Preserved visual imagery in visual form agnosia

Colors in the mind's eye

The famous "Piazza del Duomo" paper, published in Cortex in 1978, inspired a considerable amount of research on visual mental imagery in brain-damaged patients. As a consequence, single-case reports featuring dissociations between perceptual and imagery abilities challenged the prevailing model of visual mental imagery. Here we focus on mental imagery for colors. A case study published in Cortex showed perfectly preserved color imagery in a patient with acquired achromatopsia after bilateral lesions at the borders between the occipital and temporal cortex. Subsequent neuroimaging findings in healthy participants extended and specified this result; color imagery elicited activation in both a domain-general region located in the left fusiform gyrus and the anterior color-biased patch within the ventral temporal cortex, but not in more posterior color-biased patches. Detailed studies of individual neurological patients, as those often published in Cortex, are still critical to inspire and constrain neurocognitive research and its theoretical models.

Visual imagery deficits in posterior cortical atrophy

Visual imagery has a close overlapping relationship with visual perception. Posterior cortical atrophy (PCA) is a neurodegenerative syndrome marked by early impairments in visuospatial processing and visual object recognition. We asked whether PCA would therefore also be marked by deficits in visual imagery, tested using objective forced-choice questionnaires, and whether imagery deficits would be selective for certain properties. We recruited four patients with PCA and a patient with integrative visual agnosia due to bilateral occipitotemporal strokes for comparison. We administered a test battery probing imagery for object shape, size, colour lightness, hue, upper-case letters, lower-case letters, word shape, letter construction, and faces. All subjects showed significant impairments in visual imagery, with imagery for lower-case letters most likely to be spared. We conclude that PCA subjects can show severe deficits in visual imagery. Further work is needed to establish how frequently this occurs and how early it can be found.

Aphantasia: The science of visual imagery extremes

Visual imagery allows us to revisit the appearance of things in their absence and to test out virtual combinations of sensory experience. Visual imagery has been linked to many cognitive processes, such as autobiographical and visual working memory. Imagery also plays symptomatic and mechanistic roles in neurologic and mental disorders and is utilized in treatment. A large network of brain activity spanning frontal, parietal, temporal, and visual cortex is involved in generating and maintain images in mind. The ability to visualize has extreme variations, ranging from completely absent (aphantasia) to photo-like (hyperphantasia). The anatomy and functionality of visual cortex, including primary visual cortex, have been associated with individual differences in visual imagery ability, pointing to a potential correlate for both aphantasia and hyperphantasia. Preliminary evidence suggests that lifelong aphantasia is associated with prosopagnosia and reduction in autobiographical memory; hyperphantasia is associated with synesthesia. Aphantasic individuals can also be highly imaginative and are able to complete many tasks that were previously thought to rely on visual imagery, demonstrating that visualization is only one of many ways of representing things in their absence. The study of extreme imagination reminds us how easily invisible differences can escape detection.

Object recognition and visual object agnosia

The term visual agnosia is used to refer to recognition disorders that are confined to the visual modality, that are not due to an impairment in sensory functions, and that cannot be explained by other cognitive deficits or by general reduction in intellectual ability. Here, we describe the different types of visual agnosia that have been reported (form agnosia, integrative agnosia, associative agnosia, transformational and orientation agnosia as well as category-specific impairments such as pure alexia and prosopagnosia) and how they relate to the current understanding of visual object recognition. Together with related disorders such as simultanagnosia, texture agnosia, aphantasia, and optic aphasia, these visual perceptual impairments can have severe consequences for those affected. We suggest how in-depth assessment can be carried out to determine the type and the extent of these impairments. In the context of clinical assessment, a step-by-step approach reflecting a posterior to anterior gradient in visual object recognition, from more perceptual to more memory-related processes, is suggested. Individually tailored interventions targeting the identified impairments can be initiated based on the results of the assessment.

Unconscious mental imagery

Historically, mental imagery has been defined as an experiential state-as something necessarily conscious. But most behavioural or neuroimaging experiments on mental imagery-including the most famous ones-do not actually take the conscious experience of the subject into consideration. Further, recent research highlights that there are very few behavioural or neural differences between conscious and unconscious mental imagery. I argue that treating mental imagery as not necessarily conscious (as potentially unconscious) would bring much needed explanatory unification to mental imagery research. It would also help us to reassess some of the recent aphantasia findings inasmuch as at least some subjects with aphantasia would be best described as having unconscious mental imagery. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.

