Initial expressed emotion during neuropsychological assessment: investigating motivational dimensions of approach and avoidance.

Objective: Prior work indicates that discrete emotions are linked to performance across multiple domains of cognitive function and thus have the potential to impact cognitive profiles in neuropsychological assessment. However, reported presence and magnitude of the relationships between emotion and cognitive test performance are inconsistent. Variable findings in this regard could be due to failure to consider motivations associated with expressed emotion. To better understand the potential impact of expressed emotion on neuropsychological test performance, it may be beneficial to consider approach and avoidance motivation during assessment.

Method: The current cross-sectional study examined associations between cognitive performance and digitally phenotyped facial expressions of discrete emotions on dimensions of approach (i.e. joy, sadness, anger) and avoidance (i.e. fear, disgust) in the context of virtual neuropsychological assessment in 104 adults (ages 55-90).

Results: Initial facial expressions categorized as anger and joy predicted later reduced cognitive performance in aspects of memory and executive function within the virtual session, respectively. Test performance was associated neither with sadness nor with avoidance emotions (i.e. disgust or fear).

Conclusions: Results of the current study did not strongly align with approach/avoidance explanations for links between emotion and cognitive performance; however, results might support an arousal-based explanation, as joy and anger are both high arousal emotions. Additional investigation is needed to understand the intersection of emotion motivation and physiological arousal in the context of neuropsychological assessment.