A systematic review of emotional facial expression recognition in patients with mild cognitive impairment

Background Emotional facial expression recognition (EFER) plays a key role in social cognition and may be compromised in mild cognitive impairment (MCI), a heterogeneous condition often considered a prodromal stage of dementia. However, evidence remains heterogeneous, and the influence of demographic, cognitive, and methodological factors is unclear. Objective This systematic review aims to synthesize recent findings on EFER performance in individuals with MCI, examining the presence and potential moderators of emotion recognition impairments. Methods Following PRISMA 2020 guidelines, a systematic literature search was conducted to identify studies published between 2013 and 2025 that assessed EFER in individuals with MCI. Results Twenty-five studies met inclusion criteria. Most reported impaired EFER in MCI compared with healthy controls, particularly for negative emotions (anger, fear, and sadness), whereas happiness was relatively preserved. Greater impairment was observed in amnestic and multidomain MCI than in non-amnestic or single-domain forms. Findings suggested that age, educational level, global cognition and standardized emotion recognition measures may contribute to variability in EFER outcomes across studies. In contrast, evidence regarding the role of specific cognitive abilities, sex, mood, task format, stimulus exposure duration, response time constraints, and response modality was limited or inconsistent. Conclusions Overall, evidence suggests that EFER impairments are common but heterogeneous in MCI. The variability in findings may be related to differences in cognitive profiles, sociodemographic characteristics, and methodological factors across studies. These findings support EFER as a potential indicator of socioemotional changes in prodromal dementia, although further research is needed to clarify sources of heterogeneity.