Deficits in emotion processing in Alzheimer’s disease: a systematic review

Silva, Rogeria Cristina Rangel da; Carvalho, Raquel Luíza Santos de; Dourado, Marcia Cristina Nascimento

doi:10.1590/1980-57642021dn15-030003

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Brasil

Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 15 (03) • Jul-Sep 2021 • https://doi.org/10.1590/1980-57642021dn15-030003 copy

Deficits in emotion processing in Alzheimer’s disease: a systematic review

Déficits no processamento emocional na doença de Alzheimer: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Emotional processing involves the ability of the individual to infer emotional information. There is no consensus about how Alzheimer’s disease (AD) affects emotional processing. Objective: Our aim is to systematically review the impact of AD on emotion processing.

Methods:

We conducted a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search was performed using the electronic databases MEDLINE (PubMed) and Science Citation Index (Institute for Scientific Information [ISI]). The following descriptors were used in the review process: emotion or emotional processing, cognition or cognitive functions, and Alzheimer disease or Alzheimer’s disease. This systematic review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42018115891.

Results:

We identified 425 articles, 19 of which met our criteria. Visual emotional stimuli were the most used among studies. Most studies used tasks of emotional naming, discrimination, identification, and correspondence. The results were contradictory. Many studies reported that individuals with AD were impaired on emotional perception tasks, while other results reported preserved skills. The relationship between emotional processing and cognition is also unclear. Some studies suggested that general cognitive performance affects performance in emotional perception tasks among people with AD, but other studies have shown deficits in recognizing emotion, regardless of cognitive performance.

Conclusions:

Studies are scarce, present contradictory results, and report impairment in emotional processing in relation to cognition. Moreover, the analyses of the correlation between emotion processing and cognitive functioning failed to reveal clear relationships.

