Effects of Brain Disease On Our Loved Ones and Our Relationships

Virginia Sturm, PhD

May 4, 2013

Emotional Brains PromoteSocial Bonds

Brain Diseases Can Alter Emotion and Social Behavior

Frontotemporal Dementia

Alzheimer’s Disease

Alzheimer’s disease (AD)

• Cognitive symptoms primary

• Social and emotional preservation

• Posterior: parietal and medial temporal

Frontotemporal Dementia (FTD)

• Socioemotional symptoms primary

• Social and emotional impairment

• Anterior: medial frontal and insula

What is an emotion?

Short-lived phenomena (Levenson, 1994)

– Psychological• Alter attention, shift certain behaviors upward

in response hierarchies, activate memory networks

– Physiological• Rapidly organize the responses of disparate

biological systems (e.g., facial expression, somatic muscular tonus, voice, ANS)

Process Model of Emotion

Appraisal of Antecedent

Event

Emotional Response Tendency

Emotional Response

ReappraisalSuppressionAmplificationSubstitution

model based on modified versions of Levenson, 1999 and Gross, 2002

Situation SelectionSituation ModificationAttention Deployment

Process Model of Emotion

Appraisal of Antecedent

Event

Emotional Response Tendency

Emotional Response

ReappraisalSuppressionAmplificationSubstitution

model based on modified versions of Levenson, 1999 and Gross, 2002

Situation SelectionSituation ModificationAttention Deployment

How Can We Measure Emotion?• Physiological

Reactivity

• Facial Behavior

• Self-Report How sad did you feel while watching the film? 1 2 3 4 5

A little A lot

Surveying the Emotional Landscape in FTD

• Social Behavior– Gaze behavior

• Emotional Reactivity– Disgust– Embarrassment

• Emotion Regulation• Relationship Satisfaction

– Impact of emotional decline on marriage

Social Behavior: Mutual Gaze• Eyes communicate

information about emotion, intention, and attention

• Mutual gaze– Highly regulated by

social rules– Physiologically arousing

to gazer– Excess or dearth may

signal social dysfunction

Quantifying Gaze Behavior

• 15-minute conversations

• Gaze behavior– 180 5-second bins

coded– Mutual gaze =

reciprocal gaze at eyes• Physiological

reactivity

Methods

(Sturm, McCarthy, Yun, Madan, Yuan, Holley, Ascher, Boxer, Miller, & Levenson, SCAN, 2011)

Less Mutual Gaze in FTD

CONTROL SD880

900

920

940

960

980

1000

1020

Inte

r-b

ea

t In

terv

al (

ms

)Gaze Behavior

Physiology

CONTROL SD2.35

2.4

2.45

2.5

2.55

2.6

2.65

2.7

2.75

2.8

So

ma

tic

Ac

tiv

ity

(u

nit

s)

*

*

(Sturm, McCarthy, Yun, Madan Yuan, Holley, Ascher, Boxer, Miller, & Levenson, SCAN, 2011)

Functions of Embarrassment and Disgust

• Embarrassment– Emerges after violation of a

social convention– Reparation of disrupted

social bonds

• Disgust– Highly visceral emotion– Expulsion of contaminated

objects from body

Eliciting Embarrassment in the Lab

baseline

1 min.

singing

~2.5 min.

watch baseline

1 min.

watch selfsinging

~2.5 min.

X X

30 sec.

(Sturm, Ascher, Miller, & Levenson, 2008)

Diminished Embarrassment in FTD

Physiological Reactivity Emotional Behavior• Composite: FTD < Controls• Individual channels:

– FTD < Controls in heart rate, skin conductance, respiration depth

1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

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28

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30

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

1

Control FTD

Time (s)

Z-s

co

re

skin conductance

Basic, Nega-tive

Self-Conscious0

5

10

15

20

25

30

Mean Total Emo-tion

*

* p < .05

Control

FTD

Self-Report• Basic emotions: No differences• Self-conscious emotions: No differences

Measuring Disgust Reactivity

• Behavior• Physiological

Reactivity• Self-Report

baseline

1 min.

film

~1 min.

