Highlights
- •Parkinson's disease (PD) patients may present abnormalities of spontaneous, emotional and voluntary facial movements.
- •PD patients had a global reduction of static and dynamic facial expressiveness, and an impairment of recognition of facial emotions.
- •Reduced facial expressiveness in PD may be in part related to difficulties with emotional recognition.
Abstract
Background and aims
Impaired emotional facial expressiveness is an important feature in Parkinson's disease
(PD). Although there is evidence of a possible relationship between reduced facial
expressiveness and altered emotion recognition or imagery in PD, it is unknown whether
other aspects of the emotional processing, such as subjective emotional experience
(alexithymia), might influence hypomimia in this condition. In this study wee aimed
to investigate possible relationship between reduced facial expressiveness and altered
emotion processing (including facial recognition and alexithymia) in patients with
PD.
Methods
Forty PD patients and seventeen healthy controls were evaluated. Facial expressiveness
was rated on video recordings, according to the UPDRS-III item 19 and using an ad
hoc scale assessing static and dynamic facial expression and posed emotions. Six blind
raters evaluated the patients' videos. Emotion facial recognition was tested using
the Ekman Test; alexithymia was assessed using Toronto Alexithymia Scale (TAS-20).
Results
PD patients had a significantly reduced static and dynamic facial expressiveness and
a deficit in posing happiness and surprise. They performed significantly worse than
healthy controls in recognizing surprise (p = 0.03). The Ekman total score positively correlated with the global expressiveness
(R^2 = 0.39, p = 0.01) and with the expressiveness of disgust (R^2 = 0.32, p = 0.01). The occurrence of alexithymia was not different between PD patients and HC;
however, a significant negative correlation between the expressiveness of disgust
was found for a subscore of TAS (R^2 = −.447, p = 0.007).
Conclusions
Reduced facial expressiveness in PD may be in part related to difficulties with emotional
recognition in a context of an unimpaired subjective emotional experience.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A comparison of clinical and pathological features of young- and old-onset Parkinson's disease.Neurology. 1988; 38: 1402-1406
- Facial bradykinesia.J. Neurol. Neurosurg. Psychiatry. 2013; 84: 681-685
- A controlled quantitative study of facial expression in Parkinson's disease and depression.J. Nerv. Ment. Dis. 1991; 179: 683-688
- Spontaneous and posed facial expression in Parkinson's disease.J. Int. Neuropsychol. Soc. 1996; 2: 383-391
- Emotional and nonemotional facial expressions in people with Parkinson's disease.J. Int. Neuropsychol. Soc. 2004; 10: 521-535
- Awareness of expressivity deficits in non-demented Parkinson disease.Clin. Neuropsychol. 2009; 23: 805-817
- Emotional processing in Parkinson's disease: a systematic review.Mov. Disord. 2010; 27: 186-199
- Alexithymia is a non-motor symptom of Parkinson disease.Am. J. Geriatr. Psychiatry. 2012; 20: 133-141
- A meta-analysis of performance on emotion recognition tasks in Parkinson's disease.Neuropsychology. 2010; 24: 176-191
- Alexithymia in Parkinson's disease is related to severity of depressive symptoms.Eur. J. Neurol. 2006; 13: 836-841
- Prevalence and characteristics of alexithymia in Parkinson's disease.Psychosomatics. 2010; 51: 22-28
- Alexithymia is associated with depression in de novo Parkinson's disease.Psychother. Psychosom. 2011; 80: 251-253
- The association between motor subtypes and alexithymia in de novo Parkinson's disease.J. Neurol. 2011; 258: 1042-1045
- Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.J. Neurol. Neurosurg. Psychiatry. 1992; 55: 181-184
- Members of the UPDRS Development Committee.in: Fahn S. Marsden C.D. Calne D.B. Goldstein M. The Unified Parkinson’s Disease Rating Scale. Recent Developments in Parkinson's Disease. vol. 2. Macmillan Health Care Information, Florham Park, NJ1987 (153–63-293-304)
- The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure.J. Psychosom. Res. 1994; 38: 23-32
- Facial Action Coding System: the manual on CD ROM.A Human Face, Salt Lake City2002
- The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability.Educ. Psychol. Meas. 1973; 33: 613-619
- Facial expression recognition in people with medicated and unmedicated Parkinson's disease.Neuropsychologia. 2003; 41: 1047-1057
- Disgust-specific impairment of facial expression recognition in Parkinson's disease.Brain. 2006; 129: 707-717
- Structural correlates of facial emotion recognition deficits in Parkinson's disease patients.Neuropsychologia. 2012; 50: 2121-2128
- Recognition of emotion from facial, prosodic and written verbal stimuli in Parkinson's disease.Cortex. 2002; 38: 623-630
- Unmasking the face.Prentice-Hall, Englewood Cliffs, NJ1992
- Functional neuroanatomy of perceiving surprised faces.Hum. Brain Mapp. 2004; 23: 181-187
- Inverse amygdala and medial prefrontal cortex responses to surprised faces.Neuroreport. 2003; 14: 2317-2322
- Premotor cortex and the recognition of motor actions.Cogn. Brain Res. 1996; 3: 131-141
- Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas.Proc. Natl. Acad. Sci. U. S. A. 2003 Apr 29; 100: 5497-5502
- Face to face: blocking facial mimicry can selectively impair recognition of emotional expressions.Soc. Neurosci. 2007; 2: 167-178
- Alexithymia—an independent risk factor for impulsive–compulsive disorders in Parkinson's disease.Mov. Disord. 2014; 29: 214-220
- Both of us disgusted in My insula: the common neural basis of seeing and feeling disgust.Neuron. 2003; 40: 655-664
- High agreement but low kappa: I. The problems of two paradoxes.J. Clin. Epidemiol. 1990; 43: 543-549
- Impairments of speed and amplitude of movement in Parkinson's disease: a pilot study.Mov. Disord. 2009 May 15; 24: 1001-1008
- Dopamine modulates the response of the human amygdala: a study in Parkinson's disease.J. Neurosci. 2002; 22: 9099-9103
Article info
Publication history
Published online: August 23, 2015
Accepted:
August 21,
2015
Received in revised form:
August 4,
2015
Received:
April 4,
2015
Identification
Copyright
© 2015 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
