Understanding basic and social emotions in Alzheimer's disease and frontotemporal dementia

Introduction: Recent developments in the field of social cognition have led to a renewed interest in basic and social emotion recognition in early stages of Alzheimer's Disease (AD) and FrontoTemporal Dementia (FTD). Despite the growing attention to this issue, only few studies have attempted to investigate emotion recognition using both visual and vocal stimuli. In addition, recent studies have presented conflicting findings regarding the extent of impairment in patients in the early stages of these diseases. The present study aims to investigate emotion understanding (both basic and social emotions), using different tasks with visual and auditory stimuli, to identify supramodal deficits in AD and FTD to provide a reliable tool to better outline their behavioral and emotional profile and useful instruments for their management. Methods: Eighteen patients with AD and 15 patients with FTD were included in the study. Healthy control (HCs) subjects were recruited to obtain normative data for basic emotion recognition tests and social emotion recognition tasks. To evaluate basic emotion recognition, the Facial Emotion Recognition Battery (FERB) and the Emotional Prosody Recognition Battery (EPRB) were administered. To evaluate social emotion recognition, the Faux Pas (FP), Reading the Mind in the Eyes (RME), and Reading the Mind in the Voice (RMV) tests were employed. Results: FTD patients performed significantly worse than HCs in most of the subtests of the basic emotion recognition batteries, where, instead, AD patients were significantly impaired only when required to match emotional facial expression in different individuals (subtask of the FERB). Moreover, FTD patients scored significantly lower in RME and RMV tests compared both to AD patients and to HCs. In addition, ADs were selectively impaired in RMV as respect to HCs. Discussion: FTD patients showed deficits in emotion recognition, affecting both basic and social emotions, whether conveyed through facial expressions or prosody. This result may explain the well-known social behavioral difficulties observed in FTD patients from the early stages of the disease. The fewer and specific deficits in AD patients with comparable MMSE scores may be attributed to the mild degree of impairment, as these deficits may appear later in the progression of AD.