Impaired Facial Emotion Recognition Research Articles

Superior facial emotion recognition in adolescents with anorexia nervosa - A replication study.

Anorexia nervosa (AN) has been associated with alterations in the processing of socio-emotional information, including impairments in the recognition of emotions in other people's faces. However, adolescents with AN might not show the impairments found in adult patients. The present study investigated facial emotion recognition in adolescents with AN, aiming to replicate our previous results of superior emotion recognition abilities in adolescents with AN compared to adolescents without mental disorders. Adolescent girls (12-18years) with AN (n=33) were compared to girls without mental disorders (n=41). Participants completed one task requiring identification of emotions (happy, sad, afraid, angry, neutral) in faces and one control task. As expected, adolescents with AN showed superior emotion recognition, with higher accuracy rates specifically for afraid faces. This is the first study replicating previous results on basic emotion recognition in adolescents with AN using (almost) the same methodology. The results suggest that, in contrast to adults, adolescents with AN do not show impairments in facial emotion recognition. The impairments may arise in the longer course of the illness, however, longitudinal studies are necessary to confirm this assumption.

Implications of depressive mood in OSAHS patients: insights from event-related potential

BackgroundObstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic breathing disorder characterized by recurrent upper airway obstruction during sleep. Although previous studies have shown a link between OSAHS and depressive mood, the neurobiological mechanisms underlying mood disorders in OSAHS patients remain poorly understood. This study aims to investigate the emotion processing mechanism in OSAHS patients with depressive mood using event-related potentials (ERPs).MethodsSeventy-four OSAHS patients were divided into the depressive mood and non-depressive mood groups according to their Self-rating Depression Scale (SDS) scores. Patients underwent overnight polysomnography and completed various cognitive and emotional questionnaires. The patients were shown facial images displaying positive, neutral, and negative emotions and tasked to identify the emotion category, while their visual evoked potential was simultaneously recorded.ResultsThe two groups did not differ significantly in age, BMI, and years of education, but showed significant differences in their slow wave sleep ratio (P = 0.039), ESS (P = 0.006), MMSE (P < 0.001), and MOCA scores (P = 0.043). No significant difference was found in accuracy and response time on emotional face recognition between the two groups. N170 latency in the depressive group was significantly longer than the non-depressive group (P = 0.014 and 0.007) at the bilateral parieto-occipital lobe, while no significant difference in N170 amplitude was found. No significant difference in P300 amplitude or latency between the two groups. Furthermore, N170 amplitude at PO7 was positively correlated with the arousal index and negatively with MOCA scores (both P < 0.01).ConclusionOSAHS patients with depressive mood exhibit increased N170 latency and impaired facial emotion recognition ability. Special attention towards the depressive mood among OSAHS patients is warranted for its implications for patient care.

Supraphysiological testosterone levels from anabolic steroid use and reduced sensitivity to negative facial expressions in men

RationaleAnabolic-androgenic steroids (AAS) are used to improve physical performance and appearance, but have been associated with deficits in social cognitive functioning. Approximately 30% of people who use AAS develop a dependence, increasing the risk for undesired effects.ObjectivesTo assess the relationship between AAS use (current/previous), AAS dependence, and the ability to recognize emotional facial expressions, and investigate the potential mediating role of hormone levels.MethodsIn total 156 male weightlifters, including those with current (n = 45) or previous (n = 34) AAS use and never-using controls (n = 77), completed a facial Emotion Recognition Task (ERT). Participants were presented with faces expressing one out of six emotions (sadness, happiness, fear, anger, disgust, and surprise) and were instructed to indicate which of the six emotions each face displayed. ERT accuracy and response time were recorded and evaluated for association with AAS use status, AAS dependence, and serum reproductive hormone levels. Mediation models were used to evaluate the mediating role of androgens in the relationship between AAS use and ERT performance.ResultsCompared to never-using controls, men currently using AAS exhibited lower recognition accuracy for facial emotional expressions, particularly anger (Cohen’s d = −0.57, pFDR = 0.03) and disgust (d = −0.51, pFDR = 0.05). Those with AAS dependence (n = 47) demonstrated worse recognition of fear relative to men without dependence (d = 0.58, p = 0.03). Recognition of disgust was negatively correlated with serum free testosterone index (FTI); however, FTI did not significantly mediate the association between AAS use and recognition of disgust.ConclusionsOur findings demonstrate impaired facial emotion recognition among men currently using AAS compared to controls. While further studies are needed to investigate potential mechanisms, our analysis did not support a simple mediation effect of serum FTI.

