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Stam D, Rosseel S, De Winter FL, Van den Bossche MJA, Vandenbulcke M, Van den Stock J. Facial expression recognition deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic investigation of effects of phenotypic variant, task modality, geographical region and symptomatic specificity. J Neurol 2023; 270:5731-5755. [PMID: 37672106 DOI: 10.1007/s00415-023-11927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023]
Abstract
Deficits in social cognition may be present in frontotemporal dementia (FTD) and Alzheimer's disease (AD). Here, we conduct a qualitative synthesis and meta-analysis of facial expression recognition studies in which we compare the deficits between both disorders. Furthermore, we investigate the specificity of the deficit regarding phenotypic variant, domain-specificity, emotion category, task modality, and geographical region. The results reveal that both FTD and AD are associated with facial expression recognition deficits, that this deficit is more pronounced in FTD compared to AD and that this applies for the behavioral as well as for language FTD-variants, with no difference between the latter two. In both disorders, overall emotion recognition was most frequently impaired, followed by recognition of anger in FTD and by fear in AD. Verbal categorization was the most frequently used task, although matching or intensity rating tasks may be more specific. Studies from Oceania revealed larger deficits. On the other hand, non-emotional control tasks were more impacted by AD than by FTD. The present findings sharpen the social cognitive phenotype of FTD and AD, and support the use of social cognition assessment in late-life neuropsychiatric disorders.
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Affiliation(s)
- Daphne Stam
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
| | - Simon Rosseel
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
| | - François-Laurent De Winter
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Maarten J A Van den Bossche
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- KU Leuven, Leuven Brain Institute, Neuropsychiatry, 3000, Leuven, Belgium.
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium.
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Looking but not seeing: Increased eye fixations in behavioural-variant frontotemporal dementia. Cortex 2018; 103:71-81. [PMID: 29573594 DOI: 10.1016/j.cortex.2018.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/02/2018] [Accepted: 02/19/2018] [Indexed: 12/13/2022]
Abstract
Face processing plays a central role in human communication, with the eye region a particularly important cue for discriminating emotions. Indeed, reduced attention to the eyes has been argued to underlie social deficits in a number of clinical populations. Despite well-established impairments in facial affect recognition in behavioural-variant frontotemporal dementia, whether these patients also have perturbed facial scanning is yet to be investigated. The current study employed eye tracking to record visual scanning of faces in 20 behavioural-variant frontotemporal dementia patients and 21 controls. Remarkably, behavioural-variant frontotemporal dementia patients displayed more fixations to the eyes of emotional faces, compared to controls. Neural regions associated with fixations to the eyes included the left inferior frontal gyrus, right cerebellum and middle temporal gyrus. Our study is the first to show such compensatory functions in behavioural-variant frontotemporal dementia and suggest a feedback-style network, including anterior and posterior brain regions, is involved in early face processing.
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Tippett DC, Godin BR, Oishi K, Oishi K, Davis C, Gomez Y, Trupe LA, Kim EH, Hillis AE. Impaired Recognition of Emotional Faces after Stroke Involving Right Amygdala or Insula. Semin Speech Lang 2018; 39:87-100. [PMID: 29359308 PMCID: PMC5837057 DOI: 10.1055/s-0037-1608859] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite its basic and translational importance, the neural circuitry supporting the perception of emotional faces remains incompletely understood. Functional imaging studies and chronic lesion studies indicate distinct roles of the amygdala and insula in recognition of fear and disgust in facial expressions, whereas intracranial encephalography studies, which are not encumbered by variations in human anatomy, indicate a somewhat different role of these structures. In this article, we leveraged lesion-mapping techniques in individuals with acute right hemisphere stroke to investigate lesions associated with impaired recognition of prototypic emotional faces before significant neural reorganization can occur during recovery from stroke. Right hemisphere stroke patients were significantly less accurate than controls on a test of emotional facial recognition for both positive and negative emotions. Patients with right amygdala or anterior insula lesions had significantly lower scores than other right hemisphere stroke patients on recognition of angry and happy faces. Lesion volume within several regions, including the right amygdala and anterior insula, each independently contributed to the error rate in recognition of individual emotions. Results provide additional support for a necessary role of the right amygdala and anterior insula within a network of regions underlying recognition of facial expressions, particularly those that have biological importance or motivational relevance and have implications for clinical practice.
