Sensory contributions to impaired prosodic processing in schizophrenia.

BACKGROUND: Deficits in affect recognition are prominent features of schizophrenia. Within the auditory domain, patients show difficulty in interpreting vocal emotional cues based on intonation (prosody). The relationship of these symptoms to deficits in basic sensory processing has not been previously evaluated. METHODS: Forty-three patients and 34 healthy comparison subjects were tested on two affective prosody measures: voice emotion identification and voice emotion discrimination. Basic auditory sensory processing was measured using a tone-matching paradigm and the Distorted Tunes Test (DTT). A subset of subjects was also tested on facial affect identification and discrimination tasks. RESULTS: Patients showed significantly impaired performance on all emotion processing tasks. Within the patient group, a principal components analysis demonstrated significant intercorrelations between basic pitch perception and affective prosodic performance. In contrast, facial affect recognition deficits represented a distinct second component. Prosodic affect measures correlated significantly with severity of negative symptoms and impaired global outcome. CONCLUSIONS: These results demonstrate significant relationships between basic auditory processing deficits and impaired receptive prosody in schizophrenia. The separate loading of auditory and visual affective recognition measures suggests that within-modality factors may be more significant than cross-modality factors in the etiology of affect recognition deficits in schizophrenia.     

Disordered recognition of facial identity and emotions in three Asperger type autists

In this report we aim to explore severe deficits in facial affect recognition in three boys all of whom meet the criteria of Asperger's syndrome (AS), as well as overt prosopagnosia in one (B) and covert prosopagnosia in the remaining two (C and D). Subject B, with a familially-based talent of being highly gifted in physics and mathematics, showed no interest in people, a quasi complete lack of comprehension of emotions, and very poor emotional reactivity. The marked neuropsychological deficits were a moderate prosopagnosia and severely disordered recognition of facial emotions, gender and age. Expressive facial emotion, whole body psychomotor expression and speech prosody were quasi absent as well. In all three boys these facial processing deficits were more or less isolated, and general visuospatial functions, attention, formal language and scholastic performances were normal or even highly developed with the exception of deficient gestalt perception in B. We consider the deficient facial emotion perception as an important pathogenetic symptom for the autistic behaviour in the three boys. Prosopagnosia, the absent facial and bodily expression, and speech prosody were important but varying co-morbid disorders. The total clinical picture of non-verbal disordered communication is a complex of predominantly bilateral and/or right hemisphere cortical deficits. Moreover, in B, insensitivity to pain, smells, noises and internal bodily feelings suggested a more general emotional anaesthesia and/or a deficient means of expression. It is possible that a limbic component might be involved, thus making affective appreciation also deficient. Accepted: 18 January 2000     

Acquired aprosodia in children

In adults, the affective components of language, including certain aspects of prosody and gesturing, appear to be a dominant function of the right hemisphere. The various combinations of affective processing deficits associated with focal right brain damage are called aprosodias and have functional and anatomical correlates similar to the propositional language deficits associated with aphasias secondary to focal left brain damage. Developmental affective-prosodic deficits have been reported recently in children with congenital or very early right hemisphere injury. We now report two school-aged children with acquired motor-type aprosodias following acute right focal brain injury. Their affective prosody and singing were also analyzed acoustically during the acute and recovery phases of illness. Based on these cases, we propose the term children aprosodia to describe affective-prosodic deficits that result from acquired lesions of the right hemisphere in children.     

Near‐infrared spectroscopy reveals neural perception of vocal emotions in human neonates

Processing affective prosody, that is the emotional tone of a speaker, is fundamental to human communication and adaptive behaviors. Previous studies have mainly focused on adults and infants; thus the neural mechanisms underlying the processing of affective prosody in newborns remain unclear. Here, we used near‐infrared spectroscopy to examine the ability of 0‐to‐4‐day‐old neonates to discriminate emotions conveyed by speech prosody in their maternal language and a foreign language. Happy, fearful, and angry prosodies enhanced neural activation in the right superior temporal gyrus relative to neutral prosody in the maternal but not the foreign language. Happy prosody elicited greater activation than negative prosody in the left superior frontal gyrus and the left angular gyrus, regions that have not been associated with affective prosody processing in infants or adults. These findings suggest that sensitivity to affective prosody is formed through prenatal exposure to vocal stimuli of the maternal language. Furthermore, the sensitive neural correlates appeared more distributed in neonates than infants, indicating a high‐level of neural specialization between the neonatal stage and early infancy. Finally, neonates showed preferential neural responses to positive over negative prosody, which is contrary to the “negativity bias” phenomenon established in adult and infant studies.     

