Detailed Exploration of Face-related Processing in Congenital Prosopagnosia: 1. Behavioral Findings

What is Meant by Impaired Configural Processing in Acquired Prosopagnosia?

Apperceptive prosopagnosia is supposedly characterised by impaired configural processing, which could refer to either perception of spatial structure or holistic mechanisms. Ten prosopagnosic patients were tested with (i) dot patterns, to determine if manipulations of complexity, size, orientation, or the regularity of global structure generated effects consistent with the holistic hypothesis; and (ii) hierarchical letters, to probe for a global ‘whole-object’ processing deficit. With dot patterns (experiment 1) patients were impaired even for simple two-dot stimuli, but did better with more complex patterns, when size or orientation varied, or with a regular global structure. In experiment 2, they demonstrated normal latency effects of global-level processing. Apperceptive prosopagnosia, including that from lesions encompassing the right fusiform gyrus, is thus associated with a ‘configural deficit’ that impairs perception of spatial structure, not just for faces but also for non-facial patterns. While it cannot be concluded that holistic processing is entirely normal in these subjects, their performance shows significant modulation by whole-object structure, indicating that some whole-object processing is occurring in these patients.

Comment on prevalence of hereditary prosopagnosia (HPA) in Hong Kong Chinese population

Kennerknecht et al. [Kennerknecht et al. (2008); Am J Med Genet Part A 146A] estimate that 1.9% of the Chinese population are hereditary prosopagnosics. I discuss concerns about their assumption that the great majority of prosopagnosia resulting from developmental problems are heritable and present data from my laboratory that suggests that a considerable proportion of developmental prosopagnosics do not have relatives who share their face recognition deficits.

Prevalence of hereditary prosopagnosia (HPA) in Hong Kong Chinese population

Prosopagnosia (PA), or the inability to recognize a familiar person by the face alone, had been considered to be a rare dysfunction mainly acquired by trauma to the brain. Recently we have shown that the congenital form of PA, which was considered to be even rarer, is common in Caucasians, with a prevalence of 2.5%. As these cases were familial we coined the term Hereditary Prosopagnosia (HPA). The present study is the first systematic screening for HPA in a defined population of ethnic Chinese. In 2004-2005, 533 out of around 750 medical students of The University of Hong Kong took part in a questionnaire-based screening. The responses of 133 students indicated that they were likely to be candidates for PA. One hundred twenty agreed for diagnostic interview. Finally we made the clinical diagnosis of PA in 10 subjects. A prevalence of 1.88% (95% CI, 1.05-2.71) is established which is in the same range as in Caucasians. We took a detailed family history of four index prosopagnosic persons and were able to further investigate the families of four probands. Each had other first-degree relatives with the same visual cognitive dysfunction. Thus, as in the Caucasians, regular autosomal dominant inheritance might best explain the segregation pattern.

Seeing with profoundly deactivated mid-level visual areas: non-hierarchical functioning in the human visual cortex

A fundamental concept in visual processing is that activity in high-order object-category distinctive regions (e.g., lateral occipital complex, fusiform face area, middle temporal+) is dependent on bottom-up flow of activity in earlier retinotopic areas (V2, V3, V4) whose main input originates from primary visual cortex (V1). Thus, activity in down stream areas should reflect lower-level inputs. Here we qualify this notion reporting case LG, a rare case of developmental object agnosia and prosopagnosia. In this person, V1 was robustly activated by visual stimuli, yet intermediate areas (V2-V4) were strongly deactivated. Despite this intermediate deactivation, activity in down stream visual areas remained robust, showing selectivity for houses and places, while selectivity for faces and objects was impaired. The extent of impairment evident in functional magnetic resonance imaging and electroencephalography activations was somewhat larger in the left hemisphere. This pattern of brain activity, coupled with fairly adequate everyday visual performance is compatible with models emphasizing the role of nonlinear local "amplification" of neuronal inputs in eliciting activity in ventral and dorsal visual pathways as well as perceptual experience in the human brain. Thus, while the proper functioning of intermediate areas appears essential for specialization in the cortex, daily visual behavior and reading are maintained even with deactivated intermediate visual areas.

