Facial Emotion Recognition Impairments in Bipolar Disorder. A Cognitive Problem?

Abstract

In their recent study investigating emotion recognition impairments in bipolar disorder (BD), Robinson et al. (2015) report that two well-characterized groups of BD individuals failed to show performance deficits on a series of facial emotion processing tasks when compared to controls. This is in contrast to our findings of BD patient impairments on a similar set of facial emotion recognition measures in a group of stable outpatients in mixed mood states but with relatively minimal mean symptom severity .Robinson et al. state that methodological issues related to neurocognitive ability may account for some inconsistencies in the literature. In particular, they highlight that tasks with time pressured response formats or elevated memory demands could elicit group differences more readily than tasks without such features. We agree with this argument and speculate that it is possible that the participants in our sample were placed under greater neuropsychological pressure than those of Robinson et al., since the task used in our study did not display visual labels for each of the emotional expressions and enforced a strict inter-stimulus response window of 1500 ms. It is arguable that these factors imposed a heightened reliance on processing speed and working memory skills.In a previous study using a regression-based technique (path analysis) in our sample, we were able to show that a collapsed neurocognitive score encompassing processing speed, working memory, attention, learning, and executive functioning measures was predictive of emotion processing in BD (Van Rheenen, Meyer, & Rossell, 2014). This approach was useful in identifying the proportion of variance in facial emotion recognition performance that was accounted for by neurocognitive functioning in the BD group as a whole. However, recent work suggests that there is substantial heterogeneity in cognitive ability in individuals with this disorder (Burdick et al., 2014), with 30-40% of BD patients reported to be neuropsychologically intact (Martino et al., 2008(Martino et al., , 2014. Thus, although we were able to establish the presence of a predictive relationship between neurocognition and emotion processing in our previous path analysis, we were not able to explicitly clarify whether emotion-recognition impairment was a feature shared by those BD individuals with and without neurocognitive impairment themselves.In an attempt to place the results of both our own emotion processing study and that of Robinson et al., in the context of methodological considerations related to neuropsychological demands, we conducted an exploratory re-analysis of our data (see Van Rheenen & Rossell, 2014 for details). Specifically, we implemented a K-means clustering analysis on the BD sample reported in our 2014 study, on the basis of performance on available processing speed (Trail Making Test A and Digit Symbol Coding subtests) and working memory (SS and LNS subtests) measures from the MATRICS Consensus Cognitive Battery (Nuechterlein et al., 2008). The analysis, using 10...

Emotion processing and psychosocial functioning in euthymic bipolar disorder

“…Some studies found that neurocognition predicts a significant percentage of the variance of social cognition in a way which could explain abnormalities in social cognition . In line with this, we observed that in a sample of euthymic patients with BD, alterations in emotion processing were present in a subgroup of patients with neurocognitive impairment . Future studies should clarify whether deficits in social cognition and, especially in emotion processing, are a consequence of neurocognitive impairment.…”

“…A recent study determined that the variance obtained in the theory of mind and emotion perception domains is directly explained by neurocognitive functioning. Interestingly, it has been found that facial emotion recognition impairment is present in those patients with BD that present a cognitive dysfunction .…”

Neurocognitive heterogeneity in patients with bipolar disorder and their unaffected relatives: associations with emotional cognition

“…Neuroimaging studies indicate that non-emotional neurocognition and affective cognition involve a shared ‘cognitive control’ neural circuitry including dorsal and medial prefrontal regions (Ochsner, Silvers, & Buhle, 2012; Phillips, Ladouceur, & Drevets, 2008). Further, behavioural evidence has shown that neurocognition – particularly performance on processing speed and working memory tests – is closely associated with the performance on emotional face processing tasks (Van Rheenen, Meyer, & Rossell, 2014; Van Rheenen & Rossell, 2016) and emotion regulation in BD (Lima et al, 2018). Emerging evidence also suggests that patients with BD who are neurocognitively impaired experience difficulties with facial expression recognition (Van Rheenen & Rossell, 2016) and social cognition (Lima et al, 2019).…”

“…Further, behavioural evidence has shown that neurocognition – particularly performance on processing speed and working memory tests – is closely associated with the performance on emotional face processing tasks (Van Rheenen, Meyer, & Rossell, 2014; Van Rheenen & Rossell, 2016) and emotion regulation in BD (Lima et al, 2018). Emerging evidence also suggests that patients with BD who are neurocognitively impaired experience difficulties with facial expression recognition (Van Rheenen & Rossell, 2016) and social cognition (Lima et al, 2019). In contrast, patients who are neurocognitively intact display no facial expression recognition difficulties (Van Rheenen & Rossell, 2016) but rather superior social cognition relative to HCs (Burdick et al, 2014).…”

Commentary on “Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force”

“…The inclusion of secondary social cognitive outcomes is also recommended. Again there is research indicating that neurocognitive impairment in BD predicts performance on measures of facial emotion recognition and theory of mind, where a social cognitive performance decline of between 0.3 and 0.5 SDs is evident for every one point decrease in performance on a global neurocognitive score; and analyses that show that only BD patients with global neurocognitive impairments have deficits on facial emotion recognition measures, relative to their cognitively unimpaired BD counterparts and controls . These findings and others suggest that social cognitive deficits may scale with the severity of global cognitive deficits in BD—raising the possibility that treatment of cognitive deficits may indirectly, and at least partially, remediate social cognitive deficits.…”