ABSTRACT Learning objective: To validate a novel video-based emotion identification measure in persons with neurodegeneration and show correspondence to emotion-relevant brain systems Background: Given advances in disease-modifying therapies for dementia, the dementia field needs objective, practical behavioral assessment tools for patient trial selection and monitoring. The Dynamic Affect Recognition Test (DART) was designed to remedy limitations of instruments typically used to measure emotion identification deficits in persons with dementia (PWD). Method: Participants included 372 individuals, including 257 early stage PWD (Clinical Dementia Rating <= 1, Mini-Mental State Examination > 20, 66 behavioral variant frontotemporal dementia [bvFTD], 27 semantic variant primary progressive aphasia [svPPA], 23 semantic bvFTD [sbvFTD], 33 non-fluent PPA [nfvPPA], 26 progressive supranuclear palsy [PSP], 28 corticobasal syndrome [CBS], 42 Alzheimer's disease [AD], 12 logopenic variant PPA [lvPPA]), and 115 healthy controls (HC), watched 12 15-second videos of an actor expressing a basic emotion (happy, surprised, sad, angry, fearful, disgusted) via congruent facial/vocal/postural cues, with semantically neutral scripts. Participants selected the emotion from a randomized visual array. Voxel-based morphometry (VBM) analysis was performed to show brain structure correlates of DART, controlling for non-emotional naming ability (Boston Naming Test, BNT). Results: DART performance was worse in PWD than older HC (p<0.001), with the lowest scores observed in the sbvFTD group. A DART 10 cut-off score differentiates PWD from HC with a 90% sensitivity and 49% specificity (AUC=82%). A DART 9/12 score yielded 93% sensitivity/67% specificity (AUC=87%) for discriminating social cognition disorders from HC, while a 7/12 score differentiated sbvFTD from HC with 100% sensitivity/93% specificity (AUC=97%). VBM showed poorer DART performance significantly predicts focal brain volume loss in right-sided emotion processing areas including insula, temporal pole, caudate, superior frontal gyrus and supplementary motor cortex (pFWE<0.05). Conclusions: The DART is a brief, psychometrically robust video-based test of emotion reading (i) designed to be practically useful in realistic assessment settings, (ii) effectively reveals emotion identification impairments in PWD, (iii) shows specificity for identifying PWD exhibiting real-life SCDs (i.e. bvFTD, svPPA, sbvFTD), (iv) corresponds to the expected structural anatomy of emotion reading, and (v) is freely available to researchers and clinicians.

The authors have declared no competing interest.

The National Institutes of Health (R01/RFI AG029577, P50AG023501, P30 AG062422) and the Larry L. Hillblom Foundation (2014-A-004-NET). HU is supported by an Alzheimer's Association Grant (AACSF-22-849085).

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