Neural Correlates of Facial Emotion Recognition Impairment in Blepharospasm: A Functional Magnetic Resonance Imaging Study.

Selective impairment in recognizing facial expressions of disgust was reported in patients with focal dystonia several years ago, but the basic neural mechanisms remain largely unexplored. Therefore, we investigated whether dysfunction of the brain network involved in disgust recognition processing was related to this selective impairment in blepharospasm. Facial emotion recognition evaluations and resting-state functional magnetic resonance imaging were performed in 33 blepharospasm patients and 33 healthy controls (HCs). The disgust processing network was constructed, and modularity analyses were performed to identify sub-networks. Regional functional indexes and intra- and inter-functional connections were calculated and compared between the groups. Compared to HCs, blepharospasm patients demonstrated a worse performance in disgust recognition. In addition, functional connections within the sub-network involved in perception processing rather than recognition processing of disgust were significantly decreased in blepharospasm patients compared to HCs. Specifically, decreased functional connections were noted between the left fusiform gyrus (FG) and right middle occipital gyrus (MOG), the left FG and right FG, and the right FG and left MOG. We identified decreased functional activity in these regions, as indicated by a lower amplitude of low-frequency fluctuation in the left MOG, fractional amplitude of low-frequency fluctuation in the right FG, and regional homogeneity in the right FG and left MOG in blepharospasm patients versus HCs. Our results suggest that dysfunctions of the disgust processing network exist in blepharospasm. A deficit in disgust emotion recognition may be attributed to disturbances in the early perception of visual disgust stimuli in blepharospasm patients.

3.42 Impairment of Facial Emotion Recognition in Children With High Levels of Irritability

3.42 Impairment of Facial Emotion Recognition in Children With High Levels of Irritability

Impaired facial emotion recognition in relation to social behaviours in de novo Parkinson's disease.

Facial emotion recognition (FER) is a crucial component of social cognition and is essential in social-interpersonal behaviour regulation. Although FER impairment is well-established in advanced PD, data about FER at the time of diagnosis and its relationship with social behavioural problems in daily life are lacking. The aim was to examine FER at the time of PD diagnosis compared to a matched healthy control (HC) group and to associate FER with indices of social behavioural problems. In total, 142 de novo, treatment-naïve PD patients and 142 HC were included. FER was assessed by the Ekman 60 faces test (EFT). Behavioural problems in PD patients were assessed using the Dysexecutive Questionnaire (DEX-self and DEX-proxy) and the Apathy Evaluation Scale (AES-self). PD patients had significantly lower EFT-total scores (p = .001) compared to HC, with worse recognition of Disgust (p = .001) and Sadness (p = .016). Correlational analyses yielded significant correlations between AES-self and both EFT-total (rs = .28) and Fear (rs = .22). Significant negative correlations were found between DEX-proxy and both EFT-total (rs = -.28) and Anger (rs = -.26). Analyses of DEX-subscales showed that proxy ratings were significantly higher than patient-ratings for the Social Conventions subscale (p = .047). This DEX-proxy subscale had the strongest correlation with EFT-total (rs = -.29). Results show that de novo PD patients already show impaired FER compared to HC. In addition, lower FER is linked to self-reported apathy and proxy-reported social-behavioural problems, especially concerning social conventions. These findings validate the importance of the inclusion of social cognition measures in the neuropsychological assessment even in early PD.