A bilateral occipitotemporal network mediates face perception

The aim of the present study was to further explore the neuronal mechanisms of face processing in healthy subjects which may help to understand the difficulties experienced by prosopagnosia subjects. A further goal was to compare face specific activation patterns in the right and left occipital face area (OFA) and fusiform face area (FFA) for famous faces, non-famous faces and caricatures of famous faces in four individuals suffering from developmental prosopagnosia (DP) and seven healthy controls, using functional magnetic resonance imaging and psychophysiological interaction analysis (PPI). Control subjects showed higher face related activations in the right compared to the left FFA. Caricatures of faces of famous people and photographs of non-famous faces yielded higher percent signal changes in the OFA and FFA compared to photographs of famous faces. These data support the idea that the OFA and FFA discriminate between familiar and new face representations. The activation patterns of DP subjects were heterogeneous, with none of the patients showing bilateral face related activations in both OFA and FFA. There was no evidence of a left hemispheric activation when the right homologue failed to be activated, supporting the view of a right hemispheric dominance in face perception. PPI analysis indicated a link between activation of the right FFA and the other three tested regions, the left FFA and the right and left OFA. In summary, all four face related brain regions appear to be necessary for successful face processing, and disruption of one component may lead to face recognition deficits.

Family resemblance: ten family members with prosopagnosia and within-class object agnosia

We report on neuropsychological testing done with a family in which many members reported severe face recognition impairments. These 10 individuals were high functioning in everyday life and performed normally on tests of low-level vision and high-level cognition. In contrast, they showed clear deficits with tests requiring face memory and judgements of facial similarity. They did not show deficits with all aspects of higher level visual processing as all tested performed normally on a challenging facial emotion recognition task and on a global-local letter identification task. On object memory tasks requiring recognition of particular cars and guns, they showed significant deficits so their recognition impairments were not restricted to facial identity. These results strongly suggest the existence of a genetic condition leading to a selective deficit of visual recognition.

Early left-hemispheric dysfunction of face processing in congenital prosopagnosia: an MEG study

BACKGROUND

Congenital prosopagnosia is a severe face perception impairment which is not acquired by a brain lesion and is presumably present from birth. It manifests mostly by an inability to recognise familiar persons. Electrophysiological research has demonstrated the relevance to face processing of a negative deflection peaking around 170 ms, labelled accordingly as N170 in the electroencephalogram (EEG) and M170 in magnetoencephalography (MEG). The M170 was shown to be sensitive to the inversion of faces and to familiarity--two factors that are assumed to be crucial for congenital prosopagnosia. In order to locate the cognitive dysfunction and its neural correlates, we investigated the time course of neural activity in response to these manipulations.

METHODOLOGY

Seven individuals with congenital prosopagnosia and seven matched controls participated in the experiment. To explore brain activity with high accuracy in time, we recorded evoked magnetic fields (275 channel whole head MEG) while participants were looking at faces differing in familiarity (famous vs. unknown) and orientation (upright vs. inverted). The underlying neural sources were estimated by means of the least square minimum-norm-estimation (L2-MNE) approach.

PRINCIPAL FINDINGS

The behavioural data corroborate earlier findings on impaired configural processing in congenital prosopagnosia. For the M170, the overall results replicated earlier findings, with larger occipito-temporal brain responses to inverted than upright faces, and more right- than left-hemispheric activity. Compared to controls, participants with congenital prosopagnosia displayed a general decrease in brain activity, primarily over left occipitotemporal areas. This attenuation did not interact with familiarity or orientation.

CONCLUSIONS

The study substantiates the finding of an early involvement of the left hemisphere in symptoms of prosopagnosia. This might be related to an efficient and overused featural processing strategy which serves as a compensation of impaired configural processing.

Are faces special? A case of pure prosopagnosia

The ability to recognize individual faces is of crucial social importance for humans and evolutionarily necessary for survival. Consequently, faces may be "special" stimuli, for which we have developed unique modular perceptual and recognition processes. Some of the strongest evidence for face processing being modular comes from cases of prosopagnosia, where patients are unable to recognize faces whilst retaining the ability to recognize other objects. Here we present the case of an acquired prosopagnosic whose poor recognition was linked to a perceptual impairment in face processing. Despite this, she had intact object recognition, even at a subordinate level. She also showed a normal ability to learn and to generalize learning of nonfacial exemplars differing in the nature and arrangement of their parts, along with impaired learning and generalization of facial exemplars. The case provides evidence for modular perceptual processes for faces.