Keywords:
Alzheimer’s disease; cognition; emotion

Authors, year	Design	Sample	AD diagnosis	Objective	Emotional processing evaluation	Cognitive evaluation	Quality assessment
Bourgin, 2018⁴¹41. Bourgin J, Guyader N, Chauvin A, Juphard A, Sauvée M, Moreaud O, et al. Early Emotional Attention is Impacted in Alzheimer’s Disease: An Eye-Tracking Study. J Alzheimers Dis. 2018;63(4):1445-58. https://doi.org/10.3233/JAD-180170 https://doi.org/https://doi.org/10.3233/...	Cross-sectional	AD 16 HOAs 25	NINCDS-ADRDA Imaging exams	To determine whether early emotional attention mechanisms are affected by AD.	An eye-tracking technique during a simple but time-constrained cognitive task.	MMSE BDI	*****
Daley, 2018³⁹39. Daley RT, Sugarman MA, Shirk SD. Spared emotional perception in patients with Alzheimer’s disease is associated with negative caregiver outcomes. Aging Ment Health. 2018;22(5):595-602. https://doi.org/10.1080/13607863.2017.1286457 https://doi.org/https://doi.org/10.1080/...	Cross-sectional	AD=28 OCs 30	NINCDS-ADRDA	To investigate the relationship between emotional perception abilities in AD participants and CG well-being.	Advanced Clinical Solutions Social Perception subtest (ACS-SP)	Montreal Cognitive Assessment (MoCA).	*****
Dourado, 2019⁵⁶56. Dourado MC, Torres MM, Simões NJ, Alves G, Alves C. Facial expression recognition patterns in mild and moderate Alzheimer’s disease. J Alzheimers Dis. 2019;69(2):539-49. https://doi.org/10.3233/JAD-181101 https://doi.org/https://doi.org/10.3233/...	Cross-sectional	52 participants AD (mild n=29; moderate n=23)	DSM-IV-TR Imaging exams	To compare facial expression recognition in this AD sample and to identify which factors were associated with the impairment of the ability according to disease severity	The protocol FACES	Assessment Scale– Cognitive Subscale (ADAS-Cog), MMSE, Wechsler Digit Span Test, TMT And Semantic fluency tests	*****
Duclos, 2018⁴²42. Duclos H, Bejanin A, Eustache F, Desgranges B, Laisney M. Role of context in affective Theory of Mind in Alzheimer’s disease. Neuropsychologia. 2018;19:363-72. https://doi.org/10.1016/j.neuropsychologia.2018.08.025 https://doi.org/https://doi.org/10.1016/...	Cross-sectional	n=60 AD 20 HOS 20 and HYS 20	NINCDS-ADRDA	To assess both decoding and reasoning processes in AD, as well as the effect of context on emotion attribution	Peter and Mary emotion tasks Battery	MMSE	*****
Giffard, 2009⁴³43. Giffard B, Laisney M, Eustache F, Desgranges B. Can the emotional connotation of concepts modulate the lexico-semantic deficits in Alzheimer’s disease? Neuropsychologia. 2009;47(1):258-67. https://doi.org/10.1016/j.neuropsychologia.2008.07.013 https://doi.org/https://doi.org/10.1016/...	Cross-sectional	AD 26 CG 26	NINCDS-ADRDA	To introduce and control the emotional nature of concepts in order to conduct a more ecological investigation of semantic memory in AD using a semantic and affective priming paradigm.	The lexical decision task was composed of 270 pairs of stimuli.	MDRS	****
Kalenzaga, 2013⁴⁴44. Kalenzaga S, Clarys D. Self-referential processing in Alzheimer’s disease: Two different ways of processing self-knowledge? J Clin Exp Neuropsychol. 2013;35(5):455-71. https://doi.org/10.1080/13803395.2013.789485 https://doi.org/https://doi.org/10.1080/...	Cross-sectional	AD 22 CG 21	NINCDS-ADRDA	To explore the impairment in patients with AD working self with regard to the affective dimension of AD.	Remember/Know/Guess paradigm following encoding of emotional and neutral words.	MDRS MMSE	****
