Emotion Recognition Deficits in Alzheimer’s Disease: A Meta-Analysis.

Emotion recognition is a core component of social cognition and is essential for effective interpersonal communication. A growing body of literature suggests that this ability is impaired in Alzheimer’s disease (AD), although the magnitude and nature of the deficit remain unclear. This meta-analysis aimed to quantify emotion recognition impairments in individuals with AD relative to healthy older adults (HOA). A systematic search identified 24 eligible studies comparing emotion recognition performance in individuals with AD and HOA. Random-effects models were used to calculate pooled effect sizes (Hedges’ g). Primary analyses were conducted after influence diagnostics, and sensitivity analyses examined the impact of influential studies. Subgroup analyses examined the role of stimulus modality, while meta-regressions assessed potential moderation by MMSE scores, age, and education. Publication bias analyses were also conducted. The primary meta-analysis revealed a large and statistically significant impairment in emotion recognition in AD (g = –1.059, p <.0001). MMSE scores significantly moderated the effect, with higher global cognitive status associated with smaller deficits. Age and education did not significantly influence outcomes. Subgroup analyses showed comparable impairments across facial and non-facial tasks, with no significant differences between stimulus modalities. Emotion recognition is substantially impaired in AD. Although the magnitude of this deficit is associated with global cognitive status, it is unlikely to be fully explained by it alone. These findings support the relevance of social cognitive dysfunction in AD, highlight the importance of more ecologically valid assessment paradigms, and have implications for person-centred care and everyday interpersonal functioning in dementia settings. • Emotion recognition is notably impaired in Alzheimer’s disease compared with healthy ageing. • Cognitive status strongly predicts the severity of emotion recognition deficits in Alzheimer’s disease. • Emotion processing deficits appear across facial and non-facial tasks, regardless of stimulus type. • Findings highlight the need for ecologically valid, emotion-responsive care in dementia assessment.