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Título

THE NEURAL BASIS OF FACIAL EMOTION RECOGNITION IN PROGRESSIVE SUPRANUCLEAR PALSY: A NEUROIMAGING STUDY

Resumo

Background: Deficits in facial emotion recognition have been described in Progressive Supranuclear Palsy (PSP). However, the neural basis of these deficits remains uncertain.
Objectives: To investigate the correlations between the Facial Emotion Recognition Test (FERT) and measures of cortical and subcortical volume in patients with PSP.
Methods: 21 patients with PSP (age = 68.0 ± 7.4 years) and 20 healthy controls (age = 67.5 ± 10.8 years) underwent cognitive assessment, including the FERT, which is composed of 35 images from Ekman’s portfolio, with 7 different emotions (happiness, sadness, fear, disgust, surprise, anger, and neutral). All participants underwent brain MRI (3T). We conducted two neuroimaging analyses: 1) subcortical structures were segmented with Freesurfer software and volumes were extracted for analyses. We explored correlations (Spearman’s test) between subcortical nuclei volumes (putamen, caudate, amygdala; corrected for total intracranial volume) and FERT scores in PSP patients; 2) voxel-based morphometry (VBM) was performed with FSL software, exploring correlations between gray matter density and FERT scores within the PSP group. Age, sex and disease duration were considered as covariates. A threshold of 50 contiguous voxels was adopted, corrected at family-wise error (FWE) at the p<0.05 threshold, for all analyses.
Results: PSP and controls did not differ on age and schooling. PSP patients performed worse than controls (p < 0.001) on the FERT (total score, disgust, anger, sadness and neutral). Compared to controls, PSP had lower volumes of brainstem (p < 0.001), caudate (p < 0.001), putamen (p < 0.001), and frontal atrophy. Within PSP patients, surprise score correlated to right (p < 0.001, rho = 0.72) and left (p < 0.003, rho = 0.66) amygdala; disgust correlated to right (p < 0.02, rho = 0.54) and left (p < 0.03, rho = 0.52) amygdala; neutral score correlated to right (p < 0.01, rho = 0.55) and left (p < 0.0001, rho = 0.74) putamen and right (p < 0.008, rho = 0.6) and left (p < 0.001, rho = 0.7) amygdala. VBM analyses yielded significant direct correlations between frontal pole and scores of disgust, sadness, anger, and surprise. Disgust also directly correlated with insula.
Conclusions: Subcortical nuclei and frontoinsular regions play a role in the recognition of facial emotions in PSP, suggesting that a complex fronto-subcortical network participate in emotional processing in the disease.

Palavras Chave

Emotions, progressive supranuclear palsy