Emotional, social and cognitive functioning in neurodegenerative disorders

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Emotional, social and cognitive functioning in
neurodegenerative disorders

• Dr Louise Phillips,
• School of Psychology,
• College of Life Sciences and Medicine,
• Aberdeen University.
• louise.phillips_at_abdn.ac.uk

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Outline

• What is emotional functioning?
• Why should neuropsychologists be interested in
  emotional functions?
• What are the effects of dementia on emotion
  processing ?
• Focus Alzheimers Disease and emotion perception
• What are the effects of other degenerative
  conditions on emotional functioning?

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Emotional functioning

• Monitoring and regulating mood
• Decoding others emotions

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Emotional functioning
Understanding own emotions
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Emotional functioning in neuropsychology

• Brain injury/disease can impair emotional
  functioning
• Direct effects of brain illness on social and
  emotional processing.
• Indirect effects as a consequence of
• Emotional response to illness
• Changes in social participation
• Impaired cognitive functioning

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Cognitive neuropsychology

• Neuropsychology traditionally deals with
  cognition and perception.
• Emotions and social behaviour seen as outside the
  realm of neuropsychology
• E.g. Lezak Neuropsychological Assessment.
• 19 chapters on cognitive neuropsychology
• 1 chapter on Tests of personal adjustment and
  emotional functioning.
• Section on projective personality tests
• Section on depression, personality and QOL
  questionnaires BDI, MMPI

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Why are emotions important?

• Contrary to the past 40 years of cognitive
  psychology PEOPLE ARE NOT COMPUTERS!
• Humans are very social creatures and
  understanding emotions is essential in
  interaction.
• Regulating and decoding emotions important in
• Social relationship maintenance
• Rehabilitation success
• Social participation

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Dementia and emotions
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Dementia and behavioural problems

• Memory problems usually seen as key symptom in
  dementia.
• But lots of clinical and anecdotal evidence of
  behavioural problems
• Control of attention and behaviour
• Inappropriate social behaviour
• Mood disorder, poor control of emotions

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Cognition in Alzheimers Disease (AD)

• Memory impairment
• Episodic memory failures
• Problems with new learning
• Impaired working memory
• Language impairment
• Naming difficulties
• Content-poor conversation
• Poor control of attention and cognition
• Executive function
• Inhibition and updating

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Social aspects of AD

• Social behaviours
• Interaction with other people
• Problems e.g. aggressive, withdrawn
• Communication
• Impact of language changes
• Importance of emotional cues and other nonverbal
  indicators in social interaction
• Quality of life
• Is QOL in person with dementia and caregivers
  influenced by emotion changes in AD?

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AD and experience and expression of emotions

• Co-occurrence of AD and mood disorders
• Incidence of depression up to 50
• Diagnosis issues
• Regulation of emotions poorer?
• Labile or flat affect
• Mood regulation irritability and aggression
• 20 of AD patients rated by carers
• Loss in ability to express emotions or affection.
• Occurs early in disease process.

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Why study emotions in dementia?

• For hospital staff and relatives
• Emotional and behavioural problems can
  particularly disruptive and distressing
• Implications for QoL of patients and carers.
• Little known about emotional problems in AD
• Assessment issues
• Emotional issues not considered in interventions
  e.g. drug trials

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Emotion perception in Alzheimer's Disease (AD)

• Funded by the Alzheimers Research Trust.
• Collaborators
• Donald Mowat, Stephen Bell, Clare Scott.

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Emotion perception

• Ability to perceive facial expressions of emotion
  critical in social communication.
• Standardised stimuli available.
• Widely used in cross-cultural and
  neuropsychological studies.

Choose from emotion labels happiness
sadness anger disgust surprise fear
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The brain emotional processing

• Brain areas involved in experiencing and
  perceiving emotions
• Limbic structures amygdala, medial temporal lobe
• Frontal regions orbitofrontal, ventromedial
• Cingulate cortex
• Basal ganglia and insula
• Different brain regions involved in different
  emotions?

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AD and neuroanatomical changes

• Build up of neurofibrillary tangles
• Considerable individual differences
• Can be widespread
• Initial changes most commonly
• Medial temporal lobes, hippocampus
• Spreads to neocortex e.g. frontal lobes

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AD and emotion perception

• Patients with AD poorer at interpreting facial
  expressions of emotion
• Especially sadness
• AD results in poorer ability to interpret
  emotions from videoclips of moving faces
• AD patients impaired in interpreting prosody from
  speech

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Rosen et al. (2005)

• 50 patients with dementia
• Impaired on emotion perception
• Structural changes in inferior temporal gyrus
  associated with poor emotion recognition

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AD, emotion perception and interpersonal behaviour

• Shimokawa et al. (2001)
• Assessed emotion perception and problem
  behaviours in AD
• Difficulties in relationships and patient
  management
• Measure of emotion perception predictive
• Cognitive measures not predictive

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Aims of current study

• 1. To identify the pattern of emotion perception
  deficits seen in patients with AD.
• 2. To investigate the link between emotion
  processing and cognitive problems in AD
• 3. To investigate the effects of emotional
  problems in AD patients on their QOL.

