Impaired Emotion Recognition is Sign of Behavioral Symptoms in ALS, Study Finds

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by Alice Melão |

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Difficulty in recognizing emotions may be a sign of changes in the frontal lobe of the brain and associated behavioral symptoms in patients with amyotrophic lateral sclerosis (ALS).

The study with that finding, “Deficits in Emotion Recognition as Markers of Frontal Behavioral Dysfunction in Amyotrophic Lateral Sclerosis,” was published by The Journal of Neuropsychiatry and Clinical Neurosciences.

ALS is recognized mainly for its severe and progressive motor symptoms. But patients also experience non-motor symptoms, including cognitive and behavioral problems.

A previous study revealed that patients with ALS have difficulty reading emotions due to microscopic changes in the brain. However, it is not yet clear whether emotion recognition deficits in ALS can occur independently of specific cognitive and behavioral symptoms that overlap with frontotemporal dementia.

Behavior variant frontotemporal dementia is characterized by significant changes in personality, interpersonal relationships, and conduct due to progressive nerve cell loss in the brain’s frontal lobes (the areas behind the forehead) or temporal lobes (the regions behind the ears).

A team led by Brazilian researchers investigated the possible association between recognition of facial emotions and frontal behavioral symptoms in ALS.

Twenty-one patients diagnosed with probable or definite sporadic ALS and 25 age- and sex-matched healthy volunteers were enrolled in the study.

Assessment revealed that most of the patients had some type of behavioral impairment, such as lack of motivation, changes in eating habits, or abnormal behavior. Moderate to very severe apathy was the most common neuropsychiatric syndrome, affecting 48% of the patients.

Patients also showed higher anxiety and depression scores; 43% and 33% had clinically relevant symptoms of anxiety and depression, respectively.

“Here we found that depressive or anxiety symptoms may overlap with apathy and other behavior variant frontotemporal dementia features in ALS,” researchers wrote.

In general, ALS patients showed similar scores compared to control on the Facial Emotion Recognition Test (FERT) and Ekman Faces Test. However, ALS patients had more difficulty recognizing sadness than did healthy controls. This was more noticeable in patients who had behavioral impairments.

“Taken together, these results suggest that deficits in emotion recognition co-occur with frontal behavioral symptoms in ALS,” they stated.

Still, the team did not find any correlation between FERT scores and patients’ mental status, anxiety or severity of depressive symptoms. This suggests that emotion recognition impairment in ALS “does not reflect either mood disorders or deficits in general cognition or executive functions,” the researchers said.