National Geographic

With Alzheimer’s Comes Empathy

When you hear Alzheimer’s, you probably think of memory loss, language problems, and general confusion. These cognitive symptoms of the degenerative brain disease are devastating, and so it makes sense that they get the most attention in the media and scientific community.

Of course, the disease has emotional consequences, too. Some of these aren’t the least bit surprising: Depression, irritability, and agitation are expected as memory wanes and daily life becomes more difficult.

But Alzheimer’s brings other kinds of emotional changes that aren’t as easily explained, as I learned from a study published yesterday in the Proceedings of the National Academy of Sciences. Researchers found for the first time that individuals with Alzheimer’s show a high level of ‘emotional contagion’, the unconscious ability to mimic another person’s emotions. And as the disease progresses, destroying more brain cells and cognitive skills, this emotional empathy gets stronger, allowing patients to become more sensitive — and more vulnerable — to the feelings, words, and behaviors of other people.

“Patients with Alzheimer’s can become very sweet and nice and warm, and we all just fall in love with them a lot of the time,” says lead investigator Virginia Sturm, an assistant professor at the University of California, San Francisco’s Memory and Aging Center. That might be because they’re picking up on emotional cues of the people around them, she says. “A caregiver’s emotional state can really influence the patient.”

This aspect of Alzheimer’s hasn’t been studied much, partly because complex social cognition is difficult to measure in people with declining intellectual capacity. That’s why Sturm was interested in emotional contagion. It’s a rudimentary imitation skill, present not only in adults but newborn babies, who cry in response to cries of other babies, as well as monkeys, rodents, and birds. “It’s a building block for more complicated forms of empathy,” she says.

Sturm’s team scanned the brains of 237 older people: 62 with mild cognitive impairment (a precursor to Alzheimer’s), 64 with Alzheimer’s disease, and 111 healthy controls. The researchers gave participants’ caretakers a questionnaire called the Interpersonal Reactivity Index, which measures emotional contagion (for instance, caretakers rated the accuracy of statements such as, “Being in a tense emotional state scares him/her”). The researchers also measured the participants’ depressive symptoms with the Geriatric Depression Scale.

Both emotional contagion scores and depressive symptoms rise as Alzheimer’s progresses, the study found. But only emotional contagion correlates with changes in the brain. The greater the loss of brain tissue from the temporal lobe —  a region important for memory and emotional processing, and the first area to degrade in Alzheimer’s — the higher the emotional contagion.

Emotional connectedness doesn’t happen in every type of dementia. In fact, people with frontotemporal dementia (FTD), caused by degeneration in the brain’s frontal lobe, seem to change in the opposite direction, becoming more aloof as the disease progresses. “They’re just really oblivious to social cues,” says Sturm, who has spent a lot of time doing psychological testing on FTD patients. “With them I have a really different feeling. I know that they don’t really care if I make small talk, so I won’t.”

How could these two similar forms of neurodegeneration lead to such different emotional outcomes? The answer probably lies somewhere in the yin and yang of the brain’s emotional and cognitive networks.

Several years ago, Sturm’s colleagues began scanning the brains of people with Alzheimer’s disease and with FTD using a technique called resting-state functional connectivity. Unlike the typical brain scan, which captures the brain’s firing patterns while it’s involved in some specific task, such as looking at a picture or hearing words, this method scans the brain while the person is lying quietly, focused on nothing in particular. Even at rest, certain brain regions are known to synchronize their activity, ramping up or down at the same time, implying that they’re part of the same “functional” network.

Sturm’s colleagues showed that people with Alzheimer’s have weak connections (that is, out-of-sync activity) in the default mode network, which has hubs in the temporal lobe and the frontal cortex and seems to be important for episodic memory (and has been linked to a wide variety of other behaviors). Intriguingly, though, as this default mode network breaks down, another circuit, the so-called salience network, gets stronger. The salience network has hubs in part of the insula and part of the anterior cingulate cortex, both of which are involved in emotion and perception.

Perhaps most interesting of all: The opposite pattern happens in FTD. With that disease, Sturm’s colleagues found, the default mode network actually gets stronger and the salience network gets weaker.

Nobody understands yet why the default mode network and the salience network have these reciprocal interactions, Sturm says. In the paper, she notes a similar relationship between emotional and cognitive circuits in post-traumatic stress disorder. In PTSD, emotional circuits get stuck in an over-active state, and this leads to shrinkage of the hippocampus, a region important for memory and cognitive control. Over time, the more cognitive, “rational” brain networks seem to lose their ability to dial down the emotional ones, leading to a positive feedback loop that can make PTSD worse. (I wrote about these stress circuits in a Nature story last year.)

