Document Type : Original Article


1 Neurology Research Center, Kerman University of Medical Sciences, Kerman Iran

2 Department of Neurology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran


Background: Facial emotion recognition (FER) is a complex process, involving many brain circuits, including the basal ganglia that its motor involvement causes Parkinson's disease (PD). The previous studies used different tools for assessment of FER in PD. There is a discrepancy between the results of these studies due to different tools. In this study, we used a modified version of the Multimodal Emotion Recognition Test (MERT) to compare patients with PD to healthy controls (HCs).
Methods: It was a cross-sectional study with primary objective of the mean percentage of the correct answers in MERT. Subjects had to name the emotions presented with different modalities.
Results: 30 subjects were recruited and assessed in each group. The mean total MERT score was significantly lower in subjects with PD compared to HCs (35.0% vs. 44.5%). FER was significantly better when emotions were presented by video and worse when presented by still pictures. Both subjects with PD and HCs had lower MERT scores in recognizing negative emotions. There was no significant correlation between the duration and severity of PD and MERT score.
Conclusion: Our study provided more pieces of evidence for impairment of FER in PD for recognizing emotions like sadness, disgust, and fear compared to happy expressions.


  1. Adolphs R, Schul R, Tranel D. Intact recognition of facial emotion in Parkinson's disease. Neuropsychology 1998; 12(2): 253-8.
  2. Assogna F, Pontieri FE, Caltagirone C, Spalletta G. The recognition of facial emotion expressions in Parkinson's disease. Eur Neuropsychopharmacol 2008; 18(11): 835-48.
  3. Pietschnig J, Schroder L, Ratheiser I, Kryspin-Exner I, Pfluger M, Moser D, et al. Facial emotion recognition and its relationship to cognition and depressive symptoms in patients with Parkinson's disease. Int Psychogeriatr 2016; 28(7): 1165-79.
  4. Argaud S, Verin M, Sauleau P, Grandjean D. Facial emotion recognition in Parkinson's disease: A review and new hypotheses. Mov Disord 2018; 33(4): 554-67.
  5. De Risi M, Di Gennaro G, Picardi A, Casciato S, Grammaldo LG, D'Aniello A, et al. Facial emotion decoding in patients with Parkinson's disease. Int J Neurosci 2018; 128(1): 71-8.
  6. Wagenbreth C, Kuehne M, Voges J, Heinze HJ, Galazky I, Zaehle T. Deep brain stimulation of the subthalamic nucleus selectively modulates emotion recognition of facial stimuli in Parkinson's patients. J Clin Med 2019; 8(9).
  7. Palmeri R, Buono VL, Bonanno L, Allone C, Drago N, Sorbera C, et al. Impaired recognition of facial emotion in patients with parkinson disease under dopamine therapy. J Geriatr Psychiatry Neurol 2020; 33(5): 265-71.
  8. Le JF, Peron J, Biseul I, Fournier S, Sauleau P, Drapier S, et al. Subthalamic nucleus stimulation affects orbitofrontal cortex in facial emotion recognition: A PET study. Brain 2008; 131(Pt 6): 1599-608.
  9. Wabnegger A, Ille R, Schwingenschuh P, Katschnig-Winter P, Kogl-Wallner M, Wenzel K, et al. Facial emotion recognition in Parkinson's disease: An fMRI investigation. PLoS One 2015; 10(8): e0136110.
  10. Bowers D, Miller K, Bosch W, Gokcay D, Pedraza O, Springer U, et al. Faces of emotion in Parkinsons disease: Micro-expressivity and bradykinesia during voluntary facial expressions. J Int Neuropsychol Soc 2006; 12(6): 765-73.
  11. Marneweck M, Hammond G. Discriminating facial expressions of emotion and its link with perceiving visual form in Parkinson's disease. J Neurol Sci 2014; 346(1-2): 149-55.
  12. Kan Y, Kawamura M, Hasegawa Y, Mochizuki S, Nakamura K. Recognition of emotion from facial, prosodic and written verbal stimuli in Parkinson's disease. Cortex 2002; 38(4): 623-30.
  13. Benson PJ. A means of measuring facial expressions and a method for predicting emotion categories in clinical disorders of affect. J Affect Disord 1999; 55(2-3): 179-85.
  14. Hipp G, Diederich NJ, Pieria V, Vaillant M. Primary vision and facial emotion recognition in early Parkinson's disease. J Neurol Sci 2014; 338(1-2): 178-82.
  15. Assogna F, Pontieri FE, Cravello L, Peppe A, Pierantozzi M, Stefani A, et al. Intensity-dependent facial emotion recognition and cognitive functions in Parkinson's disease. J Int Neuropsychol Soc 2010; 16(5): 867-76.
  16. Pontieri FE, Assogna F, Stefani A, Pierantozzi M, Meco G, Benincasa D, et al. Sad and happy facial emotion recognition impairment in progressive supranuclear palsy in comparison with Parkinson's disease. Parkinsonism Relat Disord 2012; 18(7): 871-5.
  17. Narme P, Bonnet AM, Dubois B, Chaby L. Understanding facial emotion perception in Parkinson's disease: the role of configural processing. Neuropsychologia 2011; 49(12): 3295-302.
  18. Ibarretxe-Bilbao N, Junque C, Tolosa E, Marti MJ, Valldeoriola F, Bargallo N, et al. Neuroanatomical correlates of impaired decision-making and facial emotion recognition in early Parkinson's disease. Eur J Neurosci 2009; 30(6): 1162-71.
  19. Baggio HC, Segura B, Ibarretxe-Bilbao N, Valldeoriola F, Marti MJ, Compta Y, et al. Structural correlates of facial emotion recognition deficits in Parkinson's disease patients. Neuropsychologia 2012; 50(8): 2121-8.
  20. Ricciardi L, Visco-Comandini F, Erro R, Morgante F, Bologna M, Fasano A, et al. Facial emotion recognition and expression in Parkinson's disease: An emotional mirror mechanism? PLoS One 2017; 12(1): e0169110.
  21. Dan R, Ruzicka F, Bezdicek O, Roth J, Ruzicka E, Vymazal J, et al. Impact of dopamine and cognitive impairment on neural reactivity to facial emotion in Parkinson's disease. Eur Neuropsychopharmacol 2019; 29(11): 1258-72.