Kalenzaga, 2013⁴⁵45. Kalenzaga S, Bugaïska A, Clarys D. Self-reference effect and autonoetic consciousness in Alzheimer disease. Alzheimer Dis Assoc Disord. 2013;27(2):116-22. https://doi.org/10.1097/WAD.0b013e318257dc31 https://doi.org/https://doi.org/10.1097/...	Cross-sectional	n=40 AD 22 CG 18	NINCDS-ADRDA	To investigate the effect of emotional words encoded with reference to the self on the state of consciousness associated with memory retrieval in AD.	Remember/Know/Guess paradigm following encoding of emotional and neutral words.	MMSE MDRS	****
Kalenzaga, 2014⁴⁶46. Kalenzaga S, Piolino P, Clarys D. The emotional memory effect in Alzheimer’s disease: Emotional words enhance recollective experience similarly in patients and control participants. Cogn Emotion. 2014;29(2):342-50. https://doi.org/10.1080/02699931.2014.907127 https://doi.org/https://doi.org/10.1080/...	Cross-sectional	n=33 AD 18 CG 15	NINCDS-ADRDA	To investigate emotional memory enhancement (EME) in AD. And in exploring which memory process (i.e., recollection or familiarity) could be improved by emotional information in the course of the disease.	Remember/Know/Guess paradigm following encoding of emotional and neutral words.	MDRS	****
Kalenzaga, 2016⁴⁷47. Kalenzaga S, Lamidey V, Ergis A-M, Clarys D, Piolino P. The positivity bias in aging: Motivation or degradation? Emotion. 2016;16(5):602-10. https://doi.org/10.1037/emo0000170 https://doi.org/https://doi.org/10.1037/...	Cross-sectional	n=155 YA 38 OA 39 VOA 37 AD 41	NINCDS-ADRDA	To introduce some elements concerning positivity effect in aging	Emotional valence rating using an 8-point scale (1 highly negative, 8 highly positive).	MMSE	****
Laisney, 2013⁴⁸48. Laisney M, Bon L, Guiziou C, Daluzeau N, Eustache F, Desgranges B. Cognitive and affective Theory of Mind in mild to moderate Alzheimer’s disease. J Neuropsychol. 2013;7(1):107-20. https://doi.org/10.1111/j.1748-6653.2012.02038.x https://doi.org/https://doi.org/10.1111/...	Cross-sectional	16 AD 15 CG	NINCDS-ADRDA	To investigate changes in the cognitive and affective dimensions of ToM in AD	Affective ToM was assessed via a modified version of the Reading the Mind in the Eyes test	Cognitive ToM was assessed by means of preference judgment (PJ) and FB tasks.	*****
Maki, 2013⁴⁹49. Maki Y, Yoshida H, Yamaguchi T, Yamaguchi H. Relative preservation of the recognition of positive facial expression “happiness” in Alzheimer disease. Int Psychogeriatr. 2013;25(1):105-10. https://doi.org/10.1017/S1041610212001482 https://doi.org/https://doi.org/10.1017/...	Cross-sectional	n=54 AD 12 ANC 17 YNC 25	NINCDS-ADRDA	To examine whether recognition of positive facial expressions is preserved in patients with AD	DB99 (Advanced Telecommunications Research Institute International)	CDR	*****
Mograbi, 2012⁵⁰50. Mograbi DC, Brown RG, Morris RG. Emotional reactivity to film material in Alzheimer’s disease. Dement Geriatr Cogn Disord. 2012;34(5-6):351-9. https://doi.org/10.1159/000343930 https://doi.org/https://doi.org/10.1159/...	Cross-sectional	n=43 AD 22 CG 21	DSM-IV-TR	To explore emotional reactivity in mild to moderate AD using film material, investigating the influence of dementia-related material and awareness of condition.	The rating of facial expressions was made with EMFACS, a selective system based on the Facial Action Coding System (FACS).	MMSE, CERAD	****
Mograbi, 2012⁵¹51. Mograbi DC, Brown RG, Salas C, Morris RG. Emotional reactivity and awareness of task performance in Alzheimer’s disease. Neuropsychologia. 2012;50(8):2075-84. https://doi.org/10.1016/j.neuropsychologia.2012.05.008 https://doi.org/https://doi.org/10.1016/...	Cross-sectional	AD 23 CG 21	DSM-IV-TR	To investigate emotional reactions to success or failure in tasks despite unawareness of performance in AD.	The rating of facial expressions was made with EMFACS, a selective system based on the Facial Action Coding System (FACS). and Mann–Whitney U-test.	MMSE, CERAD	*****
