Introduction
Older adults face various cognitive changes over time. One of the common disorders in old age is the mild cognitive impairment (MCI), which is a condition in which the person has minor cognitive problems, but are not so severe to disrupt the daily life. Studies have recently found that one of the problems of people with MCI is impairment in social cognition. Social cognition refers to the perception, interpretation, and processing of information in a social environment. It includes mentalizing, theory of mind, empathy, social perception, emotional processing, and attributional biases. One of the methods to improve social cognition is social cognition and interaction training (SCIT). This study aims to use this educational method on the elderly with MCI to evaluate its effect on their facial emotion recognition (FER).

Materials and Methods
This is a quasi-experimental study with a pre-test/post-test/ follow-up design using a control group. The study population includes all older people with MCI aged over 60 years living in nursing homes in Tehran, Iran. Samples were selected using a convenience sampling method from six nursing homes. The Montreal Cognitive Assessment Test was used to diagnose their MCI.  Those who scored less than 26 were selected. Finally, 40 older adults with MCI were randomly assigned to intervention (n=20) and control (n=20) groups. The intervention group received group SCIT at 20 sessions for two months, each for 60 minutes. The group SCIT was designed according to the protocol proposed by Roberts et al. In the present study, the following tests were used:
• Montreal Cognitive Assessment Test: It examines various dimensions of cognitive function and was developed by Nasreddine et al. in 2005 to determine MCI. The different parts and abilities that the test measures are short-term memory (5 points), abstraction (4 points), decision-making power (4 points), attention, concentration and behavioral memory (6 points), language. (5 points), and visuospatial (6 points). 
• Face Emotion Recognition Test: It was designed and developed by Montagne et al. in 2007 to assess the ability to recognize facial emotion. It is a computerized tool that displays faces with six facial expressions (surprise, joy, sadness, fear, disgust, anger). These expressions are produced in five different intensities from zero (natural face) to 100%. The subject is asked to identify the related emotion from among six expressions. 
Before examining the research hypotheses, first, the assumptions of parametric tests were tested. The results of Shapiro-Wilk test showed that the assumption of normal data distribution for the FER variable in the two groups was confirmed (P>0.05). The assumption of the homogeneity of variances was measured by the Levene’s test. The results confirmed of homogeneity of variances (P>0.05). Therefore, the data were analyzed using a mixed analysis of variance.

Results
The mean score of FER in the intervention group were 42.16, 46.61 and 50 at the pre-test, post-test, and follow-up phases, respectively. For the control group, they were equal to 42.35, 42.85, and 42.95, respectively. The F value based on the three phases of pre-test, post-test, and follow-up was 115.29 and the F value based on the study groups was 80.74. Wilks' lambda, Pillai's trace, Hotelling's trace, and Roy's largest root test statistics were significantly affected (P<0.001). Therefore, it can be concluded that there was a significant difference in FER between the two groups at least in one of the evaluation times. Between-group and within-group effects were also studied. The results showed that the evaluation time significantly affected the FER scores in the elderly with MCI and explained 71% of the variance. The effect of group factor on the FER score was also significant, which explained 51% of the variance in FER. Bonferroni post hoc test was used to investigate this difference accurately, which showed a significant difference among the pre-test, post-test, and follow-up phases and indicated that SCIT significantly increased FER in the post-test and follow-up phases compared to the pre-test phase. 

Discussion
The SCIT can significantly increase the FER in the elderly with MCI. The limitations of this study included the evaluation of older people living in nursing homes only, no blinding, and not controlling the effects of environmental, family, and individual factors affecting FER and MCI. Therefore, further studies are recommended on the community-dwelling elderly with different cultures and other aging disorders such as dementia, Alzheimer, etc., by controlling the mentioned factors. It is also recommended to provide SCIT to the elderly on a large scale to increase their social cognition abilities.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the ethics committee of Payame Noor University (code: IR.PNU.REC.1399.156).

Funding
The present study was extracted from the PhD thesis of the first author approved by the Department of General Psychology, Payame Noor University. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
All authors contributed equally in preparing all parts of the research.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We are grateful to all the elderly people present in the research and the officials of the Smile of Peace nursing home who fully cooperated in the implementation of the research.

 

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