Familiar smiling faces in Alzheimer's disease: Understanding the positivity-related recognition bias

Recent research has revealed a recognition bias favoring positive faces and other stimuli in older compared to younger adults. However, it is yet unclear whether this bias reflects an age-related preference for positive emotional stimuli, or an affirmatory bias used to compensate for episodic memory deficits. To follow up this point, the present study examined recognition of emotional faces and current mood state in patients with mild Alzheimer disease (AD) and healthy controls. Expecting lower overall memory performance, more negative and less positive mood in AD patients, the critical question was whether the positivity-related recognition bias would be increased compared to cognitively unimpaired controls. Eighteen AD patients and 18 healthy controls studied happy, neutral, and angry faces, which in a subsequent recognition task were intermixed with 50% distracter faces. As expected, the patient group showed reduced memory performance, along with a less positive and more negative mood. The recognition bias for positive faces persisted. This pattern supports the view that the positivity-induced recognition bias represents a compensatory, gist-based memory process that is applied when item-based recognition fails.

• The positivity-related recognition bias is preserved in mild Alzheimer's disease.
• The bias might represent an intuitive decision bias that compensates for reduced episodic memory.
• Alzheimer's patients can apply a decision bias based on relatively preserved emotional expression analysis.