Facial Emotion Recognition in Insomnia: Mechanisms and Consequences

Insomnia is a sleep disorder that is closely related with various physiological and psychological problems. Facial emotion recognition (FER) is an important part of social function, and has been found impaired in individuals with insomnia. This paper aims to explore the mechanisms of the correlation between insomnia and FER impairment, and the possible consequences of impaired FER for people with insomnia. Impaired expression expressivity and amygdala dysfunction are proposed as potential mechanisms underlying the link between insomnia and impaired FER. FER impairment in insomnia patients might lead to overlooking danger and lower levels of vigilance and arousal, which could result in disastrous outcomes. Moreover, impaired FER could lead to social function disturbance, making insomnia patients vulnerable to bullying.

Facial Emotion Recognition in Patients with Juvenile Myoclonic Epilepsy.

Previous studies have found facial emotion recognition (FER) impairments in individuals with epilepsy. While such deficits have been extensively explored in individuals with focal temporal lobe epilepsy, studies on individuals with generalized epilepsies are rare. However, studying FER specifically in individuals with juvenile myoclonic epilepsy (JME) is particularly interesting since they frequently suffer from social and neuropsychological difficulties in addition to epilepsy-specific symptoms. Furthermore, recent brain imaging studies have shown subtle microstructural alterations in individuals with JME. FER is considered a fundamental social skill that relies on a distributed neural network, which could be disturbed by network dysfunction in individuals with JME. This cross-sectional study aimed to examine FER and social adjustment in individuals with JME. It included 27 patients with JME and 27 healthy controls. All subjects underwent an Ekman-60 Faces Task to examine FER and neuropsychological tests to assess social adjustment as well as executive functions, intelligence, depression, and personality traits. Individuals with JME performed worse in global FER and fear and surprise recognition than healthy controls. However, probably due to the small sample size, no significant difference was found between the two groups. A potential FER impairment needs to be confirmed in further studies with larger sample size. If so, patients with JME could benefit from addressing possible deficits in FER and social difficulties when treated. By developing therapeutic strategies to improve FER, patients could be specifically supported with the aim of improving social outcomes and quality of life.

The “zipper model of empathy” applied to violence in schizophrenia: A search for social cognitive underpinnings of lack of empathic behavior

BackgroundThe “zipper model of empathy” has been proposed for psychopathy. It postulates that empathic behavior may fail to arise due to impaired facial emotion recognition. In this study, we examined if the model may be of relevance for schizophrenia. MethodsIn a sample of participants with schizophrenia and a history of severe interpersonal violence, associations between measures of social cognition (emotion recognition, theory of mind) and aspects of psychopathy (lack of empathy, lack of remorse) were investigated. A non-violent sample experiencing schizophrenia served as a control group. ResultsCorrelation analyses revealed a specific and statistically significant association between facial emotion recognition and lack of empathy in the violent sample. Follow-up analyses identified that neutral emotions were of particular importance. Logistic regression analyses confirmed that impairments in facial emotion recognition predicted levels of empathy in the violent sample experiencing schizophrenia. ConclusionsOur results suggest that the “zipper model of empathy” may be relevant for schizophrenia. The findings further point to the potential benefit of including social cognitive training in the treatment of persons with schizophrenia and a history of interpersonal aggression.

Structural integrity of the insula and emotional facial recognition performance following stroke.

