Apathy Associated With Impaired Recognition of Happy Facial Expressions in Huntington’s Disease

Abstract

Objective Previous research has demonstrated an association between emotion recognition and apathy in a number of neurological conditions involving fronto-striatal pathology, including Parkinson’s disease and brain injury. In line with these findings, we aimed to determine whether apathetic participants with early Huntington’s disease (HD) were more impaired on an emotion recognition task compared to non-apathetic participants and healthy controls. Method We included 43 participants from the TRACK-HD study who reported apathy on the Problem Behaviours Assessment – short version (PBA-S), 67 participants who reported no apathy and 107 controls matched for age, sex and level of education. During their baseline TRACK-HD visit, participants completed a battery of cognitive and psychological tests including an emotion recognition task, the Hospital Depression and Anxiety Scale (HADS) and were assessed on the PBA-S. Results Compared to the non-apathetic group and the control group, the apathetic group were impaired on the recognition of happy facial expressions, after controlling for depression symptomology on the HADS and general disease progression (UHDRS total motor score). This was despite no difference between the apathetic and non-apathetic group on overall cognitive functioning assessed by a cognitive composite score. Conclusions Impairment of the recognition of happy expressions may be part of the clinical picture of apathy in HD. While shared reliance on fronto-striatal pathways may broadly explain associations between emotion recognition and apathy found across a number of patient groups, further work is needed to determine what relationships exist between recognition of specific emotions, distinct subtypes of apathy and underlying neuropathology.

On the association between apathy and deficits of social cognition and executive functions in Huntington’s disease

“…One explanation for why the RMET task was not associated with apathy in this study could be that while the task draws on abilities of both emotion recognition and theory of mind, it is directed at examining theory of mind. These results are in accordance with the previous studies (Kempnich et al, 2018;Osborne-Crowley et al, 2019), and similar findings have been shown in Parkinson's disease (Martínez-Corral et al, 2010;Robert et al, 2014). Thus, although social cognition as a domain might not be associated with apathy, processes of emotion recognition might be to some extent.…”

“…In two previous studies, it has been shown that emotion recognition may be linked to apathy in premanifest and manifest HD (Kempnich et al, 2018;Osborne-Crowley et al, 2019) which we sought to replicate. Also, we extended the examination to involve several social cognitive functions.…”

“…Apathy may also be associated with social cognitive deficits since a significant association was found in two recent studies with premanifest and early manifest HD gene expansion carriers (Kempnich et al, 2018;Osborne-Crowley et al, 2019). Moreover, Ruff and Fehr (2014) illustrated that social decision making is based on similar neural processes as the value evaluations of nonsocial factors implicated in goal-directed behavior, and research into the neurobiological basis of apathy has increasingly focused on regions of the limbic loop, which is also thought to be relevant for the value evaluation processes (Le Heron et al, 2018;Levy & Dubois, 2006;Martínez-Horta et al, 2018).…”

“…One study included only 32 premanifest and manifest participants, and assessment of apathy was based on family ratings (Kempnich et al, 2018). In the study by Osborne-Crowley et al (2019), the indirect associations were investigated based on a classification of patients as apathetic or nonapathetic. Thus, whether the association between apathy and social cognition is based on specific functions, like emotion recognition as in the previous studies, or if other functions contribute to this association is not known.…”

Social cognition and quality of life in Huntington's disease

“…Apathy has been linked to damage within subcortical and cortical regions in HD, including emotional-related prefrontal, temporal, and limbic areas such as the amygdala ( 57 ), which may suggest dysfunction within a common emotional component, an interpretation in line with the correlation we found between apathy and alexithymia. Furthermore, we found a correlation between apathy and the RMET, while a previous study, highlighted an association between apathy and recognition of happy facial expressions ( 58 ). Alternatively, relationships between apathy and social skills could reflect a more cognitive overlap, given that difficulty considering multiple perspectives and possibilities may help to explain help to explain both apathy and impaired social cognition, supported by the correlation between apathy and TMT shifting scores.…”