Monti, 2010⁵²52. Monti JM, Weintraub S, Egner T. Differential age-related decline in conflict-driven task-set shielding from emotional versus non-emotional distracters. Neuropsychologia. 2010;48(6):1697-706. https://doi.org/10.1016/j.neuropsychologia.2010.02.017 https://doi.org/https://doi.org/10.1016/...	Cross-sectional	PRAD 19 HEA 15 HYA 22	NINCDS-ADRDA	To evaluate the efficacy of non-emotional and emotional conflict adaptation mechanisms in healthy young, healthy elderly, and PRAD.	Presentation software Pictures of Facial Affect FACS	CDR	***
Sapey, 2015⁵³53. Sapey-Triomphe L-A, Heckemann RA, Boublay N, Dorey J-M, Hénaff M-A, Rouch I. Neuroanatomical correlates of recognizing face expressions in mild stages of Alzheimer’s disease. PLoS One. 2015;10(12):e0143586. https://doi.org/10.1371/journal.pone.0143586 https://doi.org/https://doi.org/10.1371/...	Cross-sectional	n=78 AD 39 HC 39	NINCDS-ADRDA	To better specify the early emotion recognition deficits at mild stages of AD and to disentangle their neuroanatomical correlates.	Facial emotional expression recognition task.	MMSE, CDR	****
Sava, 2017⁵⁴54. Sava A-A, Krolak-Salmon P, Delphin-Combe F, Cloarec M, Chainay H. Memory for faces with emotional expressions in Alzheimer’s disease and healthy older participants: positivity effect is not only due to familiarity. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2017;24(1):1-28. https://doi.org/10.1080/13825585.2016.1143444 https://doi.org/https://doi.org/10.1080/...	Cross-sectional	n=63 AD 17 HO 21 HYs 25 n=60 AD 18 HO 21 HYs 21	NINCDS-ADRDA Brain morphology imaging	To compare the memory performance of healthy young and older participants and patients with AD for faces with positive, neutral, and negative emotional expressions in tasks in which memory performance could not be enhanced by familiarity.	Montreal Set of Facial Displays of Emotion	MMSE	*****
Seid, 2012⁵⁷57. Seidl U, Lueken U, Thomann PA, Kruse A, Schröder J. Facial expression in Alzheimer’s disease. Am J Alzheimers Dis Other Dement. 2012;27(2):100-6. https://doi.org/10.1177/1533317512440495 https://doi.org/https://doi.org/10.1177/...	Cross-sectional	AD 47	NINCDS-ADRDA	To explore the determinants of emotional facial expression in AD and to address the impact of cognitive and neuropsychiatric symptoms, which were considered as potential moderating variables.	International affective picture system (IAPS). The rating of facial expressions was made with EMFACS, a selective system based on the Facial Action Coding System (FACS).	MMSE, GDS, NPI AES	****
Torres, 2015⁵⁸58. Torres B, Santos RL, Sousa MFB. de, Simões Neto JP, Nogueira MML, Belfort TT, et al. Facial expression recognition in Alzheimer’s disease: a longitudinal study. Arq Neuro-Psiquiatr. 2015;73(5):383-9. https://doi.org/10.1590/0004-282X20150009 https://doi.org/https://doi.org/10.1590/...	Longitudinal	AD 30	DSM-IV-TR And NINCDS-ADRDA	To investigate the patterns of change in the ability to recognize emotions in facial expressions among people with mild AD and to explore the sociodemographic and clinical factors that may influence facial emotion recognition in AD over time	The protocol FACES	CDR MMSE	*****
Werheid, 2011⁵⁵55. Werheid K, McDonald RS, Simmons-Stern N, Ally BA, Budson AE. Familiar smiling faces in Alzheimer’s disease: Understanding the positivity-related recognition bias. Neuropsychologia. 2011;49(1):2935-40. https://doi.org/10.1016/j.neuropsychologia.2011.06.022 https://doi.org/https://doi.org/10.1016/...	Cross-sectional	AD 18 CG 18	Not reported	To compare patients with mild AD and age-matched healthy adults with respect to performance in a recognition task involving positive, negative, and neutral faces.	Benton Facial Recognition Test PANAS	MEEM CERAD	****

