Decreased emotion recognition and reduced focus on facial hallmarks in behavioral variant frontotemporal dementia compared to primary psychiatric disorders and controls

• Published in: European journal of neurology Vol. 30; no. 8; pp. 2222 - 2229
• Main Authors: Fieldhouse, Jay L. P., Singleton, Ellen H., Engelen, Marie‐Paule E., Hooft, Jochum J., Boer, Sterre C. M., Froeling, Violet E., Braun, Michelle, Oudega, Mardien L., Grootheest, Daniël, Kerssens, Cora, Duits, Flora H., Harten, Argonde C., Vijverberg, Everard G. B., Pijnenburg, Yolande A. L.
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2023
• Subjects: Autism; behavior; Biometrics; Cognition; Dementia; Dementia disorders; Differentiation; Disorders; Dwell time; Emotion recognition; Emotions; Eye movements; eye tracking; face perception; Frontotemporal dementia; Medical imaging; Mental disorders; Mouth; Pattern recognition; Psychosis; social cognition; Social interactions; Variance analysis; face perception; biometrics; social cognition; behavior; eye tracking
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.15837

Background and purpose Early diagnosis of behavioral variant frontotemporal dementia (bvFTD) is challenging due to symptomatic overlap with primary psychiatric disorders (PPD). As emotion recognition deficits are early and key features of bvFTD, the aim was to explore processes driving social cognition deficits that may aid in the differentiation between bvFTD and PPD. Methods The total sample (N = 51) included 18 patients with bvFTD, 11 patients with PPD (mood, autism spectrum and psychotic disorders) and 22 controls from the Alzheimer Center Amsterdam of the Amsterdam UMC. Emotion recognition was assessed with the Ekman 60 Faces test, during which eye tracking metrics were collected in the first 5 s a face was presented. Group differences in dwell time on the total image as well as the circumscribed eyes area and mouth area were analysed using ANOVA, with post hoc comparisons. Results Patients with bvFTD scored lowest, patients with PPD scored intermediate and controls scored highest on emotion recognition. During facial processing, patients with bvFTD spent less dwell time on the total image than controls (mean difference 11.3%, F(2, 48) = 6.095, p = 0.004; bvFTD−controls p = 0.001, 95% confidence interval [CI] −892.64, −239.70). Dwell time on the eyes area did not differ between diagnostic groups, whilst patients with bvFTD spent less dwell time on the mouth area than PPD patients (mean difference 10.7%; F(2, 48) = 3.423, p = 0.041; bvFTD−PPD p = 0.022, 95% CI −986.38, −79.47) and controls (mean difference 7.8%; bvFTD−controls p = 0.043, 95% CI −765.91, −12.76). Conclusions In bvFTD, decreased emotion recognition may be related to reduced focus on facial hallmarks. These findings suggest a valuable role for biometrics in social cognition assessment and the differentiation between bvFTD and PPD.