Measuring emotion recognition: Added value in diagnosing dementia of the Alzheimer’s disease type

Abstract

Neuropsychological tests, particularly for episodic memory, are used to classify patients in memory clinics. Still, the differential diagnosis between dementia of the Alzheimer’s disease type (Dementia‐AD), mild cognitive impairment (MCI), or major depressive disorder (MDD) is challenging. However, impairments in other domains, such as emotion recognition, an aspect of social cognition, might have additional value in distinguishing Dementia‐AD from MCI and MDD and hence signal progression of neurodegeneration. We evaluated this in patients visiting a memory clinic. Sixty healthy controls (HC) and 143 first time attendants of an academic hospital memory clinic who were eventually classified as Dementia‐AD (n = 45), MCI (n = 47), MDD (n = 27), or No Impairment (NI, n = 24) were included. We assessed group differences in Emotion Recognition (Ekman 60 Faces Test (EFT)) and episodic memory (Dutch Rey Auditory Verbal Learning Test (RAVLT)). With multinomial and binomial regression analysis, we assessed whether EFT was added to RAVLT in distinguishing patient groups. Dementia‐AD patients had significantly worse emotion recognition than HC, MCI, MDD, and NI groups, but no other between‐group differences were found. Episodic memory was impaired in Dementia‐AD and MCI patients. We found no memory impairments in the MDD and NI groups. Emotion recognition in addition to episodic memory was significantly better in predicting group membership than episodic memory alone. In conclusion, emotion recognition measurement had added value for differentiation between patients first visiting memory clinics, in particular in distinguishing Dementia‐AD from MCI. We recommend the standard inclusion of emotion recognition testing in neuropsychological assessment in memory clinics.

Emotion Recognition in a Health Continuum: Comparison of Healthy Adults of Advancing Age, Community Dwelling Adults Bearing Vascular Risk Factors and People Diagnosed with Mild Cognitive Impairment

“…More specifically, for neurodegenerative disorders—Alzheimer’s disease [ 26 , 27 ] Parkinson [ 28 , 29 ] and Frontotemporal dementia [ 30 ], ER seems to function as an important criterion for the diagnosis and progression of the disease. Regarding AD, the findings agree that ER deficits play a particular role in the progression of dementia [ 5 , 31 , 32 ]. Key conclusions include impaired ability to recognize negative emotions, especially at the onset of the disease [ 33 ], while in the course of the disease the weaknesses seem to generalize to other emotions [ 26 , 34 ].…”

“…Regarding ER performance differences as a result of educational level, the interaction effect of education and diagnosis on the recognition of emotions has been found in some studies [ 5 ]. Sayaka Wada et al (2021) [ 85 ] found that the years of education are associated with volumes of the right orbital gyrus, the right inferior frontal gyrus, and the right supramarginal gyrus; the right supramarginal gyrus volume is also associated with the emotion recognition ability.…”

“…Emotion recognition -ER- is defined as the ability to classify and recognize an emotional state from sensory cues [ 1 ], which is closely associated with the quality of daily life and survival [ 2 , 3 ]. Recognition of others’ emotions is considered a main component of social cognition [ 4 ] and the deficit in this ability causes adverse effects in communication, low social competency and often leads to isolation and depression [ 5 ].…”

Exploring the Relationship Between Deficits in Social Cognition and Neurodegenerative Dementia: A Systematic Review

“…However, it requires an administration time between 60 and 90 min that could interfere with the performance of the subject. Finally, the Ekman 60 Test assesses the emotional recognition of facial expressions, and is sensitive to deficits in dementia (Strijkert et al, 2021 ). Furthermore, this test showed accuracy in distinguishing between AD and bvFTD patients (Dodich et al, 2021 ).…”

Impaired Emotion Recognition: A Potential Marker for Social Behavioral Problems in Patients With Amnestic Mild Cognitive Impairment and Early Alzheimer Disease?

“…3,4 Facial emotion recognition is an important basic social cognitive process, which in several studies was found to be impaired in patients with AD dementia. 5,6 Social behavioral changes are also prevalent in patients with AD dementia, and these changes can be experienced by close others as more burdening than cognitive symptoms: apathy is the most frequently reported symptom, but behaviors, such as agitation/aggression, disinhibition, and irritability, are also common and can be very disruptive. [7][8][9] However, whereas facial emotion recognition can be easily and objectively measured with neuropsychological tests, social behavioral changes are more difficult to assess: patients themselves are not always aware of behavioral changes, and close others may have difficulties providing a reliable impression of changed behaviors, despite increased burden.…”