Subjective emotional experience at different stages of Parkinson's disease

Psychological Factors Affecting Assertiveness in Subjects with Parkinson's Disease

Background/Objectives: Assertiveness, defined as the positive affirmation of oneself, encompasses the ability to refuse requests, express anger, disagree or oppose others, show affection, and uphold personal beliefs without causing conflict. Deficits in assertive behavior are often linked to pathological changes in the basal ganglia and prefrontal dopaminergic systems, commonly observed in Parkinson's disease (PD), and are predictive of poor clinical outcomes. Psychological factors such as mood alterations and cognitive dysfunction may also impact assertiveness. This study investigated the psychological factors influencing assertiveness in individuals with PD. Methods: A cross-sectional study was conducted, involving 160 patients with PD attending a movement disorders outpatient clinic. The participants underwent assessment using a battery of standardized neuropsychological tests to evaluate cognitive function, assertiveness, mood, dysarthria, and quality of life (QoL). Results: All dimensions of assertiveness correlated with depression and anxiety. Individuals experiencing mood disturbances may struggle to express themselves assertively. Similarly, some dimensions of assertiveness correlated also with the QoL, indicating that, overall, well-being affects assertive behavior. Gender emerged as a significant influencer of assertiveness across all dimensions. Specifically, in subjects with PD, the male gender was associated with lower scores in assertiveness compared to women. No significant correlations were found between assertiveness and dysarthria. Conclusions: The findings highlight the importance of adopting a holistic approach to PD management, addressing not only motor symptoms but also psychological challenges which patients may encounter in their daily lives.

Beyond shallow feelings of complex affect: Non-motor correlates of subjective emotional experience in Parkinson's disease

Affective disorders in Parkinson's disease (PD) concern several components of emotion. However, research on subjective feeling in PD is scarce and has produced overall varying results. Therefore, in this study, we aimed to evaluate the subjective emotional experience and its relationship with autonomic symptoms and other non-motor features in PD patients. We used a battery of film excerpts to elicit Amusement, Anger, Disgust, Fear, Sadness, Tenderness, and Neutral State, in 28 PD patients and 17 healthy controls. Self-report scores of emotion category, intensity, and valence were analyzed. In the PD group, we explored the association between emotional self-reported scores and clinical scales assessing autonomic dysregulation, depression, REM sleep behavior disorder, and cognitive impairment. Patient clustering was assessed by considering relevant associations. Tenderness occurrence and intensity of Tenderness and Amusement were reduced in the PD patients. Tenderness occurrence was mainly associated with the overall cognitive status and the prevalence of gastrointestinal symptoms. In contrast, the intensity and valence reported for the experience of Amusement correlated with the prevalence of urinary symptoms. We identified five patient clusters, which differed significantly in their profile of non-motor symptoms and subjective feeling. Our findings further suggest the possible existence of a PD phenotype with more significant changes in subjective emotional experience. We concluded that the subjective experience of complex emotions is impaired in PD. Non-motor feature grouping suggests the existence of disease phenotypes profiled according to specific deficits in subjective emotional experience, with potential clinical implications for the adoption of precision medicine in PD. Further research on larger sample sizes, combining subjective and physiological measures of emotion with additional clinical features, is needed to extend our findings.

Emotional Sentence Processing in Parkinson's Disease

PURPOSE

Emotional processing allows us to predict our own and others' behavior, communicate our wants and needs, and understand those of others. Thus, deficits in emotional processing can negatively impact one's quality of life. While changes in emotional processing across several domains (e.g., prosody, faces) in Parkinson's disease (PD) are widely accepted, there is a dearth of literature, with equivocal results, regarding how emotional language processing is affected by PD. This study investigated emotional sentence processing in this population.

METHOD

Eighteen persons with PD and 22 healthy adults (HAs) completed a language task in which they rated sentences on their pleasantness (valence), and a battery of cognitive tasks and mood measures that were examined as factors influencing performance. As an interaction between emotionality and concreteness during processing has been indicated in prior research, concreteness of sentence stimuli was also manipulated.

RESULTS

Individuals with PD rated negatively valenced sentences as less negative and positively-valenced sentences as less positive than HAs. The PD group also demonstrated a reduced overall range of valence rating scores. Sentence concreteness did not influence ratings. Results for positive sentences could be explained by individual differences in working memory (WM), whereas individual differences in WM, depression, and group explained differences in ratings to negative sentences.

CONCLUSIONS

Our study provides one of few accounts of emotional language processing deficits in PD, particularly beyond the word level. Individuals with PD may experience difficulty perceiving and assessing the intensity of the emotional content of language, and deficits may disproportionately impact processing of sentences about negative situations.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21313713.

