Perception of emotions on happy/sad chimeric faces in Alzheimer disease: relationship with cognitive functions

Aims: To investigate the ability to recognize facial emotions in patients with Alzheimer disease (AD). Happiness and sadness, fundamental emotions that are easily recognized across cultures, were evaluated. Results were further analyzed in relation to demographic, clinical, and neuropsychologic characteristics. Methods: A test exploring recognition of facial emotions using chimeric faces based on Jaynes’ happy and sad faces was administered to 71 patients with probable AD. Results: The ability to identify positive and negative facial emotions was largely preserved in AD subjects. Impaired recognition of facial emotions was found in 27%. Poor test performance was associated with low scores on constructional praxis and nonverbal memory tasks. Conclusions: Decoding of emotional facial expressions seems to be differently affected in relation to patients’ neuropsychologic profile, as poor test performance closely correlated with nonverbal cognitive impairment. This emotion-discrimination disorder likely characterizes the behavior of a subset of AD patients with predominant right-hemisphere dysfunction. A preserved ability to process the emotional features of faces may have an important role in the management of demented patients, and suggests the use of nonverbal communication as an integrative/alternative system. The simple test used in our study may be a useful clinical tool to explore emotional behavior in demented subjects.