The role of the human insula in facial emotion recognition is controversially discussed, especially in relation to lesion-location-dependent impairment following stroke. In addition, structural connectivity quantification of important white-matter tracts that link the insula to impairments in facial emotion recognition has not been investigated. In a case-control study, we investigated a group of 29 stroke patients in the chronic stage and 14 healthy age- and gender-matched controls. Lesion location of stroke patients was analysed with voxel-based lesion-symptom mapping. In addition, structural white-matter integrity for tracts between insula regions and their primarily known interconnected brain structures was quantified by tractography-based fractional anisotropy. Our behavioural analyses showed that stroke patients were impaired in the recognition of fearful, angry and happy but not disgusted expressions. Voxel-based lesion mapping revealed that especially lesions centred around the left anterior insula were associated with impaired recognition of emotional facial expressions. The structural integrity of insular white-matter connectivity was decreased for the left hemisphere and impaired recognition accuracy for angry and fearful expressions was associated with specific left-sided insular tracts. Taken together, these findings suggest that a multimodal investigation of structural alterations has the potential to deepen our understanding of emotion recognition impairments after stroke.

A retrospective case-control study of facial emotion recognition in male veterans with chronic schizophrenia and its correlation with interpersonal communication

ObjectiveTo understand the facial emotion recognition of male veterans with chronic schizophrenia and the relationship between facial emotion recognition and interpersonal communication to provide a reference for designing social skills training programmes.MethodFifty-six eligible male patients with chronic schizophrenia who were admitted to our hospital from October 2020 to April 2021 were selected, and 24 healthy people were selected as controls. Facial emotion recognition, social communication skills and self-perceived interpersonal disturbance were assessed using a facial emotion recognition stimulus manual, the Social Skills Checklist (SSC) and the Interpersonal Relationship Integrative Diagnostic Scale (IRIDS). Disease status was assessed using the Positive and Negative Syndrome Scale.ResultsBoth the control group and the patient group had the highest recognition accuracy for neutral faces. The recognition rate for neutral expression was higher in the control group than in the patient group (p = 0.008). The rate of neutral expressions identified as happiness was higher in the patient group than in the control group (p = 0.001). The identification of anger as happiness was higher in the control group than in the patient group (p = 0.026), and the pattern of misidentification was similar between the control group and the patient group. The accuracy of facial emotion recognition was negatively associated with the age of onset (p < 0.05). The recognition accuracy for happiness was negatively associated with negative symptoms, general pathological symptoms and total scale scores (p < 0.05). The total score for expression recognition was negatively associated with the negative symptom subscale scores (p < 0.05), and there was no correlation between expression recognition and positive symptoms (p > 0.05). The recognition accuracy for happiness was negatively correlated with the IRIDS conversation factor (p < 0.05). The recognition accuracy for happiness and anger and the total scores for facial emotion recognition were negatively correlated with the SSC subscale score and the total score (p < 0.05 and p < 0.01, respectively). The main influencing factors on facial emotion recognition were the SSC total score (p < 0.001) and the positive factor score (p = 0.039).ConclusionVeterans with chronic schizophrenia have facial emotion recognition impairments affected by negative symptoms. There is a correlation between facial emotion recognition and interpersonal communication.Highlights1. There are extensive facial expression recognition disorders in schizophrenia.2. The pattern of misidentification was similar in both the control group and the patient group, with the tendency for happiness to be identified as a neutral emotion, anger as happiness, and fear as neutral emotion and anger.3. Based on the comprehensive assessment of social cognitive impairment in patients with schizophrenia, prospective studies of standardised interventions are designed to provide support for clinical practice.

The relevance of social anxiety for understanding social functioning and facial emotion recognition in individuals at clinical high-risk for psychosis.

Individuals at clinical high risk (CHR) for psychosis often experience poor social functioning and impaired facial emotion recognition (FER); however, the impact of frequently comorbid symptoms upon these processes is underexplored. In particular, social anxiety is characteristic of this population and also related to poor social functioning and FER biases, such as misinterpreting neutral faces as negative or threatening; however, little is known about how social anxiety relates to these processes in CHR individuals. The present study examined the overlap of social anxiety, social functioning, and FER accuracy and bias. Participants (CHR N=62, healthy controls N=52) completed the self-report Social Interaction Anxiety Scale (SIAS), Penn Emotion Recognition-40 (ER-40) behavioural task, and interviewer-rated Global Functioning Scale-Social (GFS-S). The ER-40 was used to assess both FER accuracy (e.g., overall number of correct responses) and bias (e.g., mislabelling neutral faces as angry). Consistent with previous research, relative to controls, CHR participants had more social anxiety (d=-1.07), poorer social functioning (d=-1.62), and performed more poorly on the FER task (e.g., d=-.37). Within CHR participants, social anxiety was related to an anger detection bias (r=.28), above and beyond positive symptom severity, which in turn was related to FER accuracy (r=.26) and social functioning (r=-.28). These findings suggest that ongoing work examining social processes within CHR individuals needs to account for social anxiety and that social anxiety may be a useful preventive intervention target.