Deficits in emotion perception and cognition in patients with parkinson's disease: A systematic review

Non-motor symptoms (NMS) are common among Parkinson's disease (PD) patients and have a significant impact on quality of life. NMS such as deficits in emotion perception are gaining due focus in the recent times. As emotion perception and cognitive functions share certain common neural substrates, it becomes pertinent to evaluate existing emotion perception deficits in view of underlying cognitive deficits. The current systematic review aimed at examining studies on emotion perception PD in the last decade. We carried out a systematic review of 44 studies from the PubMed database. We reviewed studies examining emotion perception and associated cognitive deficits, especially executive function and visuospatial function in PD. This review also examines how early and advanced PD differ in emotion perception deficits and how the presence of common neuropsychiatric conditions such as anxiety, apathy, and depression as well as neurosurgical procedure such as deep brain stimulation affect emotion perception. The need for future research employing a comprehensive evaluation of neurocognitive functions and emotion perception is underscored as it has a significant bearing on planning holistic intervention strategies.

Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders

This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.

How effective are films in inducing positive and negative emotional states? A meta-analysis

Meta-analyses and reviews on emotion research have shown the use of film clips to be one of the most effective methods of mood induction. Nonetheless, the effectiveness of this method when positive, negative and neutral emotional targets are studied under similar experimental conditions is currently unknown. This comprehensive meta-analysis included only studies that implemented neutral, positive and negative mood inductions to evaluate the effectiveness of the film clip method as a mood induction procedure. In addition, several factors related to the films, sample and experimental procedure used, the number of emotional categories, for example, or the number of film clips watched, were included to study their influence on the effectiveness of this mood induction procedure. Forty-five studies were included with 6675 participants and 12 possible moderator variables according to the sample and the research procedure. Our findings suggest that film clips are especially powerful in inducing negative mood states (Hedges' g for valence = -1.49 and for arousal = -1.77) although they are also effective inducers of positive mood states (Hedges' g for valence of = . -1.22 and for arousal = -1.34). Additionally, this meta-analysis reveals that variables, such as the number of emotional categories or the type of stimulus used to measure the baseline, should be considered.

Parkinson's disease and changes in the appreciation of art: A comparison of aesthetic and formal evaluations of paintings between PD patients and healthy controls

Parkinson's disease (PD) is a progressing neurodegenerative disease predominantly involving the loss of dopamine producing neurons with hallmark symptoms of motor disorders and cognitive, motivational, emotional, and perceptual impairments. Intriguingly, PD can also be connected-often anecdotally-with a sudden burst of artistic creativity, motivation, or changed quality/style of produced art. This has led to growing empirical interest, promising a window into brain function and the unique neurological signature of artists. This topic also fits a growing interest from researchers in other areas, including Alzheimer's or other dementia, which have suggested that specific changes in art production/appraisal may provide a unique basis for therapy, diagnosis, or understanding of these diseases. However, whether PD also shows similar impacts on how we perceive and evaluate art has never been systematically addressed. We compared a cohort of PD patients against age-matched healthy controls, asking participants to rate paintings using scales of liking and beauty and terms pertaining to artworks' formal and conceptual qualities previously designed to provide a rubric for symptom identification. We found no evidence for PD-related differences in liking or beauty. However, PD patients showed higher ratings on assessed "emotionality," potentially relating to the tie between PD, dopamine pathways, and emotion/reward.

Apathy alters emotional arousal in chronic schizophrenia

Background

Within the heterogeneity of schizophrenia, apathy constitutes an independent cluster of negative symptoms associated with poor outcomes. Attempts to identify an emotional deficit in patients who have schizophrenia with negative symptoms have yielded mixed results, and studies that focus on the relationship between apathy and emotional disorders are lacking.

Methods

We set out to remedy this shortcoming using a validated battery of film excerpts to induce positive and negative emotions in patients with chronic schizophrenia with (n = 20) or without (n = 20) apathy, and in controls (n = 20) comparable for age, sex and socioeconomic status. We assessed emotions using an innovative but validated technique to evaluate tonic and phasic electrodermal activity and subjective feelings using a standardized visual analogue scale.

Results

Using a qualitative measure of apathy, we did not find a specific decrease in tonic activity during the induction of positive emotions. However, we did observe that patients with apathy showed reduced tonic activity independent of valence (i.e., for both positive and negative emotions) compared with controls and patients without apathy. Moreover, the quantitative measure of apathy (Apathy Evaluation Scale) was the only significant factor, explaining 24% of the variance in tonic activity during induction of positive emotions after controlling for confounding factors.

Limitations

Electrodermal activity was the only physiologic measure we acquired. We induced several emotions sequentially that might have overlapped with each other, but we added an emotional “washout” period and randomized the order of each film excerpt to limit this possibility.

Conclusion

Taken together, these results suggest that apathy in schizophrenia could impair tonic activity during positive emotions. Treatments aimed at enhancing positive emotions may help alleviate apathy in schizophrenia.

