Can the Ability to Recognize Facial Emotions in Individuals With Neurodegenerative Disease be Improved? A Systematic Review and Meta-analysis.

BACKGROUND: Facial emotion recognition (FER) is commonly impaired in individuals with neurodegenerative disease (NDD). This impairment has been linked to an increase in behavioral disorders and caregiver burden. OBJECTIVE: To identify interventions targeting the improvement of FER ability in individuals with NDD and investigate the magnitude of the efficacy of the interventions. We also wanted to explore the duration of the effects of the intervention and their possible impacts on behavioral and psychological symptoms of dementia and caregiver burden. METHOD: We included 15 studies with 604 individuals who had been diagnosed with NDD. The identified interventions were categorized into three types of approach (cognitive, neurostimulation, and pharmacological) as well as a combined approach (neurostimulation with pharmacological). RESULTS: The three types of approaches pooled together had a significant large effect size for FER ability improvement (standard mean difference: 1.21, 95% CI = 0.11, 2.31, z = 2.15, P = 0.03). The improvement lasted post intervention, in tandem with a decrease in behavioral disorders and caregiver burden. CONCLUSION: A combination of different approaches for FER ability improvement may be beneficial for individuals with NDD and their caregivers.

Eye-gaze Strategies During Facial Emotion Recognition in Neurodegenerative Diseases and Links With Neuropsychiatric Disorders.

BACKGROUND: Facial emotion recognition (FER) is primarily and severely impaired in individuals with the behavioral variant of frontotemporal dementia (bvFTD) and is often mildy impaired in individuals with Alzheimer disease (AD) or Parkinson disease (PD). Such impairment is associated with inappropriate social behaviors. OBJECTIVE: To determine whether FER impairment is linked to the use of inappropriate eye-gaze strategies to decode facial emotions, leading to misinterpretation of others' intentions and then to behavioral disorders. METHOD: We assessed FER in 9 individuals with bvFTD, 23 with AD, and 20 with PD, as well as 22 healthy controls (HC), using the Reading the Mind in the Eyes (RME) Test and the Ekman Faces Test. Eye movements (number and duration of fixations) were recorded with an eye-tracking device. Behavior was assessed using the Neuropsychiatric Inventory. RESULTS: FER was mildly impaired in the AD and PD groups and severely impaired in the bvFTD group. FER impairment was accompanied by an increase in the number of fixations and a more attracted gaze toward the lower part of one's face. FER impairment and an increase in the number of fixations were positively correlated with behavioral disorders. CONCLUSION: Our study demonstrated a link between FER impairment, modification of eye-gaze strategies during the observation of emotional faces, and behavioral disorders in individuals with bvFTD and those with AD or PD. These results suggest that an eye-gaze strategy rehabilitation program could have beneficial effects on emotion recognition and behavioral disorders in individuals with these diseases.

Facial emotion impairment in multiple sclerosis is linked to modifying observation strategies of emotional faces.

BACKGROUND: Facial emotion recognition (FER) may be impaired in patients with multiple sclerosis (MS). Nevertheless, the literature is heterogeneous, with studies not highlighting this kind of impairment. Moreover, most studies have not explored differences between MS spectrum disorders (radiologically isolated syndrome (RIS), clinically-isolated syndrome (CIS), relapsing-remitting (RRMS), and progressive (primary - (PPMS) and secondary - (SPMS)). One hypothesis would be that FER impairment results from an alteration of eye-gaze strategies while observing emotional faces. Consequently, a FER deficit would be found in MS patients for whom these observation strategies would be disturbed and more frequent in the progressive forms. METHODS: We prospectively enroled 52 patients (10 RIS, 10 CIS, 12RRMS, 10 SPMS, 10 PPMS) and 23 healthy controls (HC) to assess FER using Ekman Faces Test. Eye movements (number and duration of fixations) were recorded with an eye-tracking device. RESULTS: 21% of the MS participants had significant FER impairment. This impairment was observed in all phenotypes. In progressive forms, FER impairment was more frequent, more severe, and associated with modified emotional face observation strategies. MS participants with significant FER impairment had significantly more modification of eye-gaze strategies during observation of expressive faces than MS participants without FER impairment. CONCLUSION: FER impairment seems to be linked to a deficit of attention orientation in MS. Remediation of eye-gaze strategies during observation of emotional faces could be beneficial, as observed in other neurological diseases.

Reliability of mobile video-oculography in multiple sclerosis patients using an iPad: A prospective validation study.