Vision: A Product of a Society of Independent Experts

A lesion of primary visual cortex, V1, can result in the perceived size of objects varying with the size of their retinal image. A new study shows that the pregrasp span of the hand of an individual with such a lesion remains tuned to the object's true size, providing evidence for separate representations mediating perceptual appearance and motor interactions.

Object Recognition in Mental Representations: Directions for Exploring Diagnostic Features through Visual Mental Imagery

One of the fundamental goals of object recognition research is to understand how a cognitive representation produced from the output of filtered and transformed sensory information facilitates efficient viewer behavior. Given that mental imagery strongly resembles perceptual processes in both cortical regions and subjective visual qualities, it is reasonable to question whether mental imagery facilitates cognition in a manner similar to that of perceptual viewing: via the detection and recognition of distinguishing features. Categorizing the feature content of mental imagery holds potential as a reverse pathway by which to identify the components of a visual stimulus which are most critical for the creation and retrieval of a visual representation. This review will examine the likelihood that the information represented in visual mental imagery reflects distinctive object features thought to facilitate efficient object categorization and recognition during perceptual viewing. If it is the case that these representational features resemble their sensory counterparts in both spatial and semantic qualities, they may well be accessible through mental imagery as evaluated through current investigative techniques. In this review, methods applied to mental imagery research and their findings are reviewed and evaluated for their efficiency in accessing internal representations, and implications for identifying diagnostic features are discussed. An argument is made for the benefits of combining mental imagery assessment methods with diagnostic feature research to advance the understanding of visual perceptive processes, with suggestions for avenues of future investigation.

Making memories: the development of long-term visual knowledge in children with visual agnosia

There are few reports about the effects of perinatal acquired brain lesions on the development of visual perception. These studies demonstrate nonseverely impaired visual-spatial abilities and preserved visual memory. Longitudinal data analyzing the effects of compromised perceptions on long-term visual knowledge in agnosics are limited to lesions having occurred in adulthood. The study of children with focal lesions of the visual pathways provides a unique opportunity to assess the development of visual memory when perceptual input is degraded. We assessed visual recognition and visual memory in three children with lesions to the visual cortex having occurred in early infancy. We then explored the time course of visual memory impairment in two of them at 2 years and 3.7 years from the initial assessment. All children exhibited apperceptive visual agnosia and visual memory impairment. We observed a longitudinal improvement of visual memory modulated by the structural properties of objects. Our findings indicate that processing of degraded perceptions from birth results in impoverished memories. The dynamic interaction between perception and memory during development might modulate the long-term construction of visual representations, resulting in less severe impairment.

The perception of spatial relations in a patient with visual form agnosia

It is generally believed that neuropsychological patients presenting with visual agnosia, a deficit on object perception/recognition, have suffered damage to the ventral visual cortical pathway (Milner & Goodale, 1995). Rarely has the ability of such patients to perceive the spatial location of objects been investigated-perhaps because "spatial vision" is thought by some researchers to be mediated exclusively by the dorsal visual cortical pathway. Here we present data on spatial perception in a patient DF, who has a profound visual form agnosia. DF and two control subjects were required to make a copy of the spatial arrangement of a target display of five differently coloured circular tokens using a duplicate set of the same tokens. Spatial performance was analysed in two ways: (1) relative location measured the ability to reconstruct the relative spatial relations between the tokens such as left versus right, above versus below, and nearer versus farther; (2) absolute location measured the exact displacement in millimetres of each token's copied position relative to its true location. DF was able to copy some of relative location relations between the tokens although her abilityto do so was not nearly as accurate as that of the control subjects. Nevertheless, DF's limited appreciation of relative location was enough to enable her to discriminate rather well between spatial patterns of tokens. She could not, however, reconstruct the absolute distance relations between the tokens and showed large displacements of token position compared to the control subjects. Interestingly, although Df was not "normal" in her ability to appreciate the allocentric spatial relations between the locations of the tokens relative to one another, she could accurately process token location egocentrically (i.e. relative to her own body and hand position). Thus, like controls, she was perfectly able to point to and touch all the tokens in an array. These results demonstrate deficits in the ability to perceive spatial relations between objects in a patient with visual form agnosia and suggest that the ventral steam also plays a functional role in spatial vision, particularly allocentric spatial vision.

