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emotions misleading in Alzheimer's disease
GAINESVILLE, FL, July 2010 — Watching a
loved one struggle with Alzheimer's disease
can be a painful process, but for the
patient, the experience may be a muted one.
Alzheimer's patients can appear withdrawn
and apathetic, symptoms often attributed to
memory problems or difficulty finding the
words to communicate.
University of Florida study found that they
may also have a decreased ability to
experience emotions; that is, they do not
feel emotions as deeply as their healthy
finding in a small group of patients may be
useful for doctors assessing whether
Alzheimer's patients are clinically
study, published online in the spring issue
of the Journal of Neuropsychiatry & Clinical
Neurosciences, suggests that when
Alzheimer's patients are asked to place an
emotional value on pictures, they measure
the pleasant images as less pleasant and the
negative scenes as less negative compared
with a control group of normal elderly
people. This emotional flatness could be
incorrectly interpreted as a symptom of
found that the Alzheimer's patients as a
rule tend to go more toward the middle,"
said Kenneth Heilman, M.D., senior author of
the paper and a professor of neurology at
the College of Medicine and UF's McKnight
don't feel as positive toward the positive
pictures or as negative toward the negative
ones. They're not depressed, but their
emotional experience appears to be
research is needed, but the findings could
be valuable for clinicians trying to learn
whether a patient is depressed as well as
for families concerned about a loved one's
study presented seven patients with
Alzheimer's disease pictures of positive and
negative scenes, such as babies and spiders,
and asked them to rate each picture.
Patients recorded their emotional reaction
to the picture by marking on a piece of
paper with a happy face on one and a sad
face on the other. The closer their mark was
to either emoticon, the stronger they felt.
the time they placed their mark in the
appropriate direction, said Heilman, who is
also director of the UF Cognitive and Memory
puppy, they wouldn't rate it as high (as the
control group members did), but they would
put it more toward the happy face, showing
that they appear to understand the picture,"
they also made more inconsistent markings
than the normal control group, such as when
being shown a spider putting their mark
toward the happy face."
study's authors proposed several reasons for
why the Alzheimer's patients show a
Previous studies reveal that such symptoms
of Alzheimer's are caused by deterioration
of neural systems, Heilman said.
in its early stages, Alzheimer's destroys
the areas of the brain that produce chemical
neurotransmitters such as norepinephrine,
which is essential for experiencing fear and
anger," he said. "If we prescribed
medication to patients that replace or
increase these neurotransmitters, maybe they
would better experience emotions."
Misinterpreting the images or not
understanding the meaning of some pictures —
a comprehension disorder — could have skewed
the results, but the volunteers were given a
naming test to minimize this possibility.
Alzheimer's patients often suffer from
depression, researchers ruled it out as a
cause for lower emotional response based on
yearly face-to-face evaluations conducted
throughout the study.
Alzheimer's Association estimates 5.1
million Americans age 65 and older suffer
from Alzheimer's disease, a number that is
expected to rise to 13.5 million by 2050 if
treatments are not improved.
important implication of this work is that
when an Alzheimer's patient appears
emotionally blunted, the clinician or
caregiver should not assume the patient is
depressed and automatically treat with
antidepressants, as other organic factors
could be at work," said Todd Feinberg, M.D.,
a professor of clinical neurology and
psychiatry at Beth Israel Medical Center in
New York, who did not participate in the
findings also bring new understanding to
families of Alzheimer's patients.
"Caregivers also should be helped to
understand that it is not 'their fault' if a
loved one seems emotionally indifferent to
them," Feinberg said.
and his colleagues used a more thorough
approach to distinguish depression from
Alzheimer's symptoms, said Yonas Geda, M.D.,
an associate professor of neurology and
psychiatry at the Mayo Clinic College of
Medicine in Rochester, Minn., who reviewed
larger studies, thoroughness is sacrificed
in favor of large sample size by using
questionnaires of 10 or 20 questions
answered by caregivers or patients
questionnaire-based studies, Heilman and his
colleagues' study raises serious questions
about potential neurobiological issues to
account for the observed behavior," Yonas
replicate this thorough face-to-face
evaluation in a larger sample size? Perhaps
computers and technology may help us to
administer a rigorous evaluation that
Heilman's team did on a larger sample size."
also suggested that futures studies use
neuroimaging techniques along with the
picture test to probe a little more into the
mechanism of experiencing emotion.