Facial emotion impairment in multiple sclerosis is linked to modifying observation strategies of emotional faces

Facial emotion recognition (FER) may be impaired in patients with multiple sclerosis (MS). Nevertheless, the literature is heterogeneous, with studies not highlighting this kind of impairment. Moreover, most studies have not explored differences between MS spectrum disorders (radiologically isolated syndrome (RIS), clinically-isolated syndrome (CIS), relapsing-remitting (RRMS), and progressive (primary - (PPMS) and secondary - (SPMS)). One hypothesis would be that FER impairment results from an alteration of eye-gaze strategies while observing emotional faces. Consequently, a FER deficit would be found in MS patients for whom these observation strategies would be disturbed and more frequent in the progressive forms. We prospectively enroled 52 patients (10 RIS, 10 CIS, 12RRMS, 10 SPMS, 10 PPMS) and 23 healthy controls (HC) to assess FER using Ekman Faces Test. Eye movements (number and duration of fixations) were recorded with an eye-tracking device. 21% of the MS participants had significant FER impairment. This impairment was observed in all phenotypes. In progressive forms, FER impairment was more frequent, more severe, and associated with modified emotional face observation strategies. MS participants with significant FER impairment had significantly more modification of eye-gaze strategies during observation of expressive faces than MS participants without FER impairment. FER impairment seems to be linked to a deficit of attention orientation in MS. Remediation of eye-gaze strategies during observation of emotional faces could be beneficial, as observed in other neurological diseases.

Mask-wearing and facial emotion recognition: a preliminary analysis of the relevance of depressive symptoms

Depression is a psychiatric condition that impairs the life of millions of people around the globe. Previous research has shown that depressed individuals tend to present deficits in facial emotion perception. For instance, perception accuracy may be reduced and biases in perceived intensity may be enhanced. Mask-wearing practices initiated in response to the COVID-19 pandemic have become a new social norm often enforced by local mandates. Preliminary studies have shown that mask-wearing may impair facial emotion recognition. In this study, we aimed at understanding how facial emotion recognition impairment interacts with depressive symptoms in a sample of German adolescents and adults (N = 91, 56% female, mean age of 32.7 years) by utilizing a mixed-effects linear regression analysis. We found evidence that mask-wearing may be a limiting factor for facial emotion recognition, as well as for emotion intensity ratings. However, a significant association of depressive symptoms with these outcome variables was not detected. Still, larger sample sizes may have the potential to substantiate a trend toward an interaction of depressive symptoms and mask-wearing for the rating of happy faces. Future research should be committed to psychophysiological processes and to improving the quality of the stimulus material.

Social cognition training improves recognition of distinct facial emotions and decreases misattribution errors in healthy individuals.

