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

Impaired facial emotion recognition in individuals with bipolar disorder

BACKGROUND

Individuals with bipolar disorder (BD) often struggle with emotional regulation and social interactions, partly due to difficulties in accurately recognizing facial emotions.

METHODS

From September 2021 to February 2023, 69 BD individuals-comprising 23 with bipolar manic/hypomanic episode (BME), 23 with bipolar depressive episode (BDE), 23 with bipolar euthymic (EUT)-and 23 healthy controls (HCs) were enrolled. Diagnosis adhered to DSM-IV criteria using M.I.N.I 5.0, alongside assessments via Hamilton Depression Scale 17 and Young Manic Rating Scale. Recognition tasks involving 84 facial expression images across six categories. The Wilcoxon rank-sum test compares two groups, while the Kruskal-Wallis test compares multiple groups with subsequent adjusted pairwise comparisons.

RESULTS

The overall correct recognition rate of facial expressions in the BD group (79 %) was significantly lower than that of the HC group (83 %) (P=0.004). Primary differences were noted in neutral (93 % vs. 100 %, P=0.012) and fear (79 % vs. 86 %, P=0.023) expressions. Within the BD group, correct recognition rates were 71 % for BME, 80 % for BDE, and 80 % for EUT, all lower than in the HC group. Significant differences in correct recognition rates of neutral, fear, and joy expressions were observed among the four groups (P<0.05), with the BME group exhibiting the lowest rate. Misidentification of facial expressions was more frequent in the BD group compared to the HC group, particularly among negative expressions.

CONCLUSION

Patients with BD demonstrate lower correct recognition and higher misidentification rates of facial expressions, with those experiencing manic episodes showing impaired recognition of neutral, joy, and fear expressions.

Facial emotion recognition is associated with executive functions and depression scores, but not staging of dementia, in mild-to-moderate Alzheimer's disease

BACKGROUND

Although deficits in facial emotion recognition (FER) significantly affect interpersonal communication and social functioning, there is no consensus on how FER affects Alzheimer's disease (AD). In this study, we aimed to investigate the clinical and neuropsychological factors affecting the possible deficits in the FER abilities of patients with AD.

METHODS

This cross-sectional study included 37 patients with mild [clinical dementia rating (CDR) scale score = 1] or moderate (CDR = 2) AD, in whom vascular dementia and depression were excluded, and 24 cognitively normal (CDR = 0) subjects. FER ability was determined using the facial emotion identification test (FEIT) and facial emotion discrimination test (FEDT). All participants underwent mini-mental state examination (MMSE), frontal assessment battery (FAB), and geriatric depression scale (GDS). The neuropsychiatric inventory-clinician rating scale (NPI-C), Katz index of independence in activities of daily living, and Lawton instrumental activities of daily living were also administered to patients with AD.

RESULTS

The FEIT and FEDT total scores showed that patients with mild and moderate AD had significant FER deficits compared to healthy controls. However, no significant difference was observed between patients with mild and moderate AD in the FEIT and FEDT total scores. FEIT and FEDT scores were not correlated with the MMSE and NPI-C total and subscales scores in patients with AD. Linear regression indicated that FEIT and FEDT total scores were significantly related to age and FAB scores. The GDS score negatively moderated the relationship between FAB and FEDT.

CONCLUSIONS

This study demonstrated a decreased FER ability in patients with AD. The critical point in FER deficits is the presence of dementia, not the dementia stage, in AD. It has been determined that executive functions and depression (even at a subsyndromal level), which have limited knowledge, are associated with FER abilities.