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Affiliation(s)
- Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
- Department of Otolaryngology--Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
| | - Brittany R. Godin
- Rehabilitation Services, University of Maryland Charles Regional Medical Center, La Plata, Maryland
| | - Kumiko Oishi
- Center for Imaging Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
| | - Cameron Davis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
| | - Yessenia Gomez
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
| | - Lydia A. Trupe
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
| | - Eun Hye Kim
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
- Department of Otolaryngology--Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore MD, USA, 21287
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland
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Mendez MF, Fong SS, Ashla MM, Jimenez EE, Carr AR. Skin Conduction Levels Differentiate Frontotemporal Dementia From Alzheimer's Disease. J Neuropsychiatry Clin Neurosci 2018; 30:208-213. [PMID: 29621927 PMCID: PMC6081247 DOI: 10.1176/appi.neuropsych.17080168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Patients with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) differ in basic emotional tone. Skin conduction levels (SCLs), a measure of sympathetic tone, may be a sensitive test for discriminating these two dementias early in their course. Previous research has shown differences in resting SCLs between patients with bvFTD and AD, but no study has evaluated the discriminability of SCLs during different environmental conditions. The authors compared bvFTD patients (N=8), AD patients (N=10), and healthy control subjects (N=9) on SCL measures pertaining to real-life vignettes or scenarios differing in valence and emotional intensity. The SCLs among the bvFTD patients were decreased across all conditions, whereas the SCLs among the AD patients were increased compared with control participants. On analysis, the SCLs in response to emotional stimuli differentiated bvFTD from AD with an area under the receiver operator characteristic curve of 95.3%. At a cutoff ≤0.77 μS, emotional vignettes distinguished bvFTD from AD with a sensitivity of 86% and a specificity of 96%. These preliminary results indicate the potential utility of SCLs for differentiating bvFTD from AD early in their course, regardless of environmental condition.
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Affiliation(s)
- Mario F. Mendez
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Sylvia S. Fong
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Mark M. Ashla
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Elvira E. Jimenez
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
| | - Andrew R. Carr
- From the Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (MFM, SSF, MMA, EEJ, ARC); and the Neurobehavior Unit, VA Greater Los Angeles Healthcare System, Los Angeles (MFM, EEJ)
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Disrupted Face Processing in Frontotemporal Dementia: A Review of the Clinical and Neuroanatomical Evidence. Neuropsychol Rev 2017; 27:18-30. [DOI: 10.1007/s11065-016-9340-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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Bora E, Velakoulis D, Walterfang M. Meta-Analysis of Facial Emotion Recognition in Behavioral Variant Frontotemporal Dementia: Comparison With Alzheimer Disease and Healthy Controls. J Geriatr Psychiatry Neurol 2016; 29:205-11. [PMID: 27056068 DOI: 10.1177/0891988716640375] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/02/2016] [Indexed: 12/24/2022]
Abstract
Behavioral disturbances and lack of empathy are distinctive clinical features of behavioral variant frontotemporal dementia (bvFTD) in comparison to Alzheimer disease (AD). The aim of this meta-analytic review was to compare facial emotion recognition performances of bvFTD with healthy controls and AD. The current meta-analysis included a total of 19 studies and involved comparisons of 288 individuals with bvFTD and 329 healthy controls and 162 bvFTD and 147 patients with AD. Facial emotion recognition was significantly impaired in bvFTD in comparison to the healthy controls (d = 1.81) and AD (d = 1.23). In bvFTD, recognition of negative emotions, especially anger (d = 1.48) and disgust (d = 1.41), were severely impaired. Emotion recognition was significantly impaired in bvFTD in comparison to AD in all emotions other than happiness. Impairment of emotion recognition is a relatively specific feature of bvFTD. Routine assessment of social-cognitive abilities including emotion recognition can be helpful in better differentiating between cortical dementias such as bvFTD and AD.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Dennis Velakoulis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia Neuropsychiatry Unit, ROYAL MELBOURNE Hospital, VIC, Australia