Unaltered emotional experience in Parkinson's disease: Pupillometry and behavioral evidence

INTRODUCTION

Recognizing emotions in others is a pivotal part of socioemotional functioning and plays a central role in social interactions. It has been shown that individuals suffering from Parkinson's disease (PD) are less accurate at identifying basic emotions such as fear, sadness, and happiness; however, previous studies have predominantly assessed emotion processing using unimodal stimuli (e.g., pictures) that do not reflect the complexity of real-world processing demands. Dynamic, naturalistic stimuli (e.g., movies) have been shown to elicit stronger subjective emotional experiences than unimodal stimuli and can facilitate emotion recognition.

METHOD

In this experiment, pupil measurements of PD patients and matched healthy controls (HC) were recorded while they watched short film clips. Participants' task was to identify the emotion elicited by each clip and rate the intensity of their emotional response. We explored (a) how PD affects subjective emotional experience in response to dynamic, ecologically valid film stimuli, and (b) whether there are PD-related changes in pupillary response, which may contribute to the differences in emotion processing reported in the literature.

RESULTS

Behavioral results showed that identification of the felt emotion as well as perceived intensity varies by emotion, but no significant group effect was found. Pupil measurements revealed differences in dilation depending on the emotion evoked by the film clips (happy, tender, sadness, fear, and neutral) for both groups.

CONCLUSIONS

Our results suggest that differences in emotional response may be negligible when PD patients and healthy controls are presented with dynamic, ecologically valid emotional stimuli. Given the limited data available on pupil response in PD, this study provides new evidence to suggest that the PD-related deficits in emotion processing reported in the literature may not translate to real-world differences in physiological or subjective emotion processing in early-stage PD patients.

Pre-frontal-insular-cerebellar modifications correlate with disgust feeling blunting after subthalamic stimulation: A positron emission tomography study in Parkinson's disease

Subthalamic nucleus (STN) deep brain stimulation (DBS) has recently advanced our understanding of the major role played by this basal ganglion in human emotion. Research indicates that STN DBS can induce modifications in all components of emotion, and neuroimaging studies have shown that the metabolic modifications correlated with these emotional disturbances following surgery are both task- and sensory input-dependent. Nevertheless, to date, these modifications have not been confirmed for all emotional components, notably subjective emotional experience, or feelings. To identify the neural network underlying the modification of feelings following STN DBS, we assessed 16 patients with Parkinson's disease before and after surgery, using both subjective assessments of emotional experience and ¹⁸ [F]fluorodeoxyglucose positron emission tomography (¹⁸ FDG-PET). The patients viewed six film excerpts intended to elicit happy, angry, fearful, sad, disgusted, and neutral feelings, and they self-rated the intensity of these feelings. After DBS, there was a significant reduction in the intensity of the disgust feeling. Correlations were observed between decreased disgust experience and cerebral glucose metabolism (FDG uptake) in the bilateral pre-frontal cortices (orbitofrontal, dorsolateral, and inferior frontal gyri), bilateral insula, and right cerebellum. We suggest that the STN contributes to the synchronization process underlying the emergence of feelings.

Intact emotion recognition and experience but dysfunctional emotion regulation in idiopathic Parkinson's disease

BACKGROUND

A specific non-motor impairment in Parkinson's disease (PD) concerns difficulties to accurately identify facial emotions. Findings are numerous but very inconsistent, ranging from general discrimination deficits to problems for specific emotions up to no impairment at all. By contrast, only a few studies exist about emotion experience, altered affective traits and states in PD.

OBJECTIVE

To investigate the decoding capacity for affective facial expressions, affective experience of emotion-eliciting images and affective personality traits in PD.

METHODS

The study sample included 25 patients with mild to moderate symptom intensity and 25 healthy controls (HC) of both sexes. The participants were shown pictures of facial expressions depicting disgust, fear, and anger as well as disgusting and fear-relevant scenes. Additionally, they answered self-report scales for the assessment of affective traits.

RESULTS

PD patients had more problems in controlling anger and disgust feelings than HC. Higher disgust sensitivity in PD was associated with lower functioning in everyday life and lower capacity to recognize angry faces. Furthermore, patients reported less disgust towards poor hygiene and spoiled food and they stated elevated anxiety. However, the clinical group displayed intact facial emotion decoding and emotion experience. Everyday life functionality was lowered in PD and decreased with stronger motor impairment. Furthermore, disease duration was negatively associated to correct classification of angry faces.

CONCLUSIONS

Our data indicate that problems with emotion regulation may appear already in earlier disease stages of PD. By contrast, PD patients showed appropriate emotion recognition and experience. However, data also point to a deterioration of emotion recognition capacity with the course of the disease. Compensatory mechanisms in PD patients with less advanced disease are discussed.