Role of mental imagery in a property verification task: FMRI evidence for perceptual representations of conceptual knowledge

Is our knowledge about the appearance of objects more closely related to verbal thought or to perception? In a behavioural study using a property verification task, Kosslyn (1976) reported that there are both amodal and perceptual representations of concepts, but that amodal representations may be more easily accessed. However, Solomon (1997) argued that due to the nature of Kosslyn's stimuli, subjects may be able to bypass semantics entirely and perform this task using differences in the strength of association between words in true trials (e.g., cat-whiskers) and those in false trials (e.g., mouse-stinger). Solomon found no evidence for amodal representations when the task materials were altered to include associated false trials (e.g., cat-litter), which require semantic processing, as opposed to associative strategies. In the current study, we used fMRI to examine the response of regions of visual association cortex while subjects performed a property verification task with either associated or unassociated false trials. We found reliable activity across subjects within the left fusiform gyrus when true trials were intermixed with associated false trials but not when true trials were intermixed with unassociated false trials. Our data support the idea that conceptual knowledge is organised visually and that it is grounded in the perceptual system.

Vivid visual mental imagery in the absence of the primary visual cortex

The role of the primary visual cortex in visual mental imagery has provided significant debate in the imagery literature. Functional neuroimaging studies show considerable variation depending on task and technique. Patient studies can be difficult to interpret due to the diverse nature of cortical damage. The type of cortical damage in patient SBR is exceedingly rare as it is restricted to the gray matter of the calcarine sulcus. In this study, we show that in spite of his near-complete cortical blindness, SBR exhibits vivid visual mental imagery both behaviorally and when measured with functional magnetic resonance imaging. The pattern of cortical activation to visual mental imagery in SBR is indistinguishable from individual sighted subjects, in contrast to the visual perceptual responses, which are greatly attenuated.

Through a prism darkly: re-evaluating prisms and neglect

Many studies have demonstrated that prism adaptation can reduce several symptoms of visual neglect: a disorder in which patients fail to respond to information in contralesional space. The dominant framework to explain these effects proposes that prisms influence higher order visuospatial processes by acting on brain circuits that control spatial attention and perception. However, studies that have directly examined the influence of prisms on perceptual biases inherent to neglect have revealed very few beneficial effects. We propose an alternative explanation whereby many of the beneficial effects of prisms arise via the influence of adaptation on circuits in the dorsal visual stream controlling attention and visuomotor behaviors. We further argue that prisms have little influence on the pervasive perceptual biases that characterize neglect.

[Presentation of an assessment battery for visual mental imagery and visual perception]

INTRODUCTION

The relationship between visual perception and visual mental imagery are at the center of a lively theoretical debate between those postulating common neurocognitive processes between perception and imagery and those who emphasize the differences between these two entities. Neuropsychology can make an important contribution to this debate, by assessing associations and dissociations between perceptual and imaginal deficits in patients with brain damage. However, currently there is no standardized test battery available for such assessments.

MATERIAL AND METHODS

Here we present a battery of paper-and-pencil tests assessing different domains of visual mental imagery and visual perception abilities: object form and color, animals, orthographic material, numbers, faces, and space. We also explored the effects of age, educational level and gender on performance on a group of 103 participants free of neurological damage.

RESULTS

The battery includes two parts: one composed of 14 tests assessing mental imagery and the second part composed of eight tests assessing the abilities of visual perception. We calculated the correlations between the tests, and found that, with the exception of orthographic material, there were generally poor correlations between imagery and perceptual tests.

CONCLUSION

This result seems inconsistent with hypotheses postulating a strict correspondence between perceptual and imagery abilities.