Intervention for increasing the comprehension of affective prosody in children with autism spectrum disorders

Deficits in comprehension of others’ emotions have been well documented in children with autism spectrum disorders (ASDs). As to variety of methodological procedures, many of them can be analyzed by matching-to-sample (MTS) procedures. When using affective prosody as a sample stimulus, children with ASD have been found to have difficulties with cross-modal MTS, including understanding the relationship between affective prosody (auditory stimulus) and affective illustrations or texts (visual stimulus). Furthermore, several studies have attempted to train the perception of cross-modal processing relationships in older children with high functioning ASD or Asperger's syndrome. The purpose of the present study was to examine whether four young children with ASD (mean age, 5 years 6 months) could be taught the relationships between affective prosody and facial expression via cross-modal MTS training and, if so, whether or not this skills generalized to novel stimuli. A multiple baseline design across participants was implemented. Results showed that all four of the children acquired the cross-modal emotion relationships and generalized this learned relationship to the perception of untrained stimuli. These findings are discussed in terms of the procedures to increase the understanding of the richness of other's emotions at an early developmental stage.     

Relationship between neuropsychological and emotional functioning in severe chronic alcoholism

Previous studies of patients with severe chronic alcoholism have shown a high prevalence of emotional distress such as anxiety and depression, and neuropsychological impairments such as executive deficits, but few have examined the relationship between these disorders. We addressed this issue in 51 abstinent patients with histories of severe chronic alcoholism utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and the Halstead-Reitan Neuropsychological Test Battery (HRNTB). Applying factor analysis to the MMPI clinical and validity scales, we derived four dimensions accounting for 78% of the available variance. We found that Factor 1, which loaded on most clinical scales of the MMPI, was significantly correlated (p <.01) with performance on the Halstead Category Test (HCT), a measure of executive functioning. Further, group analysis with MANOVA using HCT (impaired and nonimpaired) as the independent variable revealed a significant main effect for Factor 1 (p <.004), which was maintained and strengthened when age and education were controlled as covariates (p <.001). The results suggest a relationship between emotional distress and executive functioning as measured by the HCT, reflecting differing facets of frontal lobe dysfunction common to cognitive and affective domains in patients with severe chronic alcoholism.     

Receptive prosody in nonfluent primary progressive aphasias

IntroductionProsody has been little studied in the primary progressive aphasias (PPAs), a group of neurodegenerative disorders presenting with progressive language impairment.MethodsHere we conducted a systematic investigation of different dimensions of prosody processing (acoustic, linguistic and emotional) in a cohort of 19 patients with nonfluent PPA syndromes (11 with progressive nonfluent aphasia, PNFA; five with progressive logopenic/phonological aphasia, LPA; three with progranulin-associated aphasia, GRN-PPA) compared with a group of healthy older controls. Voxel-based morphometry (VBM) was used to identify neuroanatomical associations of prosodic functions.ResultsBroadly comparable receptive prosodic deficits were exhibited by the PNFA, LPA and GRN-PPA subgroups, for acoustic, linguistic and affective dimensions of prosodic analysis. Discrimination of prosodic contours was significantly more impaired than discrimination of simple acoustic cues, and discrimination of intonation was significantly more impaired than discrimination of stress at phrasal level. Recognition of vocal emotions was more impaired than recognition of facial expressions for the PPA cohort, and recognition of certain emotions (in particular, disgust and fear) was relatively more impaired than others (sadness, surprise). VBM revealed atrophy associated with acoustic and linguistic prosody impairments in a distributed cortical network including areas likely to be involved in perceptual analysis of vocalisations (posterior temporal and inferior parietal cortices) and working memory (fronto-parietal circuitry). Grey matter associations of emotional prosody processing were identified for negative emotions (disgust, fear, sadness) in a broadly overlapping network of frontal, temporal, limbic and parietal areas.ConclusionsTaken together, the findings show that receptive prosody is impaired in nonfluent PPA syndromes, and suggest a generic early perceptual deficit of prosodic signal analysis with additional relatively specific deficits (recognition of particular vocal emotions).     

