The brain behind the mask.

I recently read an article just released this month out of The University of Texas Health Science Center at Houston (UTHealth) regarding brain areas that are stimulated by facial recognition, which gave me pause to reflect upon my own experiences of late in our neurology practice.

We are seeing in a number of patients more instances of significant cognitive decline and I have to consider whether the ongoing COVID 19 situation and related changes to daily life, the isolation, lack of human connections and face coverings that literally mask expression are impacting some of the ways our brain processes information.

Your face is worth a thousand words.
Face recognition and expression is critical to social interaction and both serve to enhance our interpersonal communications. To date, facial expression has been found to be the richest source of information about emotions; years ago, Charles Darwin proposed that facial expressions actually evolved in order to quickly communicate emotional states that are important to social survival.1

But it stands to reason that over the last three months, we can assume some of these important human cues have been impacted due to the wearing of masks. And if we are blocking facial recognition and expression we should wonder too if our brain wellness might become impaired especially in patients who had preexisting mild cognitive impairments.  

Facial recognition and neuroplasticity.
Our brain allows us to identify and store patterns for thousands of individual faces. Human face perception depends on identifying specific features, such as the eyes, nose, and mouth, and on perceiving the specific spatial arrangement of those features.  The brain becomes engaged in a number of different neural regions to allow facial recognition and facial expressions to occur.

In this recent study Category Selectivity for Face and Scene Recognition in Human Medial Parietal Cortex using "sub-millimeter" brain implants, researchers at UTHealth have been able to determine which parts of the brain are linked to facial and scene recognition.2

The medial temporal lobe (parahippocampus and hippocampus) is the primary site of facial recognition, but we know that this is also where Alzheimer’s begins. The new UTHealth study sheds light on yet another part of the brain, the MPC or medial parietal cortex, which is the primary region that houses the memory software for facial identification.

What is most important is that face recognition stimulates these parts of the brain time and time again. So could wearing a mask for extended periods be hindering neuroplasticity mechanisms that serve these two critical memory centers of the brain? These are questions that we have to ask ourselves and continue to study in the medical community so we are best prepared to be of the greatest help to our patients.

I miss your smile.
Begin to take note of the differences in day-to-day interactions when you’re not wearing a mask. Notice how this recognition changes the course of an interaction, perhaps softening it, making it more authentic and more human. Trying to engage with other humans without being able to smile is the facial equivalent of communicating via text message or email alone. The ability to understand facial expressions is an important part of nonverbal communication – and as we have learned, it is vital for brain health.

So as you continue to communicate with friends, family and colleagues, especially if you are at a distance, be sure to incorporate opportunities for video (e.g. Skype or Zoom) or “face time” phone calls so you can truly see one another’s expressions and understand the cues you may not have even realized you were missing…aside from missing those smiles. They too are an important part of our complex neurological processes that even the simplest things, or lack thereof, can affect.

In health and hope,
Dr. Suzanne Gazda  

References and additional reading:

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781895/

2 Oscar Woolnough, Patrick S. Rollo, Kiefer J. Forseth, Cihan M. Kadipasaoglu, Arne D. Ekstrom, Nitin Tandon. Category Selectivity for Face and Scene Recognition in Human Medial Parietal Cortex. Current Biology, 2020; DOI: 10.1016/j.cub.2020.05.018

Facial recognition:
https://www.sciencedirect.com/topics/medicine-and-dentistry/facial-recognition

Frith C. (2009). Role of facial expressions in social interactions. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 364(1535), 3453–3458. https://doi.org/10.1098/rstb.2009.0142
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781887/