Pointing to places and spaces in a patient with visual form agnosia

Previous investigations of visuospatial abilities in the visual form agnosic patient D.F. suggest that her egocentric sensorimotor processing is intact while her 'allocentric' judgments of spatial position are impaired. The current investigation extends these previous observations by comparing D.F.'s performance at pointing to a set of spatially distributed stimuli, either directly or by 'pantomiming' the responses in an adjacent homologous workspace. The results showed accurate sensorimotor localization when D.F. pointed directly to single targets or to sequences of targets, presumably as she could use egocentric visual coding. In spite of making relatively spared spatial judgments about the arrays, however, D.F. performed quite poorly when copying them and on the pantomimed pointing task. In this latter task good performance presumably depends on an ability to represent both the categorical and coordinate properties of the array (as does copying them), and to translate these into the effector-based coordinates required for accurate action. D.F.'s pantomimed pointing was similar to her copies of target arrays, as in both tasks there was evidence of spared (although somewhat degraded) appreciation of the relative spatial positions of the stimuli. Remarkably, her accuracy in this allocentric task was not worsened by longer pointing sequences. It is possible that D.F.'s degraded performance reflects a relative (though not complete) preservation of categorical coding within the ventral stream, despite a loss of coordinate coding there.

Visual cognition: a new look at the two-visual systems model

In this paper, we argue that no valid comparison between visual representations can arise unless provision is made for three critical properties: their direction of fit, their direction of causation and the level of their conceptual content. The conceptual content in turn is a function of the level of processing. Representations arising from earlier stages of processing of visual input have very little or no conceptual content. Higher order representations get their conceptual content from the connections between visual cognition and other parts of the human cognitive system. The two other critical properties of visual representations are their mind/world direction of fit and their mind/world direction of causation. The output of the semantic processing of visual input has a full mind-to-world direction of fit and a full world-to-mind direction of causation: it visually registers the way the world is and is caused by what it represents. The output of the pragmatic processing yields information for the benefit of intentions, which clearly have a world-to-mind direction of fit and a mind-to-world direction of causation. An intention is both the representation of a goal and a cause of the transformation of a goal into a fact. These properties segregate representations specialized for perception from those specialized for action. Perception implies comparison between simultaneously represented and analyzed objects: hence, object perception presupposes the representation of spatial relationships among objects in a coordinate system independent from the perceiver. Spatial relationships carry cues for attributing meaning to an object, so that their processing is actually part of semantic processing of visual information. These considerations lead to a re-evaluation of the role of the two classical pathways of the human visual system: the ventral and the dorsal cortical pathways. The parietal lobe, which has been identified with the dorsal pathway, cannot be considered as a unitary entity with a single function. The superior parietal lobule carries visuomotor processing, a non-lateralized process. The right inferior parietal lobule contributes to the perception of spatial relationships, a process with a mind-to-world direction of fit and a world-to-mind direction of causation. Finally, the left inferior parietal lobule contributes to still another type of representation, related to visually goal-directed action, i.e., with both a world-to-mind direction of fit and a mind-to-world direction of causation.

Some effects of cortical and callosal damage on conscious and unconscious processing of visual information and other sensory inputs

Although new methods of investigation from the molecular level to cognition are promoting major advances in the study of the functions of the human brain, the analysis of behavioral and psychological deficits following brain damage is still a major tool for the understanding of cerebral organization. The present paper reviews some aspects of work on functional losses and residual abilities following cortical damage that have allowed to distinguish conscious and unconscious levels of visual input processing. Attention is given to the possible contribution of residual conscious vision of color to unconscious form analysis in visual agnosia. The paper also reviews findings on temporary and permanent deficits that occur after selective lesions of a prominent input-output system of the cerebral cortex, the corpus callosum, with the aim of assessing the possibility of establishing a functional callosal topography.

Visual imagery in cerebral visual dysfunction

Many sorts of deficits in imagery follow brain damage, but the relation between the site of damage and the type of deficit is not simple or straightforward. The dissociations in performance after brain damage provide hints regarding the processing system underlying imagery, but difficulties in interpretation urge caution in mapping these findings to theoretic models. Neuroimaging techniques, such as PET and fMRI, open a window into the working brain and offer valuable information not easily accessible through the study of patients, who, as noted, may have deficits beyond those observable and may rely on compensation and neural reorganization. As we come to understand the mental imagery system more fully, such issues as the laterality of image generation are likely to prove too coarse and vague. The brain is an enormously intricate organ, and even within a circumscribed domain such as imagery it seems to process information in complex and subtle ways.