S. No.	Author, Year	Sample	Stimuli and emotions	Tasks	Control tasks	Results
01	Bourgin, 2018⁴¹41. Bourgin J, Guyader N, Chauvin A, Juphard A, Sauvée M, Moreaud O, et al. Early Emotional Attention is Impacted in Alzheimer’s Disease: An Eye-Tracking Study. J Alzheimers Dis. 2018;63(4):1445-58. https://doi.org/10.3233/JAD-180170 https://doi.org/https://doi.org/10.3233/...	AD=16 HOAs=25	The stimuli were 96 color images of natural or manufactured objects, presented against a white background at a visual angle of 9×9.	Saccadic task involving both prosaccades and antisaccades.	An eye-tracking technique during a simple but time-constrained cognitive task	The results suggest that early emotional attention is indeed impaired in AD
02	Daley, 2018³⁹39. Daley RT, Sugarman MA, Shirk SD. Spared emotional perception in patients with Alzheimer’s disease is associated with negative caregiver outcomes. Aging Ment Health. 2018;22(5):595-602. https://doi.org/10.1080/13607863.2017.1286457 https://doi.org/https://doi.org/10.1080/...	AD=28 CG = 28 OCs=30	The Advanced Clinical Solutions Social Perception subtest (ACS-SP) to measure emotional perception abilities). Happy, sad, angry, disgusted, afraid, surprised, or neutral.	The Affect Naming task, the Prosody-Face Matching task, and the Prosody-Pair Matching task.	Emotion identification, emotion discrimination, and emotion matching.	The patient group performed significantly worse than control group on measures of cognition and emotional perception.
03	Dourado, 2019⁵⁶56. Dourado MC, Torres MM, Simões NJ, Alves G, Alves C. Facial expression recognition patterns in mild and moderate Alzheimer’s disease. J Alzheimers Dis. 2019;69(2):539-49. https://doi.org/10.3233/JAD-181101 https://doi.org/https://doi.org/10.3233/...	52 participants AD mild n=29 AD moderate n=23	Face drawings Sadness, happiness, anger, or surprise	Matching: instructions–match target face with one of four alternatives; point/verbal response to another example of same emotion and three other expressions. Selection: instructions–point to the sad faces/choose face that matches situation; point response to one of four alternatives.	The subjects must select the target of three other distractors in the same category. Identity discrimination: (same/different emotion). Indicate which of the four drawings best depicts that specific emotion. And indicate the drawing that best described the emotion he had inferred from the stimulus.	Emotional processing difficulties across AD stages. However, when participants needed to recognize the most salient emotion in a situation with evident emotional content, the results suggest that in both groups, there was no influence of cognitive impairment.
04	Duclos, 2018⁴²42. Duclos H, Bejanin A, Eustache F, Desgranges B, Laisney M. Role of context in affective Theory of Mind in Alzheimer’s disease. Neuropsychologia. 2018;19:363-72. https://doi.org/10.1016/j.neuropsychologia.2018.08.025 https://doi.org/https://doi.org/10.1016/...	n=60 AD 20 HOS 20 HYS 20	The Peter and Mary emotion tasks Battery. Two basic emotions (i.e., anger and surprise), two self-consciousness emotions (i.e., embarrassment and pride), plus the neutral state.	(1) context task, (2) face task, and (3) context–face task	Identification of emotions (What is the emotion expressed by the character?), Discrimination of emotions (Which of the four situations could induce that emotion), Correspondence of emotions (Does the emotion expressed by the character correspond to the context?).	The results suggest that patients with AD have difficulty attributing emotional mental states, and deficits in social norm knowledge and the presence of incongruent information may heighten this difficulty.
05	Giffard, 2009⁴³43. Giffard B, Laisney M, Eustache F, Desgranges B. Can the emotional connotation of concepts modulate the lexico-semantic deficits in Alzheimer’s disease? Neuropsychologia. 2009;47(1):258-67. https://doi.org/10.1016/j.neuropsychologia.2008.07.013 https://doi.org/https://doi.org/10.1016/...	AD 26 CG 26	Lists of words (neutral, positive, and negative).	Semantic priming task The lexical decision task.	Identification of words	The results show that this emotional process is preserved in AD and may even help patients to bind semantically close emotional concepts together more tightly.
