Objective Background and aims: It is recognized that emotional deficits are part of the non-motor features of Parkinson's disease but scant attention has been paid to specific aspects such as emotional facial expression, subjective emotional experience (alexithymia) and recognition of facial emotion expressions. This study aimed to investigate the relationship between alexithymia, emotion facial recognition, and emotion facial expression in PD patients.

Method Forty-one PD patients and seventeen healthy controls, matched for demographical characteristics, were enrolled in the study.

Alexithymia was assessed by means of Toronto Alexithymia Scale (TAS-20), emotion facial recognition was tested by means of the Ekman 60 Faces Test, emotion facial expression was investigated with a video protocol encompassing of a static expression recording (subject watching the camera in silence for 30 seconds), a dynamic expression recording (subject recorded while talking for 30 seconds) and emotion expression (subject was asked to express with his/her face the six main human expressions: happiness, sadness, anger, fear, surprise, disgust). Six blind raters evaluated the patients' video recordings.

Results No difference in alexithymia was detected between PD patients and HC. PD patients performed significantly worse than HC in recognizing Surprize (p=0.03) and showed significant poorer global facial expression than HC (in static, dynamic and emotion facial expression). There was a significant negative correlation between the factor F3 of TAS (externally orientated thoughts) and the patient's capability to express disgust (−0.447, p=0.007). Elkman total score positively correlates with the patient's capability to express disgust with his face (0.325, p=0.006).

Conclusion These results suggest that PD patients have difficulties with emotional recognition and expression in a contest of a unimpaired subjective emotional experience. These deficits need to be targeted in clinical practise for rehabilitation purposes.