| | - Mark Walterfang
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia Neuropsychiatry Unit, ROYAL MELBOURNE Hospital, VIC, Australia
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Face shape and face identity processing in behavioral variant fronto-temporal dementia: A specific deficit for familiarity and name recognition of famous faces. NEUROIMAGE-CLINICAL 2016; 11:368-377. [PMID: 27298765 PMCID: PMC4893012 DOI: 10.1016/j.nicl.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/22/2016] [Accepted: 03/01/2016] [Indexed: 11/22/2022]
Abstract
Deficits in face processing have been described in the behavioral variant of fronto-temporal dementia (bvFTD), primarily regarding the recognition of facial expressions. Less is known about face shape and face identity processing. Here we used a hierarchical strategy targeting face shape and face identity recognition in bvFTD and matched healthy controls. Participants performed 3 psychophysical experiments targeting face shape detection (Experiment 1), unfamiliar face identity matching (Experiment 2), familiarity categorization and famous face-name matching (Experiment 3). The results revealed group differences only in Experiment 3, with a deficit in the bvFTD group for both familiarity categorization and famous face-name matching. Voxel-based morphometry regression analyses in the bvFTD group revealed an association between grey matter volume of the left ventral anterior temporal lobe and familiarity recognition, while face-name matching correlated with grey matter volume of the bilateral ventral anterior temporal lobes. Subsequently, we quantified familiarity-specific and name-specific recognition deficits as the sum of the celebrities of which respectively only the name or only the familiarity was accurately recognized. Both indices were associated with grey matter volume of the bilateral anterior temporal cortices. These findings extent previous results by documenting the involvement of the left anterior temporal lobe (ATL) in familiarity detection and the right ATL in name recognition deficits in fronto-temporal lobar degeneration. Face outline and face identity recognition was tested in behavioral variant FTD Deficits were observed in recognition of famous but not unfamiliar faces The deficit comprised both familiarity and name recognition Both deficits related to structural integrity of bilateral anterio-temporal cortex
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Cummings L. Theory of mind in utterance interpretation: the case from clinical pragmatics. Front Psychol 2015; 6:1286. [PMID: 26379602 PMCID: PMC4549655 DOI: 10.3389/fpsyg.2015.01286] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/11/2015] [Indexed: 11/18/2022] Open
Abstract
The cognitive basis of utterance interpretation is an area that continues to provoke intense theoretical debate among pragmatists. That utterance interpretation involves some type of mind-reading or theory of mind (ToM) is indisputable. However, theorists are divided on the exact nature of this ToM-based mechanism. In this paper, it is argued that the only type of ToM-based mechanism that can adequately represent the cognitive basis of utterance interpretation is one which reflects the rational, intentional, holistic character of interpretation. Such a ToM-based mechanism is supported on conceptual and empirical grounds. Empirical support for this view derives from the study of children and adults with pragmatic disorders. Specifically, three types of clinical case are considered. In the first case, evidence is advanced which indicates that individuals with pragmatic disorders exhibit deficits in reasoning and the use of inferences. These deficits compromise the ability of children and adults with pragmatic disorders to comply with the rational dimension of utterance interpretation. In the second case, evidence is presented which suggests that subjects with pragmatic disorders struggle with the intentional dimension of utterance interpretation. This dimension extends beyond the recognition of communicative intentions to include the attribution of a range of cognitive and affective mental states that play a role in utterance interpretation. In the third case, evidence is presented that children and adults with pragmatic disorders struggle with the holistic character of utterance interpretation. This serves to distort the contexts in which utterances are processed for their implicated meanings. The paper concludes with some thoughts about the role of theorizing in relation to utterance interpretation.
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Affiliation(s)
- Louise Cummings
- English, Culture and Media Studies, School of Arts and Humanities, Nottingham Trent University Nottingham, UK
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