06	Kalenzaga, 2013⁴⁴44. Kalenzaga S, Clarys D. Self-referential processing in Alzheimer’s disease: Two different ways of processing self-knowledge? J Clin Exp Neuropsychol. 2013;35(5):455-71. https://doi.org/10.1080/13803395.2013.789485 https://doi.org/https://doi.org/10.1080/...	AD 22 CG 21	Two lists of 30 personality trait adjectives were selected from a normalized pool. Paradigms Remember/Know/Guess	Remember/Know/Guess.	The participants were asked to underline the words they recognized from the study list and to indicate whether or not they had a conscious recollection of the learning sequence.	Results indicate that self-reference increased autonoetic consciousness only for emotional and particularly negative trait adjectives.
07	Kalenzaga, 2013⁴⁵45. Kalenzaga S, Bugaïska A, Clarys D. Self-reference effect and autonoetic consciousness in Alzheimer disease. Alzheimer Dis Assoc Disord. 2013;27(2):116-22. https://doi.org/10.1097/WAD.0b013e318257dc31 https://doi.org/https://doi.org/10.1097/...	n=40 AD 22 CG 18	Two lists of 30 personality trait adjectives were selected from a normalized pool.	Remember/Know/Guess.	Read aloud, answer questions about yourself, and underline the words you recognized from the list of studies. Report whether or not they had a conscious memory of the learning sequence.	Results for patients with AD show that self-reference increased autonoetic consciousness only for emotional and particularly negative trait adjectives.
08	Kalenzaga, 2014⁴⁶46. Kalenzaga S, Piolino P, Clarys D. The emotional memory effect in Alzheimer’s disease: Emotional words enhance recollective experience similarly in patients and control participants. Cogn Emotion. 2014;29(2):342-50. https://doi.org/10.1080/02699931.2014.907127 https://doi.org/https://doi.org/10.1080/...	n=33 AD 18 CG 15	64 nouns/words were divided into four lists of 16 words (i.e., 8 neutral, 4 positive, and 4 negative) matched for frequency, concreteness, and valence.	Remember/Know/Guess	Underline the identified words from the list of studies and indicate whether or not they had a conscious recall of the learning sequence.	Patients with AD were as able as normal controls to benefit from the emotional content of information to improve the recollection of details.
09	Kalenzaga, 2016⁴⁷47. Kalenzaga S, Lamidey V, Ergis A-M, Clarys D, Piolino P. The positivity bias in aging: Motivation or degradation? Emotion. 2016;16(5):602-10. https://doi.org/10.1037/emo0000170 https://doi.org/https://doi.org/10.1037/...	n=155 YA 38 OA 39 VOA 37 AD 41	64 nouns/words were divided into four lists of 16 words (i.e., 8 neutral, 4 positive, and 4 negative) matched for frequency, concreteness, and valence.	The task was presented using the SuperLabPro software.	Participants had to read aloud and learn the words, had to generate a sentence containing the word, and after trying four items, the participants had to remember the four words and the corresponding phrases produced.	The results indicated that the positivity bias is most likely to occur in individuals whose cognitive functions are preserved, after long retention delay, and in experimental conditions that do not constrain encoding.
10	Laisney, 2013⁴⁸48. Laisney M, Bon L, Guiziou C, Daluzeau N, Eustache F, Desgranges B. Cognitive and affective Theory of Mind in mild to moderate Alzheimer’s disease. J Neuropsychol. 2013;7(1):107-20. https://doi.org/10.1111/j.1748-6653.2012.02038.x https://doi.org/https://doi.org/10.1111/...	AD 16 CG 15	Preference judgment task, False-belief task, and Reading the Mind in the Eyes test	Reading the Mind in the Eyes test	Identification in Matching emotions and Discrimination	We observed impaired performances by patients with AD on all the ToM tasks. However, affective ToM seemed affected to a lesser degree than the cognitive dimension.
