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

Being able to interpret emotional expressions is fundamental to social interaction. Although deficits in emotion recognition are well-documented in dementia, they have received less attention in mild cognitive impairment (MCI). Due to the overlap in neural processes supporting emotion and cognition, early disruptions in emotion recognition may indicate broader functional decline. This study examined behavioral and neural responses to emotional faces in patients with MCI using a functional magnetic resonance imaging (fMRI) paradigm. For that aim, N=60 participants were recruited, including 30 patients with MCI and 30 healthy controls. During fMRI, participants completed a facial emotion recognition task with expressions of anger, fear, sadness, happiness, and neutral faces. Behavioral assessments further included measures of cognitive domains (attention, memory, executive functioning, language, visuospatial skills), face processing, emotional intelligence, and emotional interference. Patients with MCI showed impaired recognition of negative emotions, such as anger (β=–0.37, p<0.05), fear (β=–0.37, p<0.05), and sadness (β=–0.85, p<0.001), whereas recognition of happiness remained intact. Sadness recognition was predicted by face processing ability, and overall emotion recognition was associated with memory performance. fMRI results showed widespread, emotion-specific activation in healthy controls, particularly in occipital, frontal, and subcortical regions. Patients with MCI showed reduced activation and less differentiated patterns, though group-level BOLD differences were not statistically significant. In summary, patients with MCI demonstrated difficulties in recognizing negative emotions, which may impact social functioning, while neural mechanisms supporting emotion recognition appear largely preserved at this stage of cognitive decline.