Emotion recognition of morphed facial expressions in presymptomatic and symptomatic frontotemporal dementia, and Alzheimer’s dementia

Abstract

Background The emotion recognition task (ERT) was developed to overcome shortcomings of static emotion recognition paradigms, by identifying more subtle deficits in emotion recognition across different intensity levels. In this study, we used the ERT to investigate emotion recognition deficits across the frontotemporal (FTD) and Alzheimer’s Dementia (AD) spectrum. Methods With the ERT, we assessed the recognition of facial emotional expressions (anger-disgust-fear-happiness-sadness-surprise) across four intensities (40–60–80–100%) in patients with behavioural variant FTD (bvFTD; n = 32), and AD ( n = 32), presymptomatic FTD mutation carriers ( n = 47) and controls ( n = 49). We examined group differences using multilevel linear regression with age, sex and education level as covariates, and performed post hoc analyses on presymptomatic ( MAPT , GRN and C9orf72 ) mutation carriers. Classification abilities were investigated by means of logistic regression. Results Lowest ERT total scores were found in patients with bvFTD and AD, whereas equal highest performance was found in presymptomatic mutation carriers and controls. For all emotions, significantly lower subscores were found in patients with bvFTD than in presymptomatic mutation carriers and in controls (highest p value = 0.025). Patients with bvFTD performed lower than patients with AD on anger ( p = 0.005) and a trend towards significance was found for a lower performance on happiness ( p = 0.065). Task performance increased with higher emotional intensity, and classification was better at the lowest than at the highest intensity. C9orf72 mutation carriers performed worse on recognizing anger at the lowest intensity than GRN mutation carriers ( p = 0.047) and controls ( p = 0.038). The ERT differentiated between patients with bvFTD and controls, and between patients with AD and controls (both p < 0.001). Discussion Our results demonstrate emotion recognition deficits in both bvFTD and AD, and suggest the presence of subtle emotion recognition changes in presymptomatic C9orf72 -FTD. This highlights the importance of incorporating emotion recognition paradigms into standard neuropsychological assessment for early differential diagnosis, and as clinical endpoints in upcoming therapeutic trials. Electronic supplementary material The online version of this article (10.1007/s00415-020-10096-y) contains supplementary material, which is available to authorized users.

Longitudinal Cognitive Changes in Genetic Frontotemporal Dementia Within the GENFI Cohort

“…Validation in other cohorts such as ALLFTD or DINAD is warranted. Fourth, practice effects were strikingly visible for the FCSRT and Facial Emotion Recognition Test, stressing the need for different test versions in the former, but more sensitive tasks for emotion recognition (e.g., the use of morphed facial expressions 22 ) and social cognition in general. Lastly, in the interpretation of memory–immediate recall, social cognition, and visuoconstruction results, it should be taken into account that they were represented by only a single cognitive test, and those individual tests might not be a representation of the entire cognitive domain.…”

“…Only at a later progressed stage, when atrophy spreads from the temporal to frontal areas of the brain, does impairment in cognitive functions that are typically associated with bvFTD develop, such as executive function and social cognition. 22 , 45 …”

“… 6 , 10 , 15 - 26 For example, previous reports have shown decline in memory, 17 , 19 , 20 , 26 language, 17 , 20 , 23 and social cognition 17 , 19 , 20 in MAPT pathogenic variant carriers, decline in attention 15 , 16 , 19 , 20 and executive function 15 , 16 , 18 , 20 in GRN pathogenic variant carriers, and a decline in social cognition in C9orf72 pathogenic variant carriers. 22 , 24 , 25 However, other studies on genetic FTD failed to find these results. 13 , 21 , 26 , 27 …”

Facial emotion recognition in Parkinson’s disease: The role of executive and affective domains.

“…To combine the advantages of dynamic and varying intensities, Kessels et al (2007) came up with an innovative computer-generated paradigm which comprises dynamic facial emotional expressions in a different range of intensities, the ermotion ecognition task (ERT). This task has been validated in a wide range of clinical populations (e.g., Jiskoot et al, 2021; Poljac et al, 2011; Rosenberg et al, 2014), but no study has yet employed the ERT in PD.…”

Impaired Knowledge of Social Norms in Dementia and Psychiatric Disorders: Validation of the Social Norms Questionnaire–Dutch Version (SNQ-NL)

“…The perception of social and emotional information (Level 1) and theory of mind (Level 2) are relatively well-studied in neurodegenerative and psychiatric disorders. Examples include deficits in facial emotion recognition in bvFTD and AD (Jiskoot et al, 2020; Torralva et al, 2009; Wiechetek Ostos et al, 2011), impaired (affective and cognitive) theory of mind in schizophrenia (Vucurovic et al, 2020), and reduced empathy in psychotic disorders (Green et al, 2015). However, knowing and understanding social norms (Level 3) has received much less attention.…”