The relationship between visual perception and visual mental imagery: a reappraisal of the neuropsychological evidence

Visual perception and visual mental imagery, the faculty whereby we can revisualise a visual item from memory, have often been regarded as cognitive functions subserved by common mechanisms. Thus, the leading cognitive model of visual mental imagery holds that visual perception and visual imagery share a number of mental operations, and rely upon common neural structures, including early visual cortices. In particular, a single visual buffer would be used "bottom-up" to display visual percepts and "top-down" to display internally generated images. The proposed neural substrate for this buffer consists of some cortical visual areas organised retinotopically, that is, the striate and extrastriate occipital areas. Empirical support for this model came from the report of brain-damaged patients showing an imagery deficit which parallels a perceptual impairment in the same cognitive domain. However, recent reports of patients showing double dissociations between perception and imagery abilities challenged the perception-imagery equivalence hypothesis from the functional point of view. From the anatomical point of view, the available evidence suggests that occipital damage is neither necessary nor sufficient to produce imagery deficits. On the other hand, extensive left temporal damage often accompanies imagery deficits for object form or colour. Thus, visual mental imagery abilities might require the integrity of brain areas related to vision, but at an higher level of integration than previously proposed.

Seeing, since childhood, without ventral stream: a behavioural study

We report the case of a 30-year-old man (S.B.) who developed visual agnosia following a meningoencephalitis at the age of 3 years. MRI disclosed extensive bilateral lesions of the occipital temporal visual pathway (ventral stream) and lesions in the right dorsal pathway, sparing primary visual cortices. S.B. showed a severe visual recognition deficit (texture, colour, objects, faces and words), although movement and space perception were largely preserved. His remaining visual capacities illustrate the competence of an isolated dorsal system which essentially functions on the sole basis of magnocellular afferents (low spatial resolution, high sensitivity to low contrast and moving stimuli). Patient S.B. also shows remarkable visuomotor competences, despite his perceptual limitations. It is suggested that his perceptual capacities correspond to the visual processing limitations of the dorsal visual stream, which in this patient have become accessible to perceptual awareness.

Odor memory induces brain activation as measured by functional MRI

PURPOSE

Our goal was to use functional MRI (fMRI) to measure brain activation in response to imagination of odors in humans.

METHOD

fMR brain scans were obtained in 21 normal subjects (9 men, 12 women) using multislice FLASH MRI in response to imagination of odors of banana and peppermint and to the actual smells of the corresponding odors of amyl acetate and menthone, respectively, in three coronal sections selected from anterior to posterior temporal brain regions. Similar studies were obtained in two patients with hyposmia using FLASH MRI and in one patient with hyposmia using echo planar imaging, both before and after theophylline treatment, which returned smell function to or toward normal in each patient. Activation images were derived using correlation analysis, and ratios of areas of brain activated to total brain areas were calculated.

RESULTS

Activation was present in each section in all normal subjects and in each patient after imagination of each vapor. In normal subjects, brain activation in response to imagination of odors was significantly less than that in response to the actual smell of these odors, and activation following imagination of banana odor was significantly greater in men than in women, as was previously reported for the actual smell of the odor of amyl acetate. However, in relative terms, albeit at an absolute lower brain activation level, the ratio of brain activation by imagination of banana to activation by actual amyl acetate odor was about twice as high in women as in men. Before treatment, in patients with hyposmia, brain activation in response to odor imagination was greater than after presentation of the actual odor itself. After treatment, in patients with hyposmia in whom smell acuity returned to or toward normal, brain activation in response to odor imagination was not significantly different quantitatively from that before treatment; however, brain activation in response to the actual odor was significantly greater than that in response to imagination of the corresponding odor. Brain regions activated by both odor imagination and actual corresponding odor were similar and consistent with regions previously described as responding to odors.

CONCLUSION

These studies indicate that (a) odors can be imagined and similar brain regions are activated by both imagined and corresponding actual odors; (b) imagination of odors elicits quantitatively less brain activation than do actual smells of corresponding odors in normal subjects; (c) absolute brain activation in men by odor imagination is greater than in women for some odors, but on a relative basis, the ratio for odor imagination to actual smell in women is twice that in men; (d) odor imagination, once the odor has been experienced, is present, recallable, and capable of inducing a relatively constant degree of brain activation even in the absence of the ability to recognize an actual corresponding odor.

