| Background: Facial Emotion Recognition(FER)is a social activity in which individuals recognize specific emotional states by interpreting facial features of others.The processing processes of other people’s facial feature perception,structure coding,complex visual processing and feature construction in brain regions such as occipitotemporal region,superior temporal sulcus and amygdala involved in the extracorporeal visual cortex are the embodiment of human advanced cognitive activities.Previous studies have found that FER ability is limited in patients with Alzheimer’s Disease(AD),while FER performance in patients with preclinical stage of AD including Subjective Cognitive Decline(SCD)and Mild Cognitive Impairment(MCI)is not clear,and the value of Facial Emotion Recognition Test(FERT)in early screening of patients with cognitive impairment remains to be further explored.Objective: To investigate the changes in Facial Emotion Recognition ability of subjects in SCD,MCI and AD groups with the increase of cognitive impairment and its correlation with cognitive function scores,and to evaluate the application value of FERT tool in early screening of patients with cognitive impairment.Methods: This study was a cross-sectional study design.According to the inclusion and exclusion criteria,patients aged 50 years and over who were treated in the Department of Neurology of Xi ’an Third Hospital from January 2022 to March 2023 were selected as the research objects.General information and medical history were collected for all subjects,and the cognitive function of all subjects was evaluated by neuropsychological scales(Mo CA and MMSE).According to the cognitive assessment results and disease diagnostic criteria,the enrolled subjects were divided into AD group,MCI group,SCD group and NC group.A total of 42 photos of 7 emotions(calm,happy,surprise,anger,sadness,disgust,and fear)were selected from the Chinese Affective Face Picture System.Each emotion contained low,medium,and high intensity.The FERT tool was used to evaluate the facial emotion recognition ability and record the test score.The differences in general information,cognitive function and FERT indexes were compared between the groups.Spearman correlation analysis was used to analyze the correlation between FERT score and cognitive function score.The receiver operating characteristic(ROC)curve was used to analyze the sensitivity,specificity,cut-off value and area under the curve(AUC)of FERT total score,positive(happy,surprise)and negative(anger,sadness,disgust,fear)emotion scores in distinguishing SCD,MCI and AD.Binary Logistic analysis was used to analyze the correlation between the total score of FERT and the incidence of SCD,MCI and AD,and the relationship between the total score of FERT and cognitive function after adjusting for age,gender and education level.Results:1.A total of 216 subjects were enrolled in this study,including 45 in the NC group,35 in the SCD group,112 in the MCI group,and 24 in the AD group.There were significant differences in age,gender and education level among the four groups(F=7.852,10.170,31.039,p<0.05).The degree of cognitive impairment increased with the increase of average age and the decrease of education level.There were no significant differences in marital status,physical exercise,smoking history,drinking history,and past medical history among the four groups.2.Comparison of emotion recognition ability among the four groups:(1)The total score of FERT was 28(27,29)in SCD group,24(21,27)in MCI group,12(7,9)in AD group and 32(28,35)in NC group,and the differences among the four groups were statistically significant(F=109.953,p<0.001),and there were statistically significant differences between any two groups.(2)There were significant differences among the four groups in the scores of calm,happy,surprise,sad,anger,disgust and fear;Compared with the NC group,the SCD group had impaired ability to recognize sadness and disgust,and the MCI group had decreased ability to recognize surprise,sadness,anger,disgust and fear.Compared with SCD group,MCI group showed decreased ability to recognize surprise,sadness,anger and disgust;However,the AD group showed a decrease in the ability to recognize all seven emotions compared with the other three groups.