11	Maki, 2013⁴⁹49. Maki Y, Yoshida H, Yamaguchi T, Yamaguchi H. Relative preservation of the recognition of positive facial expression “happiness” in Alzheimer disease. Int Psychogeriatr. 2013;25(1):105-10. https://doi.org/10.1017/S1041610212001482 https://doi.org/https://doi.org/10.1017/...	n=54 AD 12 ANC 17 YNC 25	600 colored face images of 6 basic emotional expressions (i.e., happiness, surprise, anger, sadness, fear, and disgust). DB99.	The participants were required to answer by touching the 100% face that corresponded to the expression of intermediate face.	Emotion identification, (What is the emotion expressed by the face/photo on the computer screen?)	In recognition of happiness, there was no difference in sensitivity between YNC and ANC, and between ANC and patients with AD. Patients with AD were less sensitive than ANC in recognition of sadness, surprise, and anger.
12	Mograbi, 2012⁵⁰50. Mograbi DC, Brown RG, Morris RG. Emotional reactivity to film material in Alzheimer’s disease. Dement Geriatr Cogn Disord. 2012;34(5-6):351-9. https://doi.org/10.1159/000343930 https://doi.org/https://doi.org/10.1159/...	n=43 AD 22 CG 21	The groups watched four films, namely, one neutral, one positive, and two negative. Joyful and sad, relaxed and frightened, calm and irritated, and hopeful and hopeless. Joy, surprise, fear, sadness, disgust, anger, and contempt were evaluated.	The groups watched four film excerpts, namely, one neutral, one positive, and two negative.	Self-evaluation (How do you feel after watching this?’). For each emotion, participants were asked to rate how they were feeling.	The study indicates that patients show emotional reactions congruent with stimulus valence, but that subjective reactivity is reduced in comparison with healthy older adults for negative material
13	Mograbi, 2012⁵¹51. Mograbi DC, Brown RG, Salas C, Morris RG. Emotional reactivity and awareness of task performance in Alzheimer’s disease. Neuropsychologia. 2012;50(8):2075-84. https://doi.org/10.1016/j.neuropsychologia.2012.05.008 https://doi.org/https://doi.org/10.1016/...	AD 23 CG 21	Two success–failure computerized paradigms were developed, i.e., one based on reaction time and the other on memory. Frustrated, satisfied; disappointed, satisfied; ashamed, feeling good about himself; and bored, energetic.	Success condition task and one in a failure condition.	Performance evaluation	The results indicated that, relative to controls, patients with AD exhibited impaired awareness of performance, but comparable differential reactivity to failure relative to success tasks, both in terms of self-report and facial expressions.
14	Monti, 2010⁵²52. Monti JM, Weintraub S, Egner T. Differential age-related decline in conflict-driven task-set shielding from emotional versus non-emotional distracters. Neuropsychologia. 2010;48(6):1697-706. https://doi.org/10.1016/j.neuropsychologia.2010.02.017 https://doi.org/https://doi.org/10.1016/...	PRAD 19 HE 15 YA 22	Ekman photos: Happy and Fear	The nonemotional conflict task versus emotional conflict task.	Emotion identification, (What is the emotion expressed by the face/photo on the computer screen?)	It was found that, compared to the young adult cohort, the healthy elderly displayed deficits in task-set shielding in the non-emotional but not in the emotional task, whereas PRAD subjects displayed impaired performance in both tasks.
15	Sapey, 2015⁵³53. Sapey-Triomphe L-A, Heckemann RA, Boublay N, Dorey J-M, Hénaff M-A, Rouch I. Neuroanatomical correlates of recognizing face expressions in mild stages of Alzheimer’s disease. PLoS One. 2015;10(12):e0143586. https://doi.org/10.1371/journal.pone.0143586 https://doi.org/https://doi.org/10.1371/...	n=78 AD 39 CG 39	Photographs of faces and answer options were displayed on a computer screen. Happiness, anger, disgust, fear, and neutral.	Behavioral tasks, facial gender recognition task, and facial emotional expression recognition task.	Participants were asked to determine whether the face was more feminine or masculine. Participants were asked to select the label that best described the emotional expression	The results indicate that emotion recognition is impaired specifically, rather than as a consequence of global cognitive dysfunction.