Age-related impairments in comprehending affective prosody with comparison to brain-damaged subjects

This study evaluated the ability to produce and comprehend affective prosody across age groups and compared patterns of impaired performance to deficits observed after focal brain damage. Sixty-nine healthy subjects, ages 22 to 83 years, were given the Aprosodia Battery, a test that distinguishes between affective prosodic processing deficits following right- versus left-brain damage through the use of stimuli with progressively reduced verbal articulatory content. Production of affective prosody, measured by variation in fundamental frequency, was unimpaired in older subjects, whereas comprehension of affective prosody was impaired, particularly for tasks with reduced verbal articulatory content. The pattern of performance across affective comprehension tasks in the older subjects resembled the pattern found after right-brain damage. The results demonstrate age-related loss in comprehension of affective prosody that is most likely due to a processing deficit involving the right hemisphere.     

Relationship Between Neuropsychological and Emotional Functioning in Severe Chronic Alcoholism

Previous studies of patients with severe chronic alcoholism have shown a high prevalence of emotional distress such as anxiety and depression, and neuropsychological impairments such as executive deficits, but few have examined the relationship between these disorders. We addressed this issue in 51 abstinent patients with histories of severe chronic alcoholism utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and the Halstead–Reitan Neuropsychological Test Battery (HRNTB). Applying factor analysis to the MMPI clinical and validity scales, we derived four dimensions accounting for 78% of the available variance. We found that Factor 1, which loaded on most clinical scales of the MMPI, was significantly correlated (p &lt;.01) with performance on the Halstead Category Test (HCT), a measure of executive functioning. Further, group analysis with MANOVA using HCT (impaired and nonimpaired) as the independent variable revealed a significant main effect for Factor 1 (p &lt;.004), which was maintained and strengthened when age and education were controlled as covariates (p &lt;.001). The results suggest a relationship between emotional distress and executive functioning as measured by the HCT, reflecting differing facets of frontal lobe dysfunction common to cognitive and affective domains in patients with severe chronic alcoholism.     

Cognitive estimation and affective judgments in alcoholic Korsakoff patients

Alcoholic Korsakoff patients have their most marked deficits in memory, but may exhibit problems in further cognitive and behavioral domains, particularly in so-called frontal lobe functions and on the emotional level. Cognitive estimation is among the frontal lobe-associated functions; nevertheless, the underlying processes of estimation and estimation deficits are still unknown. Additionally, though affective judgments were found to be disturbed in Korsakoff patients one can question whether this result is due to a deficiency in emotional processing itself, or whether deteriorated basic processes underlying all kinds of judgment tasks result in affective judgment errors. In this study, possible relations and underlying cognitive processes of affective and nonaffective judgments (cognitive estimates) were analyzed in a large sample of 39 Korsakoff patients. A neuropsychological test battery was administered together with a new test for cognitive estimation consisting of four dimensions ('size,' 'weight,' 'quantity,' and 'time') and an affective judgment task comprising negative, neutral, and positive words. The Korsakoff patients' results showed marked deficits concerning both, cognitive estimation and affective judgments. These deficits were highly intercorrelated and performance in both tasks was related to basic (e.g., information processing speed) and higher cognitive functions (executive functions and memory), suggesting a common basis in cognitive estimation and in affective judgments in Korsakoff syndrome.     

fMRI during affect discrimination in bipolar affective disorder

Objective: It has been hypothesized that disturbances in affect may represent distinct etiologic factors for bipolar affective disorder. The neural mechanisms mediating affective processes and their relationship to brain development and the pathophysiology of bipolar affective disorder remain to be clarified. Recent advances in neuroimaging techniques have made possible the non-invasive examination of specific brain regions during cortical challenge paradigms. This study reports findings based on fMRI data acquired during fearful and happy affect recognition paradigms in patients with bipolar affective disorder and in healthy adult subjects.

Methods: Prior to the scan, subjects were instructed to view the stimuli and to identify the type of facial expression presented. Echo planar scanning was performed on a 1.5 Tesla scanner which had been retrofitted with a whole body echo planar coil, using a head coil.