Experience of negative emotions in Parkinson's disease: An fMRI investigation

OBJECTIVE

Amygdala abnormalities have been discussed as a possible mechanism underlying reduced reactivity to negative stimuli in Parkinson's disease (PD).

METHODS

The present investigation used functional magnetic resonance imaging (fMRI) in order to test this hypothesis. We compared brain activation of 17 nondepressed and nondemented PD patients with 22 healthy controls during the elicitation of negative affective states. The patients suffered from moderate motor symptoms for an average of 75 months and had stopped their antiparkinson medication 10-12h prior to the fMRI testing. All participants were shown images which depicted disgusting, fear-relevant and neutral contents and they answered self-report scales for the assessment of disgust proneness and trait anxiety.

RESULTS

Both groups did not differ from each other in affective state and trait ratings. In line with the self-report, the fMRI data showed similar activation (including the amygdala) in both groups during disgust and fear elicitation.

CONCLUSION

This fMRI investigation found no indication of diminished disgust and fear experience in PD.

SIGNIFICANCE

Previously reported affective processing deficits in PD might be due to insufficiently controlled confounding variables (medication, depression, cognitive impairment).

Objectifying facial expressivity assessment of Parkinson's patients: preliminary study

Patients with Parkinson's disease (PD) can exhibit a reduction of spontaneous facial expression, designated as “facial masking,” a symptom in which facial muscles become rigid. To improve clinical assessment of facial expressivity of PD, this work attempts to quantify the dynamic facial expressivity (facial activity) of PD by automatically recognizing facial action units (AUs) and estimating their intensity. Spontaneous facial expressivity was assessed by comparing 7 PD patients with 8 control participants. To voluntarily produce spontaneous facial expressions that resemble those typically triggered by emotions, six emotions (amusement, sadness, anger, disgust, surprise, and fear) were elicited using movie clips. During the movie clips, physiological signals (facial electromyography (EMG) and electrocardiogram (ECG)) and frontal face video of the participants were recorded. The participants were asked to report on their emotional states throughout the experiment. We first examined the effectiveness of the emotion manipulation by evaluating the participant's self-reports. Disgust-induced emotions were significantly higher than the other emotions. Thus we focused on the analysis of the recorded data during watching disgust movie clips. The proposed facial expressivity assessment approach captured differences in facial expressivity between PD patients and controls. Also differences between PD patients with different progression of Parkinson's disease have been observed.

Cancer, Health Literacy, and Happiness: Perspectives from Patients under Chemotherapy

Cancer is a dreaded disease that affects all dimensions of human life. In this context, issues related to the quality of life-as happiness, perception about health status, or health literacy-are important. This study aims to analyze the following topics the perception: the Portuguese cancer patients have about their health status while undergoing chemotherapy, the satisfaction with the information relating to their health, their level of happiness, and their vision of the future. An observational, cross-sectional, and descriptive study was developed. Data were collected between May and July 2012 in the day hospital of a central hospital in northern Portugal. The sample was composed of 92 cancer patients who were asked to answer a questionnaire during chemotherapy. The results indicate that, despite this life-threatening disease, patients consider themselves fairly happy and have an optimistic view of the future. Information about their health condition and religious beliefs was important coping mechanisms to help dealing with the suffering caused by the disease. The study highlights the importance of providing care in a holistic way. Nurses must be alert and available to listen, answer questions, provide supporting structures, or refer to other professionals when needed.

Recognition of facial and musical emotions in Parkinson's disease

BACKGROUND AND PURPOSE

Patients with amygdala lesions were found to be impaired in recognizing the fear emotion both from face and from music. In patients with Parkinson's disease (PD), impairment in recognition of emotions from facial expressions was reported for disgust, fear, sadness and anger, but no studies had yet investigated this population for the recognition of emotions from both face and music.

METHODS

The ability to recognize basic universal emotions (fear, happiness and sadness) from both face and music was investigated in 24 medicated patients with PD and 24 healthy controls. The patient group was tested for language (verbal fluency tasks), memory (digit and spatial span), executive functions (Similarities and Picture Completion subtests of the WAIS III, Brixton and Stroop tests), visual attention (Bells test), and fulfilled self-assessment tests for anxiety and depression.

RESULTS

Results showed that the PD group was significantly impaired for recognition of both fear and sadness emotions from facial expressions, whereas their performance in recognition of emotions from musical excerpts was not different from that of the control group. The scores of fear and sadness recognition from faces were neither correlated to scores in tests for executive and cognitive functions, nor to scores in self-assessment scales.

CONCLUSION

We attributed the observed dissociation to the modality (visual vs. auditory) of presentation and to the ecological value of the musical stimuli that we used. We discuss the relevance of our findings for the care of patients with PD.