Facial emotion recognition is a key component of social cognition. Impaired facial emotion recognition is tied to poor psychological wellbeing and deficient social functioning. While previous research has demonstrated the potential for social cognition training to improve overall facial emotion recognition, questions remain regarding what aspects of emotion recognition improve. We report results from a randomized controlled trial that evaluates whether computerized social cognition training can improve recognition of distinct facial emotions in healthy participants. This investigation was designed to better understand the therapeutic potential of social cognition training for individuals with neuropsychiatric disorders. Fifty-five healthy adult participants were randomly assigned to an internet-based intervention during which they either completed social cognition training (SCT) or played control computer games (CON) for 10.5 h over 2-3 weeks. Facial emotion recognition was measured with the Penn ER-40, which was conducted before and after training. The following variables were collected and analyzed: facial emotion recognition accuracy for each emotion (i.e., anger, fear, happy, neutral (no emotional expression), and sad), reaction times for each emotion, and response error types (i.e., frequency of an emotion being chosen incorrectly, frequency of an emotion being missed, and frequency of an emotion being confused for another particular emotion). ANOVAs and t-tests were used to elucidate intervention effects both within and between groups. Results showed that the SCT group improved their accuracy for angry and neutral faces. They also improved their reaction times for neutral, fearful, and sad faces. Compared to the CON group, the SCT group had significantly faster reaction times to neutral faces after training. Lastly, the SCT group decreased their tendency to confuse angry faces for no emotional expression and to confuse no emotional expression for sad faces. In contrast, the CON group did not significantly improve their accuracy or reaction times on any emotional expression, and they did not improve their response error types. We conclude that social cognition training can improve recognition of distinct emotions in healthy participants and decrease response error patterns, suggesting it has the potential to improve impaired emotion recognition and social functioning in individuals with facial emotion recognition deficits.

Comparison of Emotion Recognition in Young People, Healthy Older Adults, and Patients with Mild Cognitive Impairment.

Background: The basic discrete emotions, namely, happiness, disgust, anger, fear, surprise, and sadness, are present across different cultures and societies. Facial emotion recognition is crucial in social interactions, but normal and pathological aging seem to affect this ability. The present research aims to identify the differences in the capacity for recognition of the six basic discrete emotions between young and older healthy controls (HOC) and mildly cognitively impaired patients (MCI). Method: The sample (N = 107) consisted of 47 young adults, 27 healthy older adults, and 33 MCI patients. Several neuropsychological scales were administered to assess the cognitive state of the participants, followed by the emotional labeling task on the Ekman 60 Faces test. Results: The MANOVA analysis was significant and revealed the presence of differences in the emotion recognition abilities of the groups. Compared to HOC, the MCI group obtained a significantly lower number of hits on fear, anger, disgust, sadness, and surprise. The happiness emotion recognition rate did not differ significantly among the three groups. Surprisingly, young people and HOC did not show significant differences. Conclusions: Our results demonstrated that MCI was associated with facial emotion recognition impairment, whereas normal aging did not seem to affect this ability.

Face masks impair facial emotion recognition and induce specific emotion confusions

Face masks are now worn frequently to reduce the spreading of the SARS-CoV-2 virus. Their health benefits are undisputable, but covering the lower half of one's face also makes it harder for others to recognize facial expressions of emotions. Three experiments were conducted to determine how strongly the recognition of different facial expressions is impaired by masks, and which emotions are confused with each other. In each experiment, participants had to recognize facial expressions of happiness, sadness, anger, surprise, fear, and disgust, as well as a neutral expression, displayed by male and female actors of the Radboud Faces Database. On half of the 168 trials, the lower part of the face was covered by a face mask. In all experiments, facial emotion recognition (FER) was about 20% worse for masked faces than for unmasked ones (68% correct vs. 88%). The impairment was largest for disgust, followed by fear, surprise, sadness, and happiness. It was not significant for anger and the neutral expression. As predicted, participants frequently confused emotions that share activation of the visible muscles in the upper half of the face. In addition, they displayed response biases in these confusions: They frequently misinterpreted disgust as anger, fear as surprise, and sadness as neutral, whereas the opposite confusions were less frequent. We conclude that face masks do indeed cause a marked impairment of FER and that a person perceived as angry, surprised, or neutral may actually be disgusted, fearful, or sad, respectively. This may lead to misunderstandings, confusions, and inadequate reactions by the perceivers.

Facial Emotion Recognition in Patients with Post-Paralytic Facial Synkinesis-A Present Competence.

