognition task create a specific pattern also remains to be elucidated. Our study tested two hypotheses: first, we hypothesized, that the emotion perception impairment in borderline personality disorder is specific to the negative emotion domain. Second, we hypothesized, that BPD patients would show error patterns in a facial emotion recognition task more commonly and more systematically than healthy comparison subjects. Participants comprised 33 inpatients with BPD and 32 matched healthy control subjects who performed a computerized version of the Ekman 60 Faces test. The indices of emotion recognition and the direction of errors were processed in separate analyses. Clinical symptoms and personality functioning were assessed using the Symptom Checklist-90-Revised and the Young Schema Questionnaire Long Form. Results showed that patients with BPD were less accurate than control participants in emotion recognition, in particular, in the discrimination of negative emotions, while they were not impaired in the recognition of happy facial expressions. In addition, patients over-attributed disgust and surprise and under-attributed fear to the facial expressions relative to controls. These findings suggest the importance of carefully considering error patterns, besides measuring recognition accuracy, especially among emotions with negative affective valence, when assessing facial affect recognition in BPD.     

精神分裂症首次发病患者面孔识别事件相关电位研究

目的 探讨精神分裂症首次发病患者面孔识别障碍的特点.方法 采用病例对照研究设计,对性别、年龄、文化程度匹配的精神分裂症首次发病患者组(30例)和对照组(30例),应用Ekman标准表情库中的面孔生成刺激材料,研究2组受试者的面孔不同程度性别识别能力(分低、中、高3等程度的男女识别)和面孔不同程度表情识别能力(分低、中、高3等程度的高兴、厌恶、恐惧情绪的识别),分析面孔性别识别和面孔表情识别的判断正确率、反应时间,并比较各类视觉事件相关电位中的P100、N170、N250、晚正成分P300的波幅和潜伏期.结果 (1)行为学数据:患者组与对照组在性别识别方面的总体正确率和总体反应时间的差异均无统计学意义(F =3.306,P=0.077;F=3.866,P =0.056);患者组与对照组在表情识别方面的总体正确率为(44.5±2.4)％,低于对照组(60.5±2.1)％,差异有统计学意义(F=2.372,P=0.009),2组反应时间的差异无统计学意义(F=3.580,P =0.066).(2)脑电数据:患者组高程度的厌恶情绪和高程度的高兴情绪诱发的N170潜伏期低于对照组,差异有统计学意义(F=3.176,P=0.047);患者组与对照组N250波幅的差异有统计学意义(F =4.516,P=0.015).结论 精神分裂症首次发病患者存在面孔识别能力损害,N170、N250可能是精神分裂症的属性指标.     

The impact of neuromyelitis optica on the recognition of emotional facial expressions: A preliminary report

Although neuromyelitis optica (NMO) is classically recognized as an affectation of optic nerves and spinal cord, recent reports have shown brain atrophy and cognitive dysfunction in this condition. Importantly, emotion-related brain regions appear to be impaired in NMO. However, no studies of NMO’ emotional processing have been published. The goal of the current study was to investigate facial emotion recognition in 10 patients with NMO and 10 healthy controls by controlling for relevant cognitive factors. Consistent with previous reports, NMO patients performed poorly across cognitive domains (divided attention, working memory, and information-processing speed). Our findings further evidence the relative inability of NMO patients to recognize negative emotions (disgust, anger, and fear), in comparison to controls, with these deficits not explained by other cognitive impairments. Results provide the first evidence that NMO may impair the ability to recognize negative emotions. These impairments appear to be related to possible damage in brain regions underling emotional networks, including the anterior cingulate cortex, amygdala, and medial prefrontal cortex. Findings increased both our understanding of NMO’s cognitive impairment, and the neural networks underlying negative emotions.     

The role of trait anxiety in the recognition of emotional facial expressions

Previous work has suggested that elevated levels of trait anxiety are associated with an increased ability to accurately recognize the facial expression of fear. However, to date, recognition has only been assessed after viewing periods of 10s, despite the fact that the process of emotion recognition from faces typically takes a fraction of this time. The current study required participants with either high or low levels of non-clinical trait anxiety to make speeded emotional classification judgments to a series of facial expressions drawn from seven emotional categories. Following previous work it was predicted that recognition of fearful facial expressions would be more accurate in the high-trait anxious group compared with the low-trait anxious group. However, contrary to this prediction, no anxiety-related differences in emotion perception were observed across all seven emotions. This suggests that anxiety does not influence the perception of fear as has been previously proposed.     