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Sample
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Emotion labelling task accuracy
happiness sadness anger disgust surprise
fear
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Emotion discrimination task
  SAME  or  DIFFERENT emotion?
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Effects of AD on emotion perception

• Impaired emotion labelling (?2 .31)
• Problems identifying sadness, anger, fear,
  surprise
• Particularly likely to choose fear label
• Impaired emotion discrimination (?2 .19)
• Tend to more often say different than same
• Particularly likely to say two sad faces express
  different emotions.

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Are the effects of AD on emotion perception
linked to cognitive changes?

• MMSE
• Executive function tasks
• Letter and semantic fluency
• Stroop inhibition cost
• Face identity perception
• Benton Facial Recognition Test

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Are the effects of AD on emotion perception
linked to cognitive changes?

• AD effects on emotion labelling and emotion
  discrimination
• Overlap in variance with executive function but
  not facial identity perception.
• Group differences in emotion perception
• Not attributable to problems in face perception
• But executive function important.
• In AD group
• MMSE score does not correlate with emotion
  perception performance

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Relationship MMSE and emotion perception in AD
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QoL-AD
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Relationship emotion perception and QoL in AD
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Relationship MMSE and QoL in AD
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Conclusions AD and emotion perception

• AD has severe impact on interpreting facial
  expressions of emotion
• All negative emotions except disgust
• Linked to executive dysfunction in AD
• Rather than general severity of cognitive change
• Not attributable to changes in perceptual aspects
  of face processing?
• Implications for quality of life in AD

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Effects of other types of degenerative condition
on emotional functioning
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CerebroVascular Dementia (CVD)

• Second most common form of dementia
• Heterogeneous pathology
• Multiple infarcts cortical and subcortical
• Co-occurs with AD
• Patients with CVD perform worse on emotion
  recognition tasks than those with AD despite
  similar cognitive performance
• Anxiety and depression more prevalent in CVD than
  AD patients

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Fronto-Temporal Dementia (FTD)

• Neuronal damage localised.
• Semantic dementia involves fluent aphasia and
  mainly temporal lobe atrophy
• Frontal variant (fvFTD) involves behaviour
  problems and particularly ventromedial frontal
  atrophy
• fvFTD Social and emotional disorders.
• Disinhibition, inappropriate social conduct, flat
  affect, loss of embarrassment, personality
  change, marriage breakdown, lack of empathy.
• Relatively intact cognitive performance

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fvFTD and emotion perception

• Patients have poor ability to interpret facial
  and vocal expressions of emotion
• Not selective to particular emotions
• Not caused by general perceptual deficits
• May underlie behavioural problems
• Not generally impaired on face processing
• Greater impairment on emotion processing compared
  to AD

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Huntingtons disease

• Problems in recognising emotions
• In faces and voices
• Especially disgust, sometimes anger
• Impairment in disgust recognition linked to
  changes in insula
• Mood disorders
• Problems with anger regulation irritation
• Depression common, particularly in early stages
• Apathy

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Parkinsons disease

• Depression in around 50 patients
• Significant cause of functional impairment
• Caused by neural changes?
• Mood fluctuations common
• Poor recognition of facial expressions
• Specifically disgust linked to insula?
• Problems with emotion display
• Bowers et al. (2006) show less expression
• Due to impaired motor control

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Multiple Sclerosis

• Demyelination of neurons
• Affects white matter
• Disrupt cortical-subcortical networks
• Location hugely variable
• Emotional changes
• Depression highly prevalent
• Impaired ability to decode emotional prosody and
  facial expressions (Beatty et al., 2003)

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Conclusions
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Dementia and emotion processing

• Problems with emotion perception and mood control
  prevalent in degenerative conditions
• Emotional processing may be separate from memory
  and other cognitive disorders
• Deficits more pronounced in other types of
  dementia (e.g. FTD) compared to AD
• Specific degenerative conditions may impair
  experience and perception of particular emotions.

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Implications

• Patients with degenerative conditions may have
  difficulties interpreting negative emotions in
  others
• Implications for social interaction
• Poorer control and understanding of emotions
  impairs social interaction
• Problem behaviours
• Distressing for those involved in care
• Impairs quality of life of patients