Faces as objects of non-expertise: processing of thatcherised faces in congenital prosopagnosia

Congenital prosopagnosia (cPA) is a severe disorder in recognising familiar faces, a human characteristic that is presumably innate, without any macro-spatial brain anomalies. Following the idea that cPA is based on deficits of configural face processing, we used a speeded grotesqueness decision task with thatcherised faces, since the Thatcher illusion can serve as a test of configural disruption (Lewis and Johnston, 1997 Perception 26 225-227). The time needed to report the grotesqueness of a face in relation to orientation showed dissociate patterns between a group of fourteen people with cPA and a group of matched controls: whereas the RTs of controls followed a strong sigmoid function depending on rotation from the upright orientation, the RTs of people with cPA showed a much weaker sigmoid trend approaching a linear function. The latter result is interpreted as a diagnostic sign of impaired configural processing, being the primary cause of the absence of 'face expertise' in prosopagnosia.

Prosopagnosia associated with a left occipitotemporal lesion

Acquired prosopagnosia is usually associated with bilateral or right-sided lesions of the occipital or temporal lobes. In rare cases of prosopagnosia after left-sided lesions in left-handed subjects, it is attributed to a reversed hemispheric specialization for face processing. This study examines the face-processing functions of a left-handed prosopagnosic patient with a left-sided lesion affecting the region of the occipital face area and possibly the fusiform face area, to contrast his deficits with those of prosopagnosic patients with right-hemispheric lesions. Similar to those patients, he has a moderately severe reduction in familiarity judgments, is impaired in processing face configuration, and shares with some of those patients a greater failure to process eye than mouth information, indicating an altered pattern of facial saliency. He has a mild reduction in the identification of exemplars of non-face objects. Unlike those patients, he has better residual familiarity on a two-alternative forced-choice task and can processing facial configuration if given more time, indicating a reduction in efficiency rather than a severe limitation. He has more difficulty accessing semantic-biographic information from names. He has trouble with facial feature imagery but not imagery for global face shape. Thus this subject's deficits represent a combination of impaired familiarity and configuration processing (normally right-sided functions in right-handed subjects), and impaired feature processing and access to semantic-biographic information (normally left-sided functions). His prosopagnosia likely reflects partially anomalous rather than reversed lateralization of hemispheric perceptual functions.

Individual faces elicit distinct response patterns in human anterior temporal cortex

Visual face identification requires distinguishing between thousands of faces we know. This computational feat involves a network of brain regions including the fusiform face area (FFA) and anterior inferotemporal cortex (aIT), whose roles in the process are not well understood. Here, we provide the first demonstration that it is possible to discriminate cortical response patterns elicited by individual face images with high-resolution functional magnetic resonance imaging (fMRI). Response patterns elicited by the face images were distinct in aIT but not in the FFA. Individual-level face information is likely to be present in both regions, but our data suggest that it is more pronounced in aIT. One interpretation is that the FFA detects faces and engages aIT for identification.

Functional Plasticity in Ventral Temporal Cortex following Cognitive Rehabilitation of a Congenital Prosopagnosic

We used functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to measure neural changes associated with training configural processing in congenital prosopagnosia, a condition in which face identification abilities are not properly developed in the absence of brain injury or visual problems. We designed a task that required discriminating faces by their spatial configuration and, after extensive training, prosopagnosic MZ significantly improved at face identification. Event-related potential results revealed that although the N170 was not selective for faces before training, its selectivity after training was normal. fMRI demonstrated increased functional connectivity between ventral occipital temporal face-selective regions (right occipital face area and right fusiform face area) that accompanied improvement in face recognition. Several other regions showed fMRI activity changes with training; the majority of these regions increased connectivity with face-selective regions. Together, the neural mechanisms associated with face recognition improvements involved strengthening early face-selective mechanisms and increased coordination between face-selective and nonselective regions, particularly in the right hemisphere.

Impaired face and body perception in developmental prosopagnosia

Prosopagnosia is a deficit in face recognition in the presence of relatively normal object recognition. Together with older lesion studies, recent brain-imaging results provide evidence for the closely related representations of faces and objects and, more recently, for brain areas sensitive to faces and bodies. This evidence raises the issue of whether developmental prosopagnosics may also have an impairment in encoding bodies. We investigated the first stages of face, body, and object perception in four developmental prosopagnosics by comparing event-related potentials to canonically and upside-down presented stimuli. Normal configural encoding was absent in three of four developmental prosopagnosics for faces at the P1 and for both faces and bodies at the N170 component. Our results demonstrate that prosopagnosics do not have this normal processing routine readily available for faces or bodies. A profound face recognition deficit characteristic of developmental prosopagnosia may not necessarily originate in a category-specific face recognition deficit in the initial stages of development. It may also have its roots in anomalous processing of the configuration, a visual routine that is important for other stimuli besides faces. Faces and bodies trigger configuration-based visual strategies that are crucial in initial stages of stimulus encoding but also serve to bootstrap the acquisition of more feature-based visual skills that progressively build up in the course of development.