Pediatric anxiety associated with altered facial emotion recognition

Multiple psychiatric disorders are associated with difficulties in facial emotion recognition. However, generalized anxiety disorder may be associated with more accurate recognition of others’ emotional expressions, particularly expressions of happiness and fear, which index safety and threat. Children aged 9–14 from a community sample (N = 601) completed a facial emotion labeling task. Children’s symptoms of depressive and anxiety syndromes were assessed by self- and parent-report. Elevated symptoms of generalized anxiety disorder were associated with more accurate facial emotion recognition (β = 0.16, p = 0.007), specifically recognition of happiness (β = 0.17, p = 0.002) and fear (β = 0.15, p = 0.006). Elevated depressive symptoms were associated with less accurate facial emotion recognition (β = −0.12, p = 0.018), specifically happiness (β = −0.15, p = 0.002). Elevated symptoms of separation anxiety disorder were also associated with less accurate facial emotion recognition (β = −0.16, p = 0.003), specifically happiness (β = −0.15, p = 0.006) and fear (β = −0.15, p = 0.005), which highlights the importance of distinguishing between anxiety syndromes. Results held when adjusting for child age and sex. Evidence that symptoms of generalized anxiety disorder are associated with more accurate recognition of happiness and fear is consistent with theories of heightened social vigilance and support a transdiagnostic role of facial emotion recognition that may inform the psychosocial development of youth with anxiety and depressive symptoms.     

Intranasal oxytocin enhances emotion recognition from dynamic facial expressions and leaves eye-gaze unaffected

Previous studies have shown that oxytocin improves the encoding and recognition of facial expressions, which has been proposed to be mediated by an increased exploration of the eye region during face processing. In the present study, we used eye tracking to assess visual attention to the eye region while participants performed a dynamic facial emotion recognition task. In a double-blind, placebo-controlled between-subjects design participants received 24 IU intranasal oxytocin (n = 23) or a placebo (n = 24). Although oxytocin administration had no effect on participants' visual scanning of emotional faces, it generally enhanced recognition performance, as the oxytocin group recognized emotional expressions at lower intensity levels. These findings suggest that oxytocin-induced improvement of facial emotion recognition is independent of modulations in overt visual attention.     

Mixed emotions: alcoholics' impairments in the recognition of specific emotional facial expressions

Facial expression recognition is a central feature of emotional and social behaviour and previous studies have found that alcoholics are impaired in this skill when presented with single emotions of differing intensities. The aim of this study was to explore biases in alcoholics' recognition of emotions when they were a mixture of two closely related emotions. The amygdala is intimately involved in encoding of emotions, especially those related to fear. In animals an increased number of withdrawals from alcohol leads to increased seizure sensitivity associated with facilitated transmission in the amygdala and related circuits. A further objective therefore was to explore the effect of previous alcohol detoxifications on the recognition of emotional facial expressions. Fourteen alcoholic inpatients were compared with 14 age and sex matched social drinking controls. They were asked to rate how much of each of six emotions (happiness, surprise, fear, sadness, disgust and anger) were present in morphed pictures portraying a mix of two of those emotions. The alcoholic group showed enhanced fear responses to all of the pictures compared to the controls and showed a different pattern of responding on anger and disgust. There were no differences between groups on decoding of sad, happy and surprised expressions. In addition the enhanced fear recognition found in the alcoholic group was related to the number of previous detoxifications. These results provide further evidence for impairment in facial expression recognition present in alcoholic patients. In addition, since the amygdala has been associated with the processing of facial expressions of emotion, particularly those of fear, the present data furthermore suggest that previous detoxifications may be related to changes within the amygdala.     