BACKGROUND: Video-oculography (VOG) could be useful for monitoring neurodegenerative diseases and multiple sclerosis (MS), as a high prevalence of subclinical eye movements abnormalities (EMA) has been previously reported, with a potential prognostic value regarding disease evolution. However, access to VOG is limited in clinical practice. OBJECTIVE: To evaluate the reliability of VOG recordings performed using eVOG, a mobile application developed on an iPad. METHOD: Patients with MS or related disease without clinically detectable EMA were enrolled in a cross-sectional study during which two VOG exams (classical VOG and eVOG) were performed on the same day. We examined reflex saccades, antisaccades, smooth pursuit and fixation. The total number of deficits, saccadic latencies and velocities, qualitative smooth pursuit were compared. RESULTS: 30 patients were included. The mean number of EMA per patient on classical VOG was 4.1 and 2.3 on eVOG. We found a statistical association between the number of EMA for each exam (r = 0.66, p < 0.0001). Saccades latencies (r = 0.57, p < 0.0001) and velocities (r = 0.45, p < 0.0001) were also well correlated. Assessing eVOG accuracy, we found a sensitivity ranging from 44% to 100% and a specificity ranging from 71% to 88.9% depending on the considered abnormality. CONCLUSION: eVOG could be an easily accessible solution to screen MS patients for the presence of EMA. We plan to use eVOG on a larger cohort of patients, in a prospective study to assess the prognostic value of subclinical EMA in MS. We also plan to investigate the use of eVOG in other neurological conditions.

Theory of mind, empathy and eye gaze strategies during observation of a work of art: neurodegenerative pathologies.

OBJECTIVE: Theory of mind (ToM) and empathy are severely impaired in the behavioural variant of frontotemporal dementia (bvFTD) and more mildly in Alzheimer's (AD) and Parkinson's diseases (PD). Such impairments are associated with behavioural disorders. Modification of visual scanning strategies of complex visual scenes is also found in these pathologies. We hypothesised that these patients applied atypical gaze strategies when observing social events, which does not allow them to properly process social cues and results in the production of erroneous inferences and lack of empathy towards others. METHODS: Fifty-five participants were divided into four groups: five bvFTD subjects, 19 AD subjects, 17 PD subjects and 14 matched control subjects. ToM and empathy were assessed by eye movement recording (eye-tracking) and by a questionnaire during a painting observation. Scores obtained were compared between each group and to social cognition reference tests and correlated to the NeuroPsychiatric Inventory. RESULTS: Our paradigm was suitable for assessing cognitive ToM while it lacked sensitivity for empathy assessment. Severe ToM impairment was highlighted in bvFTD, while milder difficulties were observed in AD and for PD. Subjects with bvFTD and AD produced erroneous inferences from cognitive mental states. ToM performances were linked to visual exploration strategies of the painting. Atypical visual observation was highlighted in the bvFTD and AD groups causing a time delay in taking the perspective of the other person. Finally, we highlighted that social cognition performances, gaze strategies and behavioural disorders were correlated. CONCLUSION: Observing a painting in association with eye-tracking technology can be a good support for social cognition assessment. We highlighted a link between atypical visual scanning strategies, ToM impairment and behavioural disorders in these pathologies. ToM skills could be improved by training in the search for visual social cues. Therefore, this kind of remediation could have positive effects on behavioural disorders.

[Theory of mind, empathy and eye gaze strategies during an artwork observation in neurodegenerative pathologies]. / Théorie de l'esprit, empathie et stratégies de regard durant l'observation d'une œuvre d'art dans les pathologies neurodégénératives.

OBJECTIVE: Theory of mind (ToM) and empathy are severely impaired in the behavioral-variant of frontotemporal dementia (bvFTD) and more mildly in Alzheimer's (AD) and Parkinson's diseases (PD). Such impairments are associated with behavioral disorders (BD). Modification of visual scanning strategies of complex visual scenes is also found in these pathologies. We hypothesized that these patients applied atypical gaze strategies when observing social events, which would not allow to properly process social cues and would result in the production of erroneous inferences and lack of empathy towards others. METHODS: Fifty-five participants were divided into four groups: five bvFTD, 19 AD, 17 PD and 14 matched controls subjects. ToM and empathy were assessed by eye movements recording (eye-tracking) and by a questionnaire during a painting observation. Scores obtained were compared between each group and to social cognition reference tests, and correlated to the NeuroPsychiatric Inventory. RESULTS: Our paradigm was suitable for assessing cognitive ToM while it lacked sensitivity for empathy assessment. Severe ToM impairment was highlighted in bvFTD while milder difficulties were observed in AD and for PD. bvFTD and AD groups produced erroneous inferences from cognitive mental states. ToM performances were linked to visual exploration strategies of the painting. Atypical visual observation was highlighted in bvFTD and AD groups causing a time shift in perspective taking of the character. Finally, we have highlighted that social cognition performances, gaze strategies and BD were correlated. CONCLUSION: The observation of a painting in association with eye-tracking technology can be a good support for social cognition assessment. We highlighted a link between atypical visual scanning strategies, ToM impairment and BD in these pathologies. ToM skills could be improved by training in the search for visual social cues. Therefore, this kind of remediation could have positive effects on BD.