title: Reduced facial expressiveness in Parkinson's disease: A pure motor disorder?
abstract: OBJECTIVE
  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.
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. Electronic address: lucia.ricciardi2@gmail.com.
authors.forename: Lucia
authors.initials: L
authors.lastname: Ricciardi
authors.affiliation: Neuromed Institute (IRCCS), Pozzilli, Isernia, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bologna
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Morgante
authors.affiliation: Department of Geriatry, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Ricciardi
authors.affiliation: Department of Geriatry, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Morabito
authors.affiliation: Department of Physical Medicine & Rehabilitation, S. Raffaele Arcangelo Fatebenefratelli Hospital, Venice, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Volpe
authors.affiliation: Neuroscience & Trauma Centre, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, United Kingdom.
authors.forename: Davide
authors.initials: D
authors.lastname: Martino
authors.affiliation: Department of Neurology, Second University of Naples, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Tessitore
authors.affiliation: Department of Geriatry, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Pomponi
authors.affiliation: Department of Neurology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Bentivoglio
authors.affiliation: Department of Geriatry, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.affiliation: Movement Disorders Center, TWH, UHN, Division of Neurology, University of Toronto, Toronto, ON, Canada.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
mesh_terms: D000342:Affective Symptoms / Q000503:physiopathology / Q000523:psychology; D000368:Aged; D004644:Emotions / Q000502:physiology*; D005145:Face / Q000503:physiopathology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000503:physiopathology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology* / Q000523:psychology; D010775:Photic Stimulation; D021641:Recognition, Psychology / Q000502:physiology*
keywords: Alexithymia; Emotion; Emotion recognition; Facial amimia; Feeling; Parkinson's disease