Yamaguchi Facial Expression-Making Task in Alzheimer's Disease: A Novel and Enjoyable Make-a-Face Game

Abstract

Background: To assess the ability to make emotional facial expressions, we newly developed the Yamaguchi facial expression-making task (Y-FEMT).

Method: We recruited 20 normal controls and 61 outpatients: 10 with amnestic mild cognitive impairment (aMCI), 34 with mild Alzheimer's disease (AD), and 17 with moderate AD. In the Y-FEMT, smile and anger expressions were made by arranging face parts. We examined the relationship between each Y-FEMT score and the Mini-Mental State Examination (MMSE) score or overlapping figure identification test (Fig-test).

Results: The Total score (0-20) was nearly achieved in controls (18.9 ± 1.4) and declined with AD progression (aMCI 17.2 ± 2.4, mild AD 15.7 ± 2.6, moderate AD 12.3 ± 2.7). The Anger score (0-10) was significantly lower than the Smile score (0-10) in mild and moderate AD (p = 0.007 and p = 0.006, respectively). The Structure score (0-6 each) correlated well with both the MMSE score (r = 0.44, p < 0.001) and Fig-test (r = 0.45, p < 0.001), whereas the Expression score (0-4 each) correlated only with the MMSE score (r = 0.33, p = 0.01). The Subjective scores (0-4), evaluated by 10 therapists, highly correlated with the Total score. Additionally, the Y-FEMT promoted laughter and a convivial atmosphere.

Conclusion: The Y-FEMT pleasantly assessed the ability to make emotional facial expressions without special equipment. Furthermore, the Y-FEMT may provide helpful clues for caregivers to achieve good communication with AD patients for better care.

Keywords: Behavioral/psychiatric symptoms of dementia; Caregivers; Cognitive tests; Dementia; Dementia care; Emotional reactions to dementia; Facial expression.

Figures

Fig. 1

Parts of the Y-FEMT, exemplary results and error patterns. a The Y-FEMT consists of one outline plate and six simple parts of the human face. Exemplary results of the Smile task (b; Smile score was 10/10) and Anger task (c; Anger score was 10/10) in healthy elderly people. d–f Examples of the Smile task in AD patients. The score was decreased by 1 point for incorrect orientation of the eyes, but adopting the eyebrows as a moustache was not considered a mistake (d; Smile score was 9/10). Orientation of the nose is upside-down (e; Smile score was 9/10). Placement of the nose and symmetric property are different and expression score was 3 (f; Smile score was 7/10). g, h Examples of the Anger task in mild-to-moderate AD patients. Only the position of the eyebrows and eyes are correct, each gaining 1 point (g; Anger score was 2/10), and the fundamental structure of the face was good, except that the orientation of the eyes is left-right reversed, but the facial expression is different (h; Anger score was 5/10).

Fig. 2

Y-FEMT scores in four groups. Numbers on the graph indicate mean ± SE. Point allocation for the Total score is 0–20 (a), for the Smile score and Anger score it is 0–10 (b), for the Structure score 0–12 and for the Expression score it is 0–8 (c). All scores decreased with the progression of AD. There was a significant difference between mild and moderate AD except for the Expression score. * p < 0.05, ** p < 0.01, *** p < 0.001; n.s. = Not significant. ANCOVA with covariates of age and educational years.