Rehabilitation of emotion recognition in Alzheimer's disease and study of the consequences on gaze strategy, behavior disorders and family caregivers’ burden

Abstract

Backgrounds Emotion recognition is impaired in Alzheimer's disease (AD) [1] . Recently, we have highlighted that this kind of impairment is linked to atypical gaze strategy and behavior disorders [2] . Neuropsychiatric disorders are major factors of caregiver's burden, much more than cognitive impairment [3] . A positive impact of the training of affect recognition (TAR) has been found in AD [4] . This emotion recognition program is based on error-less learning, over-learning, immediate positive feedback and abstraction of facial features. This research aimed to confirm the improvement of facial emotion recognition performance in AD by using the TAR program, and aimed to study the consequences on gaze strategies, behavior disorders and caregiver's burden. Methods Four couples of caregivers-patients between 56–88 years old, with AD (mild and mild-moderate stage), were recruited. Participants with AD received 12 sessions of TAR (2 per week). Emotion recognition was assessed by using 28 items of the Ekman faces library. Eye movements were recorded with a Mobile EyeBrain Tracker®. The caregivers completed the ‘NeuroPsychiatric Inventory’ (NPI) to measure behavioral disorders and the ‘Zarit’ to measure the level of burden. Assessments were conducted before and after rehabilitation. Results A positive impact of TAR is highlighted with 11% improvement in emotion recognition. Especially, for sadness (133% improvement) and fear (62.5% improvement). Modification of gaze strategies is observed: eye region for anger and mouth region for happiness are more explored. Finally, there is a decrease in NPI and Zarit scores. Conclusions Emotion recognition abilities can be improved in AD by modifying gaze strategies during emotion decoding. This kind of rehabilitation has beneficial effects on caregivers’ burden due to the decrease of behaviors disorders.