Familiar smiling faces in Alzheimer's disease: understanding the positivity-related recognition bias

Recent research has revealed a recognition bias favoring positive faces and other stimuli in older compared to younger adults. However, it is yet unclear whether this bias reflects an age-related preference for positive emotional stimuli, or an affirmatory bias used to compensate for episodic memory deficits. To follow up this point, the present study examined recognition of emotional faces and current mood state in patients with mild Alzheimer disease (AD) and healthy controls. Expecting lower overall memory performance, more negative and less positive mood in AD patients, the critical question was whether the positivity-related recognition bias would be increased compared to cognitively unimpaired controls. Eighteen AD patients and 18 healthy controls studied happy, neutral, and angry faces, which in a subsequent recognition task were intermixed with 50% distracter faces. As expected, the patient group showed reduced memory performance, along with a less positive and more negative mood. The recognition bias for positive faces persisted. This pattern supports the view that the positivity-induced recognition bias represents a compensatory, gist-based memory process that is applied when item-based recognition fails.     

Emotion recognition in patients with idiopathic Parkinson's disease.

Emotion recognition (ER) was examined in 64 patients with idiopathic Parkinson's disease (PD; 56 bilateral and 8 right-sided) and 64 matched healthy volunteers. Participants were administered an ER battery, consisting of the following subscores: overall ER (OER), overall facial ER, facial emotion identification (FEI) and discrimination, overall prosodic ER, and prosodic emotion identification (PEI) and discrimination. Measures of visuospatial functions, auditory attention, and depression were also administered. After controlling for visuospatial functions, auditory attention and depression, results indicated that patients with bilateral PD had poorer performance on all ER subscores, regardless of the modality and type of experimental task involved, relative to healthy volunteers. However, patients with right-sided PD had difficulty on FEI and PEI only. Whereas none of the clinical variables examined in this study predicted any of the ER subscores, visual organization and auditory attention positively predicted OER in patients with PD. In addition, visual organization also positively predicted FEI in these patients. Implications are discussed in terms of the neural substrates underlying ER.     

Facial expression recognition in people with medicated and unmedicated Parkinson's disease

Recognition of facial expressions of emotion was investigated in people with medicated and unmedicated Parkinson's disease (PD) and matched controls (unmedicated PD, n=16; medicated PD, n=20; controls, n=40). Participants in the medicated group showed some visual impairment (impaired contrast sensitivity) and performed less well on perception of unfamiliar face identity, but did not show significant deficits in the perception of sex, gaze direction, or familiar identity from the face. For both Parkinson's disease groups, there was evidence of impaired recognition of facial expressions in comparison to controls. These deficits were more consistently noted in the unmedicated group, who were also found to perform worse than the medicated group at recognising disgust from prototypical facial expressions, and at recognising anger and disgust in computer-manipulated images. Although both Parkinson's disease groups showed impairments of facial expression recognition, the consistently worse recognition of disgust in the unmedicated group is consistent with the hypothesis from previous studies that brain regions modulated by dopaminergic neurons are involved in the recognition of disgust.     

Amygdala activation and facial expressions: explicit emotion discrimination versus implicit emotion processing

Emotion recognition is essential for social interaction and communication and is a capacity in which the amygdala plays a central role. So far, neuroimaging results have been inconsistent as to whether the amygdala is more active during explicit or incidental facial emotion processing. In consideration of its functionality in fast automatic evaluation of stimuli and involvement in higher-order conscious processing, we hypothesize a similar response to the emotional faces presented regardless of attentional focus. Using high field functional magnetic resonance imaging (fMRI) specifically optimized for ventral brain regions we show strong and robust amygdala activation for explicit and implicit processing of emotional facial expressions in 29 healthy subjects. Bilateral amygdala activation was, however, significantly greater when subjects were asked to recognize the emotion (explicit condition) than when required to discern the age (implicit condition). A significant correlation between amygdala activation and emotion recognition, but not age discrimination performance, emphasizes the amygdala's enhanced role during conscious emotion processing.     