X

(Eckart et al., 2012)

Loss of Disgust in FTD

Disgust Behavior0

0.1

0.2

0.3

0.4

0.5

0.6

FTDControl

-0.15

-0.1

-0.05

0

0.05

0.1

0.15

FTDControl

*

* p < .05

*

ANSReactivity

Mea

n E

mo

tio

nal

Beh

avio

r

Co

mp

osi

te (

z-sc

0re)

Self-Reported Experience: FTD< controls when controlling for total reported emotion

Emotion Regulation

• Process by which individuals influence:– Which emotions they have– When they have them– How they experience and

express these emotions

• Problems with emotion regulation occur in many mental disorders

Gross, 1998

19

Poor Emotion Regulation in FTD

Control

AD FTD

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Response to Acoustic Startle

No warning Spontaneous

Instructed

Emotional Behavior

Failure to down-regulate spontaneously

Goodkind et al., 2010

How does emotional decline impact close relationships?

FTD AD Control0

2

4

6

8

10

21

Expressed Negative Emotion Relates to Higher Caregiver Burden

FTD AD Control5060708090

100110120

Ascher et al. (2009)

* *

Marital Satisfaction(Caregiver)

Negative Emotion Words(Caregiver)

FTD Summary: Emotional Loss

• In FTD, emotional networks in the brain are vulnerable to disease

• Patients with FTD have changes in emotion and social behavior– E.g., in disgust, embarrassment, emotion

regulation, and emotional language• Emotional deterioration (loss of interest in

others, more negative emotion) can have a negative impact on close relationships

Can a brain disease increase emotion?

• Anxiety and depression are common in mild cognitive impairment (MCI) and AD– Emotional symptoms in MCI (35-85%) and AD (75%)– Associated with higher burden and worse function– Preclinical sign of AD pathology or reaction to

cognitive decline?– Comorbid affective symptoms associated with higher

risk of dementia conversion and more rapid decline

Enhanced Emotion in AD• Hyperconnectivity in

emotion network in AD• Measures

– Emotional contagion– Depressive symptoms

• Sample: 237 subjects– 111 healthy controls, 62 MCI, 64 AD

• Hypothesis: emotional contagion will be higher in MCI and AD secondary to emotion network hyperconnectivity

Controls MCI AD0123456789

MenWomen

Controls MCI AD0

5

10

15

20

25

MenWomen

Em

otio

nal C

onta

gion

Dep

ress

ive

Sym

ptom

s

A.

B.

***

**

* = p<.01 and ** = p<.001Sturm et al., PNAS, in press

Right temporal lobe degeneration is associated with heightened emotional contagion

blue= p<.001, uncorrected, and hot=pFWE<.05Sturm et al., PNAS, in press

AD Summary: Emotional Gain

• Biological changes in brain networks that support emotion are associated with increased emotion in AD

• Heightened emotional contagion may have effects on close relationships that are:– Positive (if empathy increases and patients

show more emotional resonance than before)– Negative (if emotional responding to others

becomes overwhelming and causes anxiety)

How do patients’ emotional changes impact caregivers’ health?

Studying Emotion in Caregivers

Study led by Robert Levenson, PhD and Jennifer Merrilees, RN, PhD

Take-Home Points• Emotions are supported by

specific brain networks• Alterations in emotion are

common in brain diseases (and after brain injuries) that affect these networks

• Changes in emotion can alter social behavior

• Changes in close relationships may reflect patients’ own emotional symptoms

Many Thanks to…

• Berkeley Psychophysiology Laboratory– Robert Levenson, PhD– Elizabeth Ascher, PhD and Sarah Holley, PhD

• UCSF Memory & Aging Center– Bruce Miller, MD; Bill Seeley, MD; Howie Rosen, MD;

Kate Rankin, PhD; Joel Kramer, PsyD• Clinical Affective Neuroscience Lab

– Alice Hua, Jessica Zakrzewski, Kaitlin Johnson• Funding from the NIA and Alzheimer’s Association• Our patients, controls, and their families