Interplay between familiarity and orientation in face processing: An ERP study

In order to tap the electrophysiological correlates of the perceptual and structural encoding stages of face processing, we investigated how inversion and familiarity affect the face-specific event-related potentials (ERPs) components. ERPs were recorded while participants performed a familiarity judgment task with upright and inverted photographs of famous and unknown faces. The early P100 component was found to be sensitive to facial configuration that is disrupted by face inversion. Noteworthy, in addition to the ongoing effect of orientation, an effect of familiarity, although limited to upright faces, emerged at the processing stage indexed by N170. Later on, as witnessed by the P250 component, the familiarity effect was generalized to both upright and inverted faces with a larger amplitude for inverted famous faces. All in all, the present results suggest that the face structural encoding stage is cognitively permeable by higher-order factors such as familiarity, especially when familiarity is crucial for mastering the task. From a more general viewpoint, these results indicate that face processing is subserved by multiple mechanisms in which structural (i.e. orientation) and semantic (i.e. familiarity) factors begin to interact at early processing stages with different time courses. The electrophysiological correlates of these mechanisms are documented by the differential involvement of the major ERP components in the "familiarity check". With upright faces familiarity affects the N170 component, while with inverted faces it affects later components, in keeping with a prolonged time course of the familiarity decision when orientation is not upright.

Event-related potentials reflect heterogeneity of developmental prosopagnosia

Event-related potential (ERP) studies of developmental prosopagnosia (DP) are rare. Previous ERP investigations have reported smaller N170 amplitude differences between faces and objects in at least three prosopagnosics. The present study is based on a combination of behavioural and electrophysiological assessment of face processing. The aim was to investigate the face-specificity of the N170 in both healthy subjects and a group of DP individuals (N = 4), using famous and nonfamous faces, caricatures and houses as stimuli. All prosopagnosic subjects showed impairments in recognition of famous faces, memory for faces and learning new faces in behavioural assessment. In healthy subjects the largest effects were found at parieto-occipital electrode positions (PO7 and PO8), along with a familiarity effect at these electrode positions. Thus, parieto-occipital areas appear to play an important role in face processing. Three prosopagnosics showed reliable N170 amplitude differences between faces and nonface stimuli, whereas one DP individual showed significantly reduced amplitude differences between faces and nonface objects. The behavioural and electrophysiological data support the idea that DP reflects a heterogeneous impairment and that face processing deficits are not necessarily correlated with a lack of face-specific N170.

Structural imaging reveals anatomical alterations in inferotemporal cortex in congenital prosopagnosia

Congenital prosopagnosia (CP) refers to the lifelong impairment in face recognition in individuals who have intact low-level visual processing, normal cognitive abilities, and no known neurological disorder. Although the face recognition impairment is profound and debilitating, its neural basis remains elusive. To investigate this, we conducted detailed morphometric and volumetric analyses of the occipitotemporal (OT) cortex in a group of CP individuals and matched control subjects using high-spatial resolution magnetic resonance imaging. Although there were no significant group differences in the depth or deviation from the midline of the OT or collateral sulci, the CP individuals evince a larger anterior and posterior middle temporal gyrus and a significantly smaller anterior fusiform (aF) gyrus. Interestingly, this volumetric reduction in the aF gyrus is correlated with the behavioral decrement in face recognition. These findings implicate a specific cortical structure as the neural basis of CP and, in light of the familial history of CP, target the aF gyrus as a potential site for further, focused genetic investigation.

Too Many Trees to See the Forest: Performance, Event-related Potential, and Functional Magnetic Resonance Imaging Manifestations of Integrative Congenital Prosopagnosia

Neuropsychological, event-related potential (ERP), and functional magnetic resonance imaging (fMRI) methods were combined to provide a comprehensive description of performance and neurobiological profiles for K.W., a case of congenital prosopagnosia. We demonstrate that K.W.'s visual perception is characterized by almost unprecedented inability to identify faces, a large bias toward local features, and an extreme deficit in global/configural processing that is not confined to faces. This pattern could be appropriately labeled congenital integrative prosopagnosia, and accounts for some, albeit not all, cases of face recognition impairments without identifiable brain lesions. Absence of face selectivity is evident in both biological markers of face processing, fMRI (the fusiform face area [FFA]), and ERPs (N170). Nevertheless, these two neural signatures probably manifest different perceptual mechanisms. Whereas the N170 is triggered by the occurrence of physiognomic stimuli in the visual field, the deficient face-selective fMRI activation in the caudal brain correlates with the severity of global processing deficits. This correlation suggests that the FFA might be associated with global/configural computation, a crucial part of face identification.

