Childhood prosopagnosia

Disentangling developmental prosopagnosia: A scoping review of terms, tools and topics

The goal of this preregistered scoping review is to create an overview of the research on developmental prosopagnosia (DP). Through analysis of all empirical studies of DP in adults, we investigate 1) how DP is conceptualized and defined, 2) how individuals are classified with DP and 3) which aspects of DP are investigated in the literature. We reviewed 224 peer-reviewed studies of DP. Our analysis of the literature reveals that while DP is predominantly defined as a lifelong face recognition impairment in the absence of acquired brain injury and intellectual/cognitive problems, there is far from consensus on the specifics of the definition with some studies emphasizing e.g., deficits in face perception, discrimination and/or matching as core characteristics of DP. These differences in DP definitions is further reflected in the vast heterogeneity in classification procedures. Only about half of the included studies explicitly state how they classify individuals with DP, and these studies adopt 40 different assessment tools. The two most frequently studied aspects of DP are the role of holistic processing and the specificity of face processing, and alongside a substantial body of neuroimaging studies of DP, this paints a picture of a research field whose scientific interests and aims are rooted in cognitive neuropsychology and neuroscience. We argue that these roots - alongside the heterogeneity in DP definition and classification - may have limited the scope and interest of DP research unnecessarily, and we point to new avenues of research for the field.

Face Blindness in Children and Current Interventions

Children with prosopagnosia, also known as face blindness, struggle to recognize the faces of acquaintances, which can have a negative impact on their social interactions and overall functioning. This paper reviews existing research on interventions for children with prosopagnosia, including compensatory and remedial strategies, and provides a summary and comparison of their effectiveness. However, despite the availability of these interventions, their effectiveness remains limited and constrained by various factors. The lack of a widely accepted treatment for children with prosopagnosia emphasizes the need for further research to improve intervention strategies. Last, three future research directions were proposed to improve interventions for prosopagnosia, including ecological approaches, the social challenges faced by children, and new potential intervention methods.

Prosopagnosia and disorders of face processing

Face recognition is a form of expert visual processing. Acquired prosopagnosia is the loss of familiarity for facial identity and has several functional variants, namely apperceptive, amnestic, and associative forms. Acquired forms are usually caused by either occipitotemporal or anterior temporal lesions, right or bilateral in most cases. In addition, there is a developmental form, whose functional and structural origins are still being elucidated. Despite their difficulties with recognizing faces, some of these subjects still show signs of covert recognition, which may have a number of explanations. Other aspects of face perception can be