Cognitive Impairment Prediction in MCI and Alzheimer's Disease: The Role of MMSE and Face Recognition Deficits

Year 2025, Volume: 26 Issue: 3, 335 - 339, 22.09.2025

Ahmet Şair , Simel Ayar , Yaşan Bilge Şair , Bilge Doğan

https://doi.org/10.69601/meandrosmdj.1677383

Abstract

Objective:
Face recognition deficits may serve as early indicators of cognitive decline in neurodegenerative disorders such as Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). This study investigates facial recognition performance in individuals with MCI and AD compared to cognitively healthy controls, exploring its association with global cognitive functioning (MMSE), demographic factors, and depressive symptoms.

Methods:
Neuropsychological records of individuals aged 65–80 were retrospectively reviewed. Participants were grouped as cognitively healthy controls, MCI, or AD. All had completed the Mini-Mental State Examination (MMSE), Benton Face Recognition Test (BFRT), and Geriatric Depression Scale (GDS). Statistical comparisons were conducted using ANOVA, Kruskal-Wallis, and chi-square tests, followed by correlation and regression analyses.

Results:
Significant group differences were observed in MMSE scores, BFRT long form (age- and education-adjusted), short form, and Part A scores. No differences were found in GDS scores or BFRT Part B. The control group outperformed both MCI and AD groups in face recognition tasks, particularly in basic face matching (BFRT Part A), with more pronounced deficits in AD. Regression analysis identified MMSE as the strongest predictor of cognitive impairment. While facial recognition impairments were observed in both MCI and AD groups, the MMSE was more effective in identifying overall cognitive decline.

Conclusion:
Face recognition deficits, especially in basic perceptual matching, are evident in early AD and may provide supplementary diagnostic information. However, MMSE remains the most robust tool for detecting general cognitive impairment. Combining global and domain-specific assessments may enhance early detection strategies. Limitations include retrospective design, group differences in age and education, and absence of neuroimaging or biomarker data.

Keywords

Alzheirmer's disease , Mild Cognitive ımpairment , Benton Face recognition test , Standardized mini mental test

References

• 1. Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund LO, et al. Mild cognitive impairment - Beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004;256:240–6.
• 2. Pelak VS. Disorders of Higher Cortical Visual Function. Third Edit. Liu, Volpe, and Galetta’s Neuro-Ophthalmology: Diagnosis and Management. 2018. 341–364 p.
• 3. Zhao R, Wang P, Liu L, Zhang F, Hu P, Wen J, et al. Whole-brain structure–function coupling abnormalities in mild cognitive impairment: a study combining amplitude of low-frequency fluctuations and voxel-based morphometry. Front Neurosci. 2023;17:1–12.
• 4. Troyer AK, Murphy KJ, Anderson ND, Craik FIM, Moscovitch M, Maione A, et al. Associative recognition in mild cognitive impairment: Relationship to hippocampal volume and apolipoprotein E. Neuropsychologia. 2012;50:3721–8.
• 5. Strijkert F, Huitema RB, Van Munster BC, Spikman JM. Impaired Emotion Recognition: A Potential Marker for Social Behavioral Problems in Patients With Amnestic Mild Cognitive Impairment and Early Alzheimer Disease? Alzheimer Dis Assoc Disord. 2023;37:189–94.
• 6. Mitchell AJ. The Mini-Mental State Examination (MMSE): An Update on Its Diagnostic Validity for Cognitive Disorders. In: Cognitive Screening Instruments. London: Springer London; 2013. p. 15–46.
• 7. Engfors LM, Wilmer J, Palermo R, Gignac GE, Germine LT, Jeffery L. Face recognition’s practical relevance: Social bonds, not social butterflies. Cognition. 2024;250:105816.
• 8. Şair A, Şair YB, Ayar S. Differentiating Mild Forms of Cognitive Impairment and Dementia: Where Other Tests Fail, Verbal Memory Assessment May Prove Critical. Meandros Medical and Dental Journal. 2021;22:187–95.
• 9. Cui Y, Liu B, Luo S, Zhen X, Fan M, Liu T, et al. Identification of Conversion from Mild Cognitive Impairment to Alzheimer’s Disease Using Multivariate Predictors. PLoS One. 2011;6:e21896.
• 10. Batum K, Çınar N, Şahin Ş, Çakmak MA, Karşıdağ S. The connection between MCI and Alzheimer disease: neurocognitive clues. Turk J Med Sci. 2015;45:1137–40.
• 11. Gelonch O, Garolera M, Valls J, Castellà G, Varela O, Rosselló L, et al. The effect of depressive symptoms on cognition in patients with fibromyalgia. PLoS One. 2018 Jul;13:e0200057.
• 12. Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression: a systematic review and meta-analysis. Psychol Med. 2014;44:2029–40.
• 13. Mukku SSR, Dahale AB, Muniswamy NR, Muliyala KP, Sivakumar PT, Varghese M. Geriatric Depression and Cognitive Impairment—An Update. Indian J Psychol Med. 2021;43:286–93.
• 14. Klee M, Aho VTE, May P, Heintz-Buschart A, Landoulsi Z, Jónsdóttir SR, et al. Education as Risk Factor of Mild Cognitive Impairment: The Link to the Gut Microbiome. J Prev Alzheimers Dis. 2024;11:759–68.
• 15. Maccora J, Peters R, Anstey KJ. What does (low) education mean in terms of dementia risk? A systematic review and meta-analysis highlighting inconsistency in measuring and operationalising education. SSM Popul Health. 2020;12:100654.
• 16. Ngandu T, von Strauss E, Helkala EL, Winblad B, Nissinen A, Tuomilehto J, et al. Education and dementia. Neurology. 2007;69:1442–50.
• 17. Soh Y, Whitmer RA, Mayeda ER, Glymour MM, Eng CW, Peterson RL, et al. Timing and level of educational attainment and late‐life cognition in the KHANDLE study. Alzheimer’s & Dementia. 2024;20:593–600.
• 18. Barton JJS. Prosopagnosia associated with a left occipitotemporal lesion. Neuropsychologia. 2008;46:2214–24.
• 19. Dhikav V, Sethi M, Anand KS. Medial temporal lobe atrophy in Alzheimer’s disease/mild cognitive impairment with depression. Br J Radiol. 2014 Oct;87:20140150.
• 20. Putcha D, Brickhouse M, Touroutoglou A, Collins JA, Quimby M, Wong B, et al. Visual cognition in non-amnestic Alzheimer’s disease: Relations to tau, amyloid, and cortical atrophy. Neuroimage Clin. 2019;23:101889.
• 21. Nguyen VQ, Gillen DL, Dick MB. Memory for unfamiliar faces differentiates mild cognitive impairment from normal aging. J Clin Exp Neuropsychol. 2014;36:607–20.
• 22. Greene JDW, Hodges JR. Identification of famous faces and famous names in early Alzheimer’s disease. Brain. 1996;119:111–28.
• 23. Connolly HL, Young AW, Lewis GJ. Face perception across the adult lifespan: evidence for age-related changes independent of general intelligence. Cogn Emot. 2021;35:890–901.
• 24. Le Carret N, Rainville C, Lechevallier N, Lafont S, Letenneur L, Fabrigoule C. Influence of education on the benton visual retention test performance as mediated by a strategic search component. Brain Cogn. 2003;53:408–11.
• 25. Wang LAL, Herrington JD, Tunç B, Schultz RT. Bayesian regression-based developmental norms for the Benton Facial Recognition Test in males and females. Behav Res Methods. 2020;52:1516–27.