A detailed investigation of facial expression processing in congenital prosopagnosia as compared to acquired prosopagnosia

Whether the ability to recognize facial expression can be preserved in the absence of the recognition of facial identity remains controversial. The current study reports the results of a detailed investigation of facial expression recognition in three congenital prosopagnosic (CP) participants, in comparison with two patients with acquired prosopagnosia (AP) and a large group of 30 neurologically normal participants, including individually age- and gender-matched controls. Participants completed a fine-grained expression recognition paradigm requiring a six-alternative forced-choice response to continua of morphs of six different basic facial expressions (e.g. happiness and surprise). Accuracy, sensitivity and reaction times were measured. The performance of all three CP individuals was indistinguishable from that of controls, even for the most subtle expressions. In contrast, both individuals with AP displayed pronounced difficulties with the majority of expressions. The results from the CP participants attest to the dissociability of the processing of facial identity and of facial expression. Whether this remarkably good expression recognition is achieved through normal, or compensatory, mechanisms remains to be determined. Either way, this normal level of performance does not extend to include facial identity.

What aspects of face processing are impaired in developmental prosopagnosia?

Developmental prosopagnosia (DP) is a severe impairment in identifying faces that is present from early in life and that occurs despite no apparent brain damage and intact visual and intellectual function. Here, we investigated what aspects of face processing are impaired/spared in developmental prosopagnosia by examining a relatively large group of individuals with DP (n = 8) using an extensive battery of well-established tasks. The tasks included measures of sensitivity to global motion and to global form, detection that a stimulus is a face, determination of its sex, holistic face processing, processing of face identity based on features, contour, and the spacing of features, and judgments of attractiveness. The DP cases showed normal sensitivity to global motion and global form and performed normally on our tests of face detection and holistic processing. On the other tasks, many DP cases were impaired but there was no systematic pattern. At least half showed deficits in processing of facial identity based on either the outer contour or spacing of the internal features, and/or on judgments of attractiveness. Three of the eight were impaired in processing facial identify based on the shape of internal features. The results show that DP is a heterogeneous condition and that impairment in recognizing faces cannot be predicted by poor performance on any one measure of face processing.

Specialized Face Perception Mechanisms Extract Both Part and Spacing Information: Evidence from Developmental Prosopagnosia

It is well established that faces are processed by mechanisms that are not used with other objects. Two prominent hypotheses have been proposed to characterize how information is represented by these special mechanisms. The spacing hypothesis suggests that face-specific mechanisms primarily extract information about spacing among parts rather than information about the shape of the parts. In contrast, the holistic hypothesis suggests that faces are processed as nondecomposable wholes and, therefore, claims that both parts and spacing among them are integral aspects of face representation. Here we examined these hypotheses by testing a group of developmental prosopagnosics (DPs) who suffer from deficits in face recognition. Subjects performed a face discrimination task with faces that differed either in the spacing of the parts but not the parts (spacing task), or in the parts but not the spacing of the parts (part task). Consistent with the holistic hypothesis, DPs showed lower performance than controls on both the spacing and the part tasks, as long as salient contrast differences between the parts were minimized. Furthermore, by presenting similar spacing and part tasks with houses, we tested whether face-processing mechanisms are specific to faces, or whether they are used to process spacing information from any stimulus. DPs' normal performance on the tasks of two houses indicates that their deficit does not result from impairment in a general-purpose spacing mechanism. In summary, our data clearly support face-specific holistic hypothesis by showing that face perception mechanisms extract both part and spacing information.

Developmental prosopagnosia: a window to content-specific face processing

Developmental prosopagnosia is characterized by severely impaired face recognition. Individuals with this disorder, which often runs in families, have no history of brain damage and intact early visual processing systems. Recent research has also demonstrated that many developmental prosopagnosics have normal or relatively good object recognition, indicating that their impairments are not the result of deficits to a unitary visual recognition mechanism. To investigate the nature of the impaired mechanisms, extensive testing was done on an individual with especially pure face processing deficits. The results ruled out all extant explanations of prosopagnosia except one that proposed that faces are recognized by a content-specific face processing mechanism. fMRI and MEG studies show that there are a variety of neural profiles in developmental prosopagnosia, which is consistent with behavioral studies demonstrating that it is a heterogeneous disorder.

