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Accepted for/Published in: JMIR Formative Research

Date Submitted: May 1, 2026
Date Accepted: Sep 24, 2026

The final, peer-reviewed published version of this preprint can be found here:

Characteristic Facial Expressions During Visual Fixation in Japanese Older Adults With Lower Cognitive Screening Performance: Exploratory Cross-Sectional Study

Miyayama M, Sekiguchi T, Sugimoto H, Kawagoe T, Tripanpitak K, Wolf A, Kumagai K, Fukumori K, Watanabe Miura K, Okada S, Ishimaru K, Otake-Matsuura M

Characteristic Facial Expressions During Visual Fixation in Japanese Older Adults With Lower Cognitive Screening Performance: Exploratory Cross-Sectional Study

JMIR Form Res 2026;10:e99948

DOI: 10.2196/99948

PMID: 42944647

Characteristic facial expressions during visual fixation in Japanese older adults with lower cognitive screening performance: An exploratory cross-sectional study

  • Mirano Miyayama; 
  • Takuya Sekiguchi; 
  • Hikaru Sugimoto; 
  • Toshikazu Kawagoe; 
  • Kornkanok Tripanpitak; 
  • Alexandra Wolf; 
  • Kazumi Kumagai; 
  • Kosuke Fukumori; 
  • Kumi Watanabe Miura; 
  • Shogo Okada; 
  • Keiichiro Ishimaru; 
  • Mihoko Otake-Matsuura

ABSTRACT

Background:

For early detection of Alzheimer’s disease, it is essential to identify individuals showing cognitive performance consistent with the mild cognitive impairment (MCI) range during preliminary screening, ideally using methods that extend beyond conventional cognitive assessments. Non-invasive, easily accessible screening tools applicable in daily life are increasingly needed. Facial expressions, particularly during rest, may offer promising biomarkers for MCI detection.

Objective:

This study aimed to identify specific facial features associated with MCI during rest to inform development of facial expression-based screening tools.

Methods:

Participants were classified into an MCI group and a healthy control (HC) group using the Montreal Cognitive Assessment (MoCA) scores. Facial Action Units (AUs) were extracted from video recordings of resting-state facial expressions in 31 individuals with MCI and 14 HC. Two statistical models were employed: a multilevel zero-inflated beta regression model for intensity of 17 AUs and a multilevel logistic regression model for presence or absence of 18 AUs.

Results:

In the zero-inflated beta regression, the AU relates to upper lip raiser showed a significant group effect (MCI vs. HC; p <0.001), remaining significant after multiple comparison correction. The logistic regression revealed significant group differences for the AUs related to lip tightener (p <0.001) and lip suck (p <0.001), both remained significant after multiple comparison correction.

Conclusions:

Distinctive facial action patterns during rest were observed in individuals with MCI. These findings highlight the potential of resting-state facial expressions as a basis for novel, unobtrusive screening tools for early MCI detection.


 Citation

Please cite as:

Miyayama M, Sekiguchi T, Sugimoto H, Kawagoe T, Tripanpitak K, Wolf A, Kumagai K, Fukumori K, Watanabe Miura K, Okada S, Ishimaru K, Otake-Matsuura M

Characteristic Facial Expressions During Visual Fixation in Japanese Older Adults With Lower Cognitive Screening Performance: Exploratory Cross-Sectional Study

JMIR Form Res 2026;10:e99948

DOI: 10.2196/99948

PMID: 42944647

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