Facial palsy is a movement disorder with impacts on verbal and nonverbal communication. The aim of this study is to investigate the effects of post-paralytic facial synkinesis on facial emotion recognition. In a prospective cross-sectional study, we compared facial emotion recognition between n = 30 patients with post-paralytic facial synkinesis (mean disease time: 1581 ± 1237 days) and n = 30 healthy controls matched in sex, age, and education level. Facial emotion recognition was measured by the Myfacetraining Program. As an intra-individual control condition, auditory emotion recognition was assessed via Montreal Affective Voices. Moreover, self-assessed emotion recognition was studied with questionnaires. In facial as well as auditory emotion recognition, on average, there was no significant difference between patients and healthy controls. The outcomes of the measurements as well as the self-reports were comparable between patients and healthy controls. In contrast to previous studies in patients with peripheral and central facial palsy, these results indicate unimpaired ability for facial emotion recognition. Only in single patients with pronounced facial asymmetry and severe facial synkinesis was an impaired facial and auditory emotion recognition detected. Further studies should compare emotion recognition in patients with pronounced facial asymmetry in acute and chronic peripheral paralysis and central and peripheral facial palsy.

Facial emotion recognition difficulties may be specific to skin picking disorder, but could also be related to the presence of alexithymia in trichotillomania

Background and objectivesPrevious research has shown high rates of alexithymia and emotion dysregulation in trichotillomania (TTM) and skin picking disorder (SPD). Unfortunately, there are no data on facial emotion recognition (FER) in TTM and SPD. The present study aimed to compare patients with TTM and SPD and a healthy control group for the severity of alexithymia and rates of FER. MethodsForty patients with SPD, 30 patients with TTM, and 30 healthy controls were enrolled in this study. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Clinical Global Impression (CGI), Toronto Alexithymia Scale (TAS-20), and the Facial Emotion Recognition Test were applied to the participants. ResultsPatients with TTM and SPD had less FER accuracy and higher alexithymia scores compared with healthy controls. According to ANCOVA analysis, when anxiety, depression, and alexithymia were fixed as covariates, disgusted facial expressions and total facial emotion recognition were still significantly lower in patients with SPD compared with the control group, but there was no difference between the TTM and control groups and TTM and SPD groups. ConclusionAlexithymia rates were high in patients with TTM and SPD. Interestingly, difficulty in recognizing disgusted facial expressions may be a distinctive sign in SPD. Future neuroimaging studies are needed to support possible FER impairment in patients with TTM/SPD.

Eye-gaze Strategies During Facial Emotion Recognition in Neurodegenerative Diseases and Links With Neuropsychiatric Disorders.

Facial emotion recognition (FER) is primarily and severely impaired in individuals with the behavioral variant of frontotemporal dementia (bvFTD) and is often mildy impaired in individuals with Alzheimer disease (AD) or Parkinson disease (PD). Such impairment is associated with inappropriate social behaviors. To determine whether FER impairment is linked to the use of inappropriate eye-gaze strategies to decode facial emotions, leading to misinterpretation of others' intentions and then to behavioral disorders. We assessed FER in 9 individuals with bvFTD, 23 with AD, and 20 with PD, as well as 22 healthy controls (HC), using the Reading the Mind in the Eyes (RME) Test and the Ekman Faces Test. Eye movements (number and duration of fixations) were recorded with an eye-tracking device. Behavior was assessed using the Neuropsychiatric Inventory. FER was mildly impaired in the AD and PD groups and severely impaired in the bvFTD group. FER impairment was accompanied by an increase in the number of fixations and a more attracted gaze toward the lower part of one's face. FER impairment and an increase in the number of fixations were positively correlated with behavioral disorders. Our study demonstrated a link between FER impairment, modification of eye-gaze strategies during the observation of emotional faces, and behavioral disorders in individuals with bvFTD and those with AD or PD. These results suggest that an eye-gaze strategy rehabilitation program could have beneficial effects on emotion recognition and behavioral disorders in individuals with these diseases.