Right hemisphere dysfunction is better predicted by emotional prosody impairments as compared to neglect.

BACKGROUND: Neurologists generally consider hemispatial neglect to be the primary cognitive deficit following right hemisphere lesions. However, the right hemisphere has a critical role in many cognitive, communication and social functions; for example, in processing emotional prosody (tone of voice). We tested the hypothesis that impaired recognition of emotional prosody is a more accurate indicator of right hemisphere dysfunction than is neglect. METHODS: We tested 28 right hemisphere stroke (RHS) patients and 24 hospitalized age and education matched controls with MRI, prosody testing and a hemispatial neglect battery. Emotion categorization tasks assessed recognition of emotions from prosodic cues. Receiver operating characteristic (ROC) analyses were used to compare tests in their ability to distinguish stroke patients from controls. RESULTS: ROC analyses revealed that the Prosody Score was more effective than the Neglect Battery Score in distinguishing stroke patients from controls, as measured by area under the curve (AUC); Prosody Score = 0.84; Neglect Battery Score =0. 57. The Prosody Score correctly classified 78.9%, while Neglect Score correctly classified 55.8% of participants as patients versus controls. The Prosody Score was similar to the total NIH Stroke Scale in identifying RHS patients (AUC=0.86, correctly classifying 80.1% of patients versus controls), but the tests only partially overlapped in the patients identified. CONCLUSIONS: Severe prosody impairment may be a better indicator of right hemisphere dysfunction than neglect. Larger studies are needed to determine if including a bedside test of Prosody with the NIH Stroke Scale would most efficiently and reliably identify right hemisphere ischemia.

Impaired emotion processing from vocal and facial cues in frontotemporal dementia compared to right hemisphere stroke.

To advance our understanding about the emotional and cognitive deficits of patients with frontotemporal dementia with behavioral variant (bvFTD), the current study examined comprehension and expression of emotions from prosodic and facial cues in a 66-year-old woman. The patient diagnosed with bvFTD is compared to six patients with acute right hemisphere stroke. Recognition of emotion from prosodic cues was assessed using an identification task in four conditions with decreasing verbal demands (neutral sentences, language-like pseudo sentences, monosyllables, and asyllabic vowel sounds). Repetition of utterances with emotional connotations and self-generated conversations were analyzed to measure relative changes in mean fundamental frequency (f0), f0 variance, speech rate, and intensity along with the facial musculature pattern. The patient showed a marked deficit in identifying emotions in all four prosody conditions; and she did not show much variation in modulating mean f0, f0 variance, speech rate and intensity for all emotion categories when compared to neutral utterances. In addition, this patient demonstrated little to no facial expressions during emotionally provoking tasks, but demonstrated no difficulty recognizing emotions from facial expressions or verbal scenarios. Results show that the patient seems to have selective impairment in recognition of emotions from prosody and expression of emotions using both prosodic and facial features. Impaired processing of emotional prosody and facial expressions could be important for detecting bvFTD with greater right hemisphere atrophy.

Vocal emotion processing in Parkinson's disease: reduced sensitivity to negative emotions.

To document the impact of Parkinson's disease (PD) on communication and to further clarify the role of the basal ganglia in the processing of emotional speech prosody, this investigation compared how PD patients identify basic emotions from prosody and judge specific affective properties of the same vocal stimuli, such as valence or intensity. Sixteen non-demented adults with PD and 17 healthy control (HC) participants listened to semantically-anomalous pseudo-utterances spoken in seven emotional intonations (anger, disgust, fear, sadness, happiness, pleasant surprise, neutral) and two distinct levels of perceived emotional intensity (high, low). On three separate occasions, participants classified the emotional meaning of the prosody for each utterance (identification task), rated how positive or negative the stimulus sounded (valence rating task), or rated how intense the emotion was expressed by the speaker (intensity rating task). Results indicated that the PD group was significantly impaired relative to the HC group for categorizing emotional prosody and showed a reduced sensitivity to valence, but not intensity, attributes of emotional expressions conveying anger, disgust, and fear. The findings are discussed in light of the possible role of the basal ganglia in the processing of discrete emotions, particularly those associated with negative vigilance, and of how PD may impact on the sequential processing of prosodic expressions.