Yamaguchi Facial Expression-Making Task in Alzheimer’s Disease: A Novel and Enjoyable Make-a-Face Game

Abstract

Background: To assess the ability to make emotional facial expressions, we newly developed the Yamaguchi facial expression-making task (Y-FEMT). Method: We recruited 20 normal controls and 61 outpatients: 10 with amnestic mild cognitive impairment (aMCI), 34 with mild Alzheimer’s disease (AD), and 17 with moderate AD. In the Y-FEMT, smile and anger expressions were made by arranging face parts. We examined the relationship between each Y-FEMT score and the Mini-Mental State Examination (MMSE) score or overlapping figure identification test (Fig-test). Results: The Total score (0–20) was nearly achieved in controls (18.9 ± 1.4) and declined with AD progression (aMCI 17.2 ± 2.4, mild AD 15.7 ± 2.6, moderate AD 12.3 ± 2.7). The Anger score (0–10) was significantly lower than the Smile score (0–10) in mild and moderate AD (p = 0.007 and p = 0.006, respectively). The Structure score (0–6 each) correlated well with both the MMSE score (r = 0.44, p < 0.001) and Fig-test (r = 0.45, p < 0.001), whereas the Expression score (0–4 each) correlated only with the MMSE score (r = 0.33, p = 0.01). The Subjective scores (0–4), evaluated by 10 therapists, highly correlated with the Total score. Additionally, the Y-FEMT promoted laughter and a convivial atmosphere. Conclusion: The Y-FEMT pleasantly assessed the ability to make emotional facial expressions without special equipment. Furthermore, the Y-FEMT may provide helpful clues for caregivers to achieve good communication with AD patients for better care.

Emotional processing in patients with mild cognitive impairment: The influence of the valence and intensity of emotional stimuli

“…With regards elderly subjects with MCI, the pattern is conspicuously distinct to that of the healthy group of individuals, which seems to indicate the influence of cognitive capacity on the identification of basic emotions. We believe that this data supports the most recent theories on the processing of EFEs indicating that these deficits are not exclusively due to sub-cortical damage but also, and perhaps more significantly, due the cortical dysfunction that occurs with age, especially when individuals are in the prodromic stage of a neurodegenerative disease [37][38][39].…”

“…More recent research showed that the complexity of an emotional stimulus evoked by an EFE influences the ability to process it [37,38]. There are two variables that define this complexity: (1) the facial information that characterizes each basic emotion; and (2) the intensity to which the emotion can be manifested.…”

Relative preservation of the recognition of positive facial expression “happiness” in Alzheimer disease

“…However, studies on emotional facial recognition in AD patients have produced various results. First, it is controversial whether facial recognition itself is declined or not; some studies reported preserved ability of emotional facial recognition (Bucks et al ., 2004; Luzzi et al ., 2007; Guaita et al ., 2009; Yamaguchi et al ., 2012), whereas others reported impairments (Spoletini et al ., 2008; Bediou et al ., 2009; Drapeau et al ., 2009). It is also controversial whether there were differences in the recognition of various emotions.…”

“…Some studies reported no difference (Bucks et al ., 2004; Luzzi et al ., 2007), whereas others reported differences, e.g. selective impairment was reported in labeling the facial expression of sadness (Hargrave et al , 2002), and recognition of happy facial expressions was reported to be relatively preserved in comparison with angry facial expressions (Yamaguchi et al ., 2012). It was also reported that the most identified emotion was happiness among seven facial expressions (six basic expressions and boredom) in the moderate and severe stage of dementia (Guaita et al ., 2009).…”

Deficits in emotion processing in Alzheimer’s disease: a systematic review

“…In relation to specific emotions involved in the decoding tasks, some studies investigated the ability to identify specific emotions such as happiness or sadness. Previous findings 31,35,73,74 highlight that the capacity to process some emotions is preserved in AD (e.g., happiness and disgust). Other studies highlight that the participants have particular impairment in the decoding of emotions, such as fear.…”