Negative Emotion Recognition Impairments Despite Preserved Neural Activity in Patients with Mild Cognitive Impairment (MCI)

Abstract

Emotion recognition is an essential component of socio-emotional functioning, yet its alteration in mild cognitive impairment (MCI) remains insufficiently understood, particularly in relation to neural mechanisms. This study examined behavioral and neural responses to facial emotions in 60 adults (30 MCI, 30 healthy controls (HC)) using a validated fMRI emotion-recognition paradigm with anger, fear, sadness, happiness, and neutral expressions. Although groups did not differ in overall recognition accuracy, a multivariate analysis revealed a significant group effect driven by a selective impairment in sadness recognition in MCI. Accuracy for anger and fear showed weaker, but non-significant differences between groups, and happiness recognition was preserved. Face-processing ability, emotional interference, emotional intelligence, and domain-specific cognitive performance showed no significant associations with facial emotion recognition, indicating that the sadness-specific deficit was not attributable to perceptual, cognitive, or socio-emotional characteristics. In fMRI analyses, HCs showed widespread activation to emotional versus neutral faces across occipital, frontal, and subcortical regions, whereas patients with MCI exhibited spatially more restricted activation. However, whole-brain group comparisons revealed no significant differences in BOLD response amplitudes for overall emotion processing or any emotion-specific contrast. These findings indicate that MCI is characterized by a selective impairment in recognizing sadness, an emotion relying on subtle, low-intensity cues, while whole-brain analyses did not reveal statistically significant group differences in neural responses during emotion processing. This pattern shows that group differences in behavior did not correspond to group differences in measured neural activity.