Configural processing in autism and its relationship to face processing

Studies of the perceptual performance of individuals with autism have focused, to a large extent, on two domains of visual behavior, one associated with face processing and the other associated with global or holistic processing. Whether autistic individuals differ from neurotypical individuals in these domains is debatable and, moreover, the relationship between the behaviors in these two domains remains unclear. We first compared the face processing ability of 14 adult individuals with autism with that of neurotypical controls and showed that the autistic individuals were slowed in their speed of face discrimination. We then showed that the two groups differed in their ability to derive the global whole in two different tasks, one using hierarchical compound letters and the other using a microgenetic primed matching task with geometric shapes, with the autistic group showing a bias in favor of local information. A significant correlation was also observed between performance on the face task and the configural tasks. We then confirmed the prediction that the ability to derive the global whole is not only critical for faces but also for other objects as well, as the autistic individuals performed more slowly than the control group in discriminating between objects. Taken together, the results suggest that the bias for local processing seen in autistic individuals might have an adverse impact on their ability to process faces and objects.

Detailed exploration of face-related processing in congenital prosopagnosia: 2. Functional neuroimaging findings

Specific regions of the human occipito-temporal cortex are consistently activated in functional imaging studies of face processing. To understand the contribution of these regions to face processing, we examined the pattern of fMRI activation in four congenital prosopagnosic (CP) individuals who are markedly impaired at face processing despite normal vision and intelligence, and with no evidence of brain damage. These individuals evinced a normal pattern of fMRI activation in the fusiform gyrus (FFA) and in other ventral occipito-temporal areas, in response to faces, buildings, and other objects, shown both as line drawings in detection and discrimination tasks and under more naturalistic testing conditions when no task was required. CP individuals also showed normal adaptation levels in a block-design adaptation experiment and, like control subjects, exhibited evidence of global face representation in the FFA. The absence of a BOLD-behavioral correlation (profound behavioral deficit, normal face-related activation in the ventral occipito-temporal cortex) challenges existing accounts of face representation, and suggests that activation in these cortical regions per se is not sufficient to ensure intact face processing.

Does Prosopagnosia Take the Eyes Out of Face Representations? Evidence for a Defect in Representing Diagnostic Facial Information following Brain Damage

One of the most impressive disorders following brain damage to the ventral occipitotemporal cortex is prosopagnosia, or the inability to recognize faces. Although acquired prosopagnosia with preserved general visual and memory functions is rare, several cases have been described in the neuropsychological literature and studied at the functional and neural level over the last decades. Here we tested a brain-damaged patient (PS) presenting a deficit restricted to the category of faces to clarify the nature of the missing and preserved components of the face processing system when it is selectively damaged. Following learning to identify 10 neutral and happy faces through extensive training, we investigated patient PS's recognition of faces using Bubbles, a response classification technique that sampled facial information across the faces in different bandwidths of spatial frequencies [Gosselin, F., & Schyns, P. E., Bubbles: A technique to reveal the use of information in recognition tasks. Vision Research, 41, 2261-2271, 2001]. Although PS gradually used less information (i.e., the number of bubbles) to identify faces over testing, the total information required was much larger than for normal controls and decreased less steeply with practice. Most importantly, the facial information used to identify individual faces differed between PS and controls. Specifically, in marked contrast to controls, PS did not use the optimal eye information to identify familiar faces, but instead the lower part of the face, including the mouth and the external contours, as normal observers typically do when processing unfamiliar faces. Together, the findings reported here suggest that damage to the face processing system is characterized by an inability to use the information that is optimal to judge identity, focusing instead on suboptimal information.

Congenital prosopagnosia: face-blind from birth

Congenital prosopagnosia refers to the deficit in face processing that is apparent from early childhood in the absence of any underlying neurological basis and in the presence of intact sensory and intellectual function. Several such cases have been described recently and elucidating the mechanisms giving rise to this impairment should aid our understanding of the psychological and neural mechanisms mediating face processing. Fundamental questions include: What is the nature and extent of the face-processing deficit in congenital prosopagnosia? Is the deficit related to a more general perceptual deficit such as the failure to process configural information? Are any neural alterations detectable using fMRI, ERP or structural analyses of the anatomy of the ventral visual cortex? We discuss these issues in relation to the existing literature and suggest directions for future research.