The same kind of thing could be happening in Alzheimer’s disease, Sturm says, though for now that’s pure speculation. She plans to continue this line of research by taking a more thorough look at emotional contagion in dementia patients — by measuring how much their faces mimic other people’s emotions, for example. Because emotional contagion is exhibited by rodents, it might also be a good way to measure emotions in animal models of Alzheimer’s.

In any case, Sturm hopes that more researchers will consider the emotional side of the disease. “There’s been a lot about the memory problems in Alzheimer’s, but no one looks at the opposite side of the coin,” she says.

There are 13 Comments. Add Yours.

  1. David
    May 28, 2013

    This article identifies what I saw in my father as he progressed through Alzheimers – when we interacted he had lost his cognitive abilities, but I always felt that he was fully engaged emotionally, even to the very end.

  2. Mette Vesterager
    May 28, 2013

    I think it is important to distinguish between emotional contagion (E.C.) and empathy. E.C. is when you “catch” somebody else’s feelings, but feel them as your own. You are (usually) not aware of the contagion. E.C. neither involves understanding nor results in any, hence no empathy. E.C. is seen in all (normal) humans, but especially in children.

    Empathy is about understanding other people’s emotions, i.e. when I empathize I understand “what it is like for the other”. It does involve experiencing a similar kind of emotion in some way. But the crucial difference is that in E.C. I feel the emotion as my own, it does not come with an understanding of you. In empathy, the emotion I have is attributed you. I’m aware that it is an emotion I have only because it involves an understanding of what it is like for you.

    Thus it is no surprise at all that a diminished cognitive capacity leads to more emotional contagion. With a growing loss of identity we become more subject to what other’s are feeling. We take on their feelings as our own. Just like babies cry when they hear somebody else cry. But it also leads to a smaller capacity for empathy. As I take your feeling as my own, I have less understanding of what it is like for you.

    To state that “With Alzheimer’s comes empathy” is fundamentally wrong in my view. In fact it is quite the opposite. It decreases the capacity for empathy, but makes the patient more subject to emotional contagion.

    That is not to say that the mentioned study is not of any importance. It seems to support the view that although Alzheimer’s patients lose cognitive capacity, they still have the ability to experience just as many emotions as the rest of us. And I think it is important to keep in mind.

  3. Brian Schmidt
    May 30, 2013

    Emotional contagion seems like a primitive form of empathy. Given that psychopaths feel much less empathy (or no empathy), Alzheimers patients previously diagnosed with psychopathy would make fascinating subjects. I wonder if strengthening the salience circuits might eventually become a type of treatment for psychopathy.

  4. Carol Dashiff
    May 30, 2013

    I agree about strengthened ability to pick up emotion. I have been amazed at my own mother’s caring response to me when I least expected it but really needed it… Much of what is believed to be known about Alzheimer’s behaviors are gross generalizations that we will likely find erroneous as we learn more. For example, I don’t believe that the generalization about loss of recent memory is fully accurate. I believe from my own experience with my mother that she can retain recent memories to some extent but they just get jumbled up and distorted. She frequently refers to my sister and I as
    Margie, the sister next up from her who she was close to. Yesterday, I sat across from her in her room and she called me Margie. Later I moved next to her and we looked at photos where she was sorting me out from Margie and noticing the difference. At one point she looked up across the room and said, “Where did Margie go?”. She had retained the memory that someone was across the room who at that point she identified as Marjorie. BTW, my sister and I recently looked at a picture of Margie when she was about 12 and my sister turned to me and said “that looks exactly like you”. I find it remarkable what is retained in the midst of all that is “lost” and hope that, as we learn more about this, it can offer hope and inspiration about the essence of humanity and some comfort to families. The challenge for many family members is being fully present with the person with Alzheimer’s enough to see and experience the connections that remain..

  5. Jeff Hertrick
    May 30, 2013

    I witnessed this with my Mom’s Alzheimer’s. She was never a touch-feely type of mom. While always very nurturing to me as a child, hugs and kisses just were not part of the norm. When I’d visit from college or even into my 30s, hugs and kisses were subdued. But then later, the hello and goodbye hugs became far more affectionate. And the whole emotional side of her personality increased a bit. It wasn’t until years later that she was diagnosed, but we’re able to look back and remember the changes through a different prism of knowledge. It was as if her inhibitions were gradually erased.

  6. AmazingSusan
    June 5, 2013

    Each individual case is so different, I think it’s not useful to generalize. My mother does not exhibit this behaviour at all – she’s as ornery, and even more so, as she has ever been :P

  7. Bonnie
    June 7, 2013

    Oh my goodness! As the caregiver to my husband who has Alzheimer’s I had the proverbial lightbulb moment when I read this and a similar article. Lately I have observed a decline in my husband and as can happen, it really got me down. I had to accept that life as I knew it will never be the same, my dear husband is not exactly the man I have loved all these years. As my emotional state heightened and anger reared its’ ugly head so did this behaviour appear in my husband. Honestly, I began to realize that my mood truly affects my husband, big time. My new mantra; ‘calm begets calm’. A much needed insight.