帕金森病患者面孔识别障碍的早期诊断：事件相关电位N170无优势

摘要：背景：认知障碍通常和PD伴随。临床工作者发现和干预PD早期的认知功能损害并且延缓痴呆的发生和恶化是PD治疗的一个十分重要的方面,但是目前缺乏客观和敏感的检测方法。目的 评估轻中度PD患者的认知功能,确定筛查PD认知损害敏感的筛查量表;研究事件相关电位（event-related potential, ERP）N170成分在视空间功能障碍帕金森病（PD）患者中的变化,探讨在PD中代表视空间功能损害的电生理参数和探索视空间损害的认知过程。设计：一个非随机的,对照研究于2008年10月-2009年5月在解放军总医院ERP工作室进行。参加者：50例PD患者,包括32例男性和18例女性,参与此研究。所有受试者均符合英国PD协会脑库的PD临床诊断标准。所有受试者的病程是7.2±3.7年,H-Y分级为1-3级。 方法 所有受试者进行神经心理学量表评估后,被分为2组：视空间功能受损组（group1,n=30）和视空间功能正常组（group2, n=20）。两组在年龄、性别比例和受教育年限上是相匹配的。我们采用面孔学习-再认的实验模式,利用ERP技术,记录10导联脑电数据,测量面孔特异性的N170的成分。此外,正确反应时和正确反应率也被记录。对N170的峰潜伏期和波幅、行为学指标和神经心理学量表评分进行统计学分析。主要的结果测量：所有的脑电数据均是在离线状态下使用ASA3.1软件进行分析。我们使用MATLAB R2006b软件在120-220ms之间,计算最小波幅及其对应的潜伏期来作为N170的波幅和潜伏期。结果 两组间MMSE评分无统计学差异。group1的蒙特利尔认知评估量表（MOCA）评分和视空间测试项目的评分明显低于group2（P<0．05）。group1对需要识别面孔的正确识别率低于group2（P<0．05）,2组间正确反应时间比较无统计学意义。group1仅在T6导联已识别出的面孔诱发N170的波幅高于group2（P<0．05）,在其余各导联分别在2种事件下所诱发N170的波幅及潜伏期两组间比较差异无统计学意义。group1在F7、F8、O1 导联N170潜伏期在两种事件下比较差异有统计学意义（P<0．05）,在T5导联N170的波幅在两种事件下比较差异有统计学意义（P<0．05）,在group1其余导联N170的潜伏期和波幅在在两种事件下比较差异无统计学意义,在group2的所有导联N170的潜伏期和波幅在两种事件下比较差异无统计学意义。结论 蒙特利尔认知评估量表可用于PD患者早期认知损害的评估,面孔再认的实验方法对于检测PD患者视空间能力损害具有临床价值。N170代表面孔识别的结构编码,两组间N170的潜伏期和波幅无统计学差异表明在轻中度PD患者的视空间功能损害发生在非结构编码阶段。在group2中两种事件诱发的N170的潜伏期和波幅存在统计学差异而在group1中却无统计学差异提示PD的视空间功能损害影响面孔的认知。我们可以在面孔学习阶段测量N170的潜伏期和波幅观察其变化或者探索其他的反应视空间功能变化的ERP成分。     

Impairments of facial emotion recognition and theory of mind in methamphetamine abusers

Chronic use of methamphetamine is related to behavioral disturbances including depression, aggressive behavior, and social isolation. These alterations of social behavior may be attributable to impairments in social cognition. However, few studies have evaluated social cognition in methamphetamine (MA) abusers. Therefore, the aim of the present study was to investigate whether MA abusers exhibit social cognition deficits in terms of facial emotion recognition and theory of mind (ToM). We also assessed cognitive flexibility by using the Wisconsin Card Sorting Test (WCST) to evaluate the impact of this function on social cognition. Twenty-eight MA abusers and twenty-seven healthy subjects enrolled in this study. All participants performed the Facial Emotion Recognition Task and advanced ToM tasks such as the Eye Test and Hinting Task. The Korean Wechsler Adult Intelligence Scale—Revised and computerized versions of the WCST were also administrated. The performances of MA abusers on the Facial Emotion Recognition Task and Eyes Test were lower than those of healthy subjects. In the WCST, MA abusers completed significantly fewer categories and made more total and perseverative errors than healthy subjects did. In addition, impairments in cognitive flexibility are correlated with impairments in facial emotion recognition and ToM within MA abusers. These findings lend further support to the assertion that the capacity to identify emotions from facial expression and infer mental state of others is impaired in MA abusers. Therefore, treatment and rehabilitation for MA abusers must consider role of social cognition and include relearning social interactions and behaviors.     

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.