(3)There were statistically significant differences in the scores of low,medium and high intensity emotions in FERT among the four groups(F=59.598,104.583,92.304,p<0.001).Compared with NC group,the ability to recognize low and moderate intensity emotions in SCD group decreased,and the ability to recognize low,medium and high intensity emotions in MCI group decreased.Compared with the SCD group,the MCI group has a decreased ability to identify moderate and high intensity.The AD group showed a decrease in the ability to identify low,medium,and high intensity emotions compared to the other three groups.(4)There were statistically significant differences in the recognition scores of neutral(calm),positive and negative emotions among the four groups(F=52.093,63.069,96.441,p<0.001).Compared with the NC group,the SCD group had a decreased ability to recognize negative emotions,and the MCI group had a decreased ability to recognize both positive and negative emotions.Compared with the SCD group,the MCI group has a decreased ability to identify positive and negative emotions.Compared with the other three groups,the AD group showed a decrease in neutral,positive and negative emotion recognition ability.3.The results of correlation analysis between FERT and cognitive function:(1)There was a significant positive correlation between the total FERT score and Mo CA score in NC,SCD,MCI and AD groups,and the correlation coefficient gradually increased;There was a significant positive correlation between FERT total score and MMSE score in MCI and AD groups(p<0.001).(2)In all subjects,there was a significant positive correlation between the total score of FERT and Mo CA score,and the total score of FERT and negative emotion had a higher correlation,the correlation coefficients were 0.803 and0.765,respectively.There was a significant positive correlation between the FERT total score,neutral,positive and negative affect scores and MMSE score,and the correlation coefficient between the FERT total score and negative affect was 0.632 and 0.615,respectively.4.ROC analysis of the screening value of FERT total score,positive and negative affect showed that:(1)The AUC of FERT total score in distinguishing NC and SCD/MCI groups was 0.731 and 0.879,and the corresponding cut-off values were 29.5 and 26.5;At the same time,the AUC of negative affect score in distinguishing the NC group from the SCD/MCI group was close to the FERT total score,but the AUC resolution of positive affect was reduced,which was 0.573 and 0.678,respectively.(2)The AUC of FERT total score,positive affect and negative affect in distinguishing SCD and MCI groups were0.773,0.629 and 0.729,respectively,and the corresponding cut-off values were 26.5,10.5and 9.5,respectively.(3)The accuracy of FERT total score,positive emotion and negative emotion in distinguishing MCI and AD groups was increased,and the AUC was 0.932,0.879 and 0.838,respectively.The corresponding cut-off values were 19.5,7.5 and 3.5,respectively,and the sensitivity could reach more than 0.9.5.We further constructed an unadjusted Logistic regression model with the total score of FERT as the independent variable and the group of patients’ cognitive status as the dependent variable.Meanwhile,age,gender and educational level were taken as covariables to construct an adjusted Logistic regression model to clarify the relationship between the total score of FERT and the cognitive status of the subjects.The results showed that the total FERT score was an independent predictor of SCD/NC and MCI/NC(OR:0.777,95%CI: 0.670-0.900,p< 0.001;OR: 0.653,95%CI: 0.569-0.750,p<0.001),after adjusting for age,sex and education,the total score of FERT was still independently correlated with SCD and MCI;When distinguishing between SCD and MCI groups,the total FERT score predicted OR of MCI occurrence was 0.724(95%CI: 0.627-0.836,p<0.001),after adjusting for other covariates,the total FERT score remained an independent predictor of MCI.When differentiating MCI and AD,the total FERT score was an independent predictor of AD occurrence(OR: 0.666,95%CI: 0.561-0.790,p<0.001),after adjusting for other covariates,the total FERT score was still independently associated with AD.Conclusions:(1)Patients with SCD,MCI and AD showed impaired facial emotion recognition ability,mainly in the recognition of low intensity emotion and negative emotion.(2)Facial emotion recognition ability was positively correlated with cognitive function.FERT total score and negative emotion score were more correlated with Mo CA score than MMSE score.(3)The total score of FERT is independently related to the cognitive status of patients,and is not affected by age,gender and education level.Fert can distinguish SCD,MCI and AD,which can be used as a potential early cognitive screening tool. |
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