  8. Glen Hutchraft
    June 26, 2013

    I have just graduated Health care in business and will be a long term care facility administrator, and i am very concerned with this disease. The subject is maybe the most important issue of the next 10 years. I am so interested how we can help these retiring people and give them some relief if at all possible, my intent is to learn all i can before i take on this awesome responsibility of caring for my people. they will always be on my mind as to how we can improve there lives.

  9. Maggie La Tourelle
    August 18, 2013

    I am a psychotherapist and I recorded conversations between my mother who had Alzheimer’s, and me, for three and a half years till the end of her life. The edited transcript of these conversations forms the heart of my new book, The Gift of Alzheimer’s. It provides a unique record of my mother’s experiences of Alzheimer’s, spoken in her own words, and my experience being with her. I believe my book could be of interest to researchers in the field.
    It highlights the difference that occurs in emotions and awareness at various stages of the disease. It was only in the later stages that she and I really bonded. Not only did she become very sensitive to the nuances of my expressions, she developed ESP and demonstrated terminal lucidity. However the quality of our communication was determined by me being totally present with her, as she was with me, a state that was easier for her to attain than me.

  10. Dan Baxley
    September 13, 2013

    this article outlines what is witnessed by victims and relatives of this disease, but does not really connect with possible causes. Read the following article by Discover magazine and you may see a connection with some victims of this disease, with the foods they ate. Shell fish leads the list in BMAA contamination. National Geo. has also reported on this in previous issue, as a side bar, but Nat. Geo. has been watching this. BMAA is commonly known as Blue Green Algae — this was a product, not reported, that was being sold by a company located in Klamath Falls Oregon, where they would process the Blue Green Algae from the bottom of a lake, package it and sell it as natures first perfect food. I am not sure if they are still selling this product but be warned, it is poison. http://discovermagazine.com/2011/may/22-seafood-toxins-causing-als-alzheimers-parkinsons I would post the Nat. Geo. article too but have been unable to find it?

  11. emma
    May 29, 2014

    I have early onset Alzheimer’s as did my Father. I helped care for my Father over 10 years and his empathy grew tremendously, we became closer emotionally even through his dying weeks in hospice. While I can attest to being very sensitive to negative emotional states of those around me, and sometimes overwhelmed by them, it is NOT the same as contagion. I do feel for my husband, my 94 year old Mother, my adult children, my grandchildren, my friends. People who suggest I am mimicking the emotions of others are probably not living around Alzheimer’s. We feel deeply, we are compassionate, and we can be wounded by the comments that suggest the dismissal of our basic humanity.

  12. Virginia Hughes
    May 29, 2014

    Hi Emma,

    Thanks for your comments; I appreciate your perspective. I don’t think my post was dismissing your basic humanity, though — far from it! Emotional contagion (according to these researchers) is one of the building blocks of empathy, and therefore something quite important to our humanity. All of us have emotional contagion, not just those with Alzheimer’s.

    • emma
      May 29, 2014

      Ms Hughes, your article touched me deeply. It was certainly about the fact Alzheimer patients DO feel empathy. I responded to a comment made by Mette Vesterager May 28, 2013 who declared the article was off base and ALZ patients are only a mimicking others sadness, pain, or loving expressions. The writer claimed any empathy shown was contagion.
      That is dehumanizing and based on false information/ideas. Very kind of your to respond to me, I appreciate that. MY brain is not so sharp to remember to indicate my comments referring to specific opinion in comment section and not the article. Other readers of the article described exactly what you were referring to. My Father in late stages saw me crying one day and came struggling over to me, sat down, patted my knee and said to my Mother, “Some one was not being nice to her on the playground.” It was poetic and heartfelt I will remember that moment the rest of my life. We were in middle of noisy family holiday gathering, I was exhausted, people there said how “Sad (his dementia) was” but did nothing to make it better, and were not about to help.
      There is some kind of cultural distaste for dementia which is Alzheimer’s afects our brians, but we have emotional memory, are sensitive, want to love and be loved in return even when we can not immediately recall the name of someone.Many people are learning to see our behavior as metaphor for fear, anxiety, and frustration over trying to function in a confusing world. To provide an environment and emotional atmosphere of simplicity, kindness, acceptance, and support is the only treatment that works 100% with no side effects. Please let us know what other writing on Alzheimer’s you have available for public. What you are doing preserves the dignity and sanity of those of us with the illness and who care for us.
      Much love and affection to you.

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