Patterns of brain activity during visual imagery of letters

Cortical signals associated with visual imagery of letters were recorded from 10 healthy adults with a whole-scalp 122-channel neuromagnetometer. The auditory stimulus sequence consisted of 20 different phonemes corresponding to single letters of the Roman alphabet and of tone pips (17%), delivered once every 1.5 sec in a random order. The subjects were instructed to visually imagine the letter corresponding to the auditory stimulus and to examine its visuospatial properties: The associated brain activity was compared with activity evoked by the same stimuli when the subjects just detected the intervening tones. All subjects produced broad imagery-related responses over multiple cortical regions. After initial activation of the auditory cortices, the earliest imagery-related responses originated in the left prerolandic area 320 msec after the voice onset. They were followed within 70 msec by signals originating in the posterior parietal lobe close to midline (precuneus) and, 100 msec later, in the posterior superior temporal areas, predominantly in the left hemisphere. The activations were sustained and partially overlapping in time. Imagery-related activity in the left lateral occipital cortex was observed in two subjects, and weak late activity in the calcarine cortex in one subject. Real audiovisually presented letters activated multiple brain regions, and task-induced visuospatial processing of these stimuli further increased activity in some of these regions and activated additional areas: Some of these areas were activated during imagery as well. The results suggest that certain brain areas involved in high-level visual perception are activated during visual imagery and that the extent of imagery-related activity is dictated by the requirements of the stimuli and the task.

The apraxias are higher-order defects of sensorimotor integration

The classical features of motor disorders due to neurological disease affecting the pyramidal pathways, cerebellum and basal ganglia in humans are well known. What is less understood is the clinical world of apraxia--'inability to perform purposeful skilled movements in the absence of any elementary motor (weakness, akinesia, abnormal posture or tone) or sensory deficits, or impaired comprehension or memory'. Much of what clinicians call apraxia is a failure of gesture production to command, due to problems of transcoding language into motor action, without motor deficit in ordinary life. However, damage to premotor regions and superior parietal lobules provokes devastating spontaneous higher-order motor deficits, including limb-kinetic apraxia, diagnostic apraxia, visuomotor apraxia and ideational apraxia.

Prosopagnosia and alexia without object agnosia

Following a trauma causing bilateral posterior brain damage, a patient complained of dyslexia and prosopagnosia, but not object agnosia. On testing she showed intact recognition of object drawings, even when it was assessed with perceptually demanding tasks such as Ghent's overlapping figures and Street completion test. This pattern of deficit is inconsistent with Farah's (1990) prediction that the simultaneous occurrence of alexia and prosopagnosia is invariably associated with object agnosia. The patient's reading performance had the features typically found in letter-by-letter readers. On face tests, she showed a discrepancy between the impairment exhibited in familiarity recognition and famous face naming and the correct (though slow) performance in matching the names of famous persons with their photographs. This apparent contradiction was clarified by showing that the patient had maintained the ability to generate the mental images of famous faces in response to the presentation of their names. We assume that face recognition units were intact, but partially disconnected from the output of perceptual processing.

Multiple-domain dissociation between impaired visual perception and preserved mental imagery in a patient with bilateral extrastriate lesions

A brain-damaged patient is described whose pattern of performance provides insight into both the functional mechanisms and the neural structures involved in visual mental imagery. The patient became severely agnosic, alexic, achromatopsic and prosopagnosic following bilateral brain lesions in the temporo-occipital cortex. However, her mental imagery for the same visual entities that she could not perceive was perfectly preserved. This clear-cut dissociation held across all the major domains of high-level vision: object recognition, reading, colour and face processing. Our findings, together with other reports on domain-specific dissociations and functional brain imaging studies, provide evidence to support the view that visual perception and visual mental imagery are subserved by independent functional mechanisms, which do not share the same cortical implementation. In particular, our results suggest that mental imagery abilities need not be mediated by early visual cortices.

Preserved imagery for colours in a patient with cerebral achromatopsia

We report the case of a patient who, after sequential bilateral strokes in the occipital regions sparing the primary visual cortex, developed a severe deficit of colour perception. At variance with other reports of acquired achromatopsic patients, she showed a perfectly vivid visual imagery for colours. These findings, together with similar data in domains other than colour processing, challenge the theories which posit that the same cognitive processes are involved in both the perception and the retrieval from memory of a given stimulus.