16	Sava, 2017⁵⁴54. Sava A-A, Krolak-Salmon P, Delphin-Combe F, Cloarec M, Chainay H. Memory for faces with emotional expressions in Alzheimer’s disease and healthy older participants: positivity effect is not only due to familiarity. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2017;24(1):1-28. https://doi.org/10.1080/13825585.2016.1143444 https://doi.org/https://doi.org/10.1080/...	n=63 AD 17 HO 21 HY 25 n=60 AD 18 HO 21 HY 21	The stimuli were 96 black and white photographs (7 cm × 5 cm) with 32 human adult faces against a gray background (each one depicting sad, neutral, and happy emotional expressions). Stimuli were selected from the Montreal Set of Facial Displays of Emotion	Delayed matching-to-sample task, and Emotion classification task.	Identity discrimination: indicate who the same person is. Emotion identification (What is the emotion expressed by the character?)	Results suggest that the positivity effect in memory is not entirely due to the sense of familiarity for smiling faces.
17	Seidl, 2012⁵⁷57. Seidl U, Lueken U, Thomann PA, Kruse A, Schröder J. Facial expression in Alzheimer’s disease. Am J Alzheimers Dis Other Dement. 2012;27(2):100-6. https://doi.org/10.1177/1533317512440495 https://doi.org/https://doi.org/10.1177/...	47 participants AD	Photos-IAPS: joy, surprise joy, surprise, anger, fear, disgust, sadness, and contempt.	The participants were encouraged to focus their attention on each presented picture (“Let’s have a look at this one”); simultaneously, facial expression was videotaped.	Attentional focus in either emotion-eliciting or neutral images	The result that cognitive deficits are associated with loss of specific facial expression point toward a progressive loss of control of facial expressions, corroborating previous findings.
18	Torres, 2015⁵⁸58. Torres B, Santos RL, Sousa MFB. de, Simões Neto JP, Nogueira MML, Belfort TT, et al. Facial expression recognition in Alzheimer’s disease: a longitudinal study. Arq Neuro-Psiquiatr. 2015;73(5):383-9. https://doi.org/10.1590/0004-282X20150009 https://doi.org/https://doi.org/10.1590/...	AD 30 CG 30	Face drawings Sadness, happiness, anger, or surprise	Tasks of identifying faces, understanding facial emotions, recognizing expression of emotion, and understanding the nature of a situation and the appropriate emotional state that someone would experience in that situation	The subjects must select the target of three other distractors in the same category. Identity discrimination: (same/different emotion). Indicate which of the four drawings best depicts that specific emotion. And indicate the drawing that best described the emotion he had inferred from the stimulus	The findings suggest that people with mild AD have difficulties making emotional interpretations of the environment, mostly due to their worsening global cognition. People with AD had an impaired ability to perceive emotions from situations, particularly when the emotions presented were relatively subtle.
19	Werheid, 2011⁵⁵55. Werheid K, McDonald RS, Simmons-Stern N, Ally BA, Budson AE. Familiar smiling faces in Alzheimer’s disease: Understanding the positivity-related recognition bias. Neuropsychologia. 2011;49(1):2935-40. https://doi.org/10.1016/j.neuropsychologia.2011.06.022 https://doi.org/https://doi.org/10.1016/...	AD 18 CG 18	The stimulus material consisted of 192 portraits of Caucasian faces gathered from different databases and selected based on computer-assisted 7-step valence ratings: happy, neutral, and angry	The participants’ task was to decide whether they had previously seen a portrait of the depicted person. Finally, on completion of the task, subjects were asked to fill out the post-test PANAS forms	Identity discrimination: indicate whether same or different person	The pattern of results supports the view that the positivity-induced recognition bias represents a compensatory, gist-based memory process that is applied when item-based recognition fails.

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[1] Rogeria Cristina Rangel da Silva. Rua Gonzaga Bastos, 12 – Jardim Meriti – 25555-040 Rio de Janeiro RJ – Brazil. E-mail: rogeria.rangel@hotmail.com