Results: The data indicate that in adult subjects with bipolar affective disorder, there is a reduction in dorsolateral prefrontal cortex activation and an increase in amygdalar activation in response to fearful facial affect. In a healthy comparison group, signal intensity changes were not found in these regions. In addition, although the patients with bipolar affective disorder completed the task demands, they demonstrated an impaired ability to correctly identify fearful facial affect but not the happy facial affect displayed.

Conclusion: These findings are consistent with the hypothesis that in some patients with bipolar affective disorder, there may be a reduction of frontal cortical function which may be associated with affective as well as attentional processing deficits.     

Kleptomania in frontal lobe lesion

A case of a kleptomaniac with frontal lobe dysfunction is presented. Kleptomania is related to the obsessive-compulsive spectrum disorders and the affective spectrum disorders. In obsessive-compulsive spectrum disorders neuroimaging and neuropsychological tasks have revealed abnormal functioning in the frontal brain which also could be related to kleptomania. Consolidated findings from animal and human studies have implied central serotonergic transmission in the genesis of obsessive-compulsive spectrum disorders and affective spectrum disorders. Altogether, these results suggest that kleptomania, like other disorders of the above mentioned spectrums, could have an abnormality in serotonergic transmission in common.     

Impaired perception of affective prosody in schizophrenia

The authors aimed to explore schizophrenia patients' ability to perceive affective prosody. Specifically, certain emotions that may be more troublesome for patients and possible gender differences in prosody perception were assessed. Thirty six schizophrenia patients and 32 age-, education-, and gender-matched healthy comparison subjects assessed on an affective prosody test were examined. Patients were impaired on recognition of affective prosody overall, and their difficulties with prosody perception may be attributed to those emotions with negative valence, specifically anger and sadness. Findings revealed that only male patients were impaired on prosody perception. Deficits in the perception of affective prosody were principally evident in emotions with negative valence and male patients with schizophrenia. Future studies should explore the influence of these deficits on social and interpersonal functioning more directly.     

Cognitive Estimation and Affective Judgments in Alcoholic Korsakoff Patients

Alcoholic Korsakoff patients have their most marked deficits in memory, but may exhibit problems in further cognitive and behavioral domains, particularly in so-called frontal lobe functions and on the emotional level. Cognitive estimation is among the frontal lobe-associated functions; nevertheless, the underlying processes of estimation and estimation deficits are still unknown. Additionally, though affective judgments were found to be disturbed in Korsakoff patients one can question whether this result is due to a deficiency in emotional processing itself, or whether deteriorated basic processes underlying all kinds of judgment tasks result in affective judgment errors. In this study, possible relations and underlying cognitive processes of affective and nonaffective judgments (cognitive estimates) were analyzed in a large sample of 39 Korsakoff patients. A neuropsychological test battery was administered together with a new test for cognitive estimation consisting of four dimensions (‘size,’ ‘weight,’ ‘quantity,’ and ‘time’) and an affective judgment task comprising negative, neutral, and positive words. The Korsakoff patients' results showed marked deficits concerning both, cognitive estimation and affective judgments. These deficits were highly intercorrelated and performance in both tasks was related to basic (e.g., information processing speed) and higher cognitive functions (executive functions and memory), suggesting a common basis in cognitive estimation and in affective judgments in Korsakoff syndrome.     

Recognition of facial emotion and affective prosody in children with ASD (+ADHD) and their unaffected siblings

Autism is a highly heritable and clinically heterogeneous neuropsychiatric disorder that frequently co-occurs with other psychopathologies, such as attention-deficit/hyperactivity disorder (ADHD). An approach to parse heterogeneity is by forming more homogeneous subgroups of autism spectrum disorder (ASD) patients based on their underlying, heritable cognitive vulnerabilities (endophenotypes). Emotion recognition is a likely endophenotypic candidate for ASD and possibly for ADHD. Therefore, this study aimed to examine whether emotion recognition is a viable endophenotypic candidate for ASD and to assess the impact of comorbid ADHD in this context. A total of 90 children with ASD (43 with and 47 without ADHD), 79 ASD unaffected siblings, and 139 controls aged 6–13 years, were included to test recognition of facial emotion and affective prosody. Our results revealed that the recognition of both facial emotion and affective prosody was impaired in children with ASD and aggravated by the presence of ADHD. The latter could only be partly explained by typical ADHD cognitive deficits, such as inhibitory and attentional problems. The performance of unaffected siblings could overall be considered at an intermediate level, performing somewhat worse than the controls and better than the ASD probands. Our findings suggest that emotion recognition might be a viable endophenotype in ASD and a fruitful target in future family studies of the genetic contribution to ASD and comorbid ADHD. Furthermore, our results suggest that children with comorbid ASD and ADHD are at highest risk for emotion recognition problems.     

Emotion recognition and marital satisfaction in stroke

Deficits in the comprehension of facial and prosodic expressions are commonly associated with right hemisphere stroke. However, little is known regarding the impact of these disorders on social relations. We examined facial and prosodic processing, mood, and marital satisfaction in 12 right hemisphere damaged (RHD) stroke patients and nine controls. Results revealed significant impairments in the comprehension of facial expressions and prosody among RHD stroke patients. Nonparametric correlations in the RHD group showed significant associations between marital satisfaction and facial affect discrimination and matching, and nonaffective prosody discrimination. We conclude that deficits in the recognition of nonverbal expressions are associated with reduced relationship satisfaction.     

Supervisory attentional system in nonamnesic alcoholic men.

BACKGROUND: Many studies have shown that recently detoxified alcoholic persons perform poorly on tasks thought to be sensitive to frontal lobe damage, supporting the hypothesis that the frontal lobes are highly vulnerable to chronic alcohol consumption. However, it appeared that most of the executive tasks used in these studies also involved nonexecutive components, and these tasks had been shown to be impaired as a result of nonfrontal lobe lesions. In this study, we examined further the "frontal lobe vulnerability" hypothesis using executive tasks, proved to be associated with frontal lobe functioning, that allowed us to distinguish the relative importance of executive and nonexecutive processes. METHOD: Thirty recently detoxified asymptomatic male alcoholic inpatients and 30 control subjects were tested for planning, inhibition, rule detection, and coordination of dual task, as well as the speed of processing and nonexecutive functions (such as short-term memory storage). RESULTS: Alcoholics performed worse than controls in almost all tasks assessing executive functions. However, they were not slower than the controls and showed normal results for nonexecutive functions. CONCLUSIONS: Chronic alcohol consumption seems to be associated with severe executive function deficits, which are still present after a protracted period of alcohol abstinence. These data support the idea that the cognitive deficits in recently detoxified sober alcoholic subjects are due, at least partly, to frontal lobe dysfunctioning.     

Characteristics of the memory loss of a patient with Wernicke-Korsakoff's syndrome without alcoholism

The memory loss in alcoholic Wernicke-Korsakoff syndrome has been well characterized. However, it has been suggested that some of the neuropsychological defects seen in these patients are due to frontal lobe dysfunction resulting from chronic alcohol abuse. The present report details the nature and extent of the amnesia in a Wernicke-Korsakoff patient who did not have a history of alcoholism. In spite of her normal performance on measures of frontal lobe function, this patient showed many characteristics similar to those seen in alcoholic Wernicke-Korsakoff syndrome including a graded loss of remote memories and abnormal semantic information processing. Thus, the extent of the "core" features of this amnesic syndrome may be greater than was previously thought.     

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.     

Disorders of affective and linguistic prosody in children after early unilateral brain damage

Prosody is that quality of speech that imparts meaning by changes in intonation, pitch, and stress. The right hemisphere (RH) appears to be dominant for affective prosody in adults, while the left hemisphere (LH) mediates the more linguistic aspects of nonverbal communication. Few similar studies have been reported of individuals who suffered early unilateral brain damage, when brain reorganization or plasticity might be expected to play a role in ameliorating the adverse effects of focal brain damage. In this study, comprehension and expression of affective and linguistic prosody were tested in subjects with documented unilateral brain damage of pre- or perinatal onset and in matched controls. Both RH- and LH-lesion groups demonstrated difficulty on tasks involving expression of affective prosody, and on tests of linguistic prosody, compared with controls. Only the RH-lesion group was impaired on an affective comprehension task. The results indicate that even after very early unilateral brain damage, prosodic deficits may be present. However, only for affective comprehension does the side of the lesion appear to determine such deficits. The findings suggest that during brain development there is not clear brain lateralization for prosody and there may be bilateral representation for these skills during early development. There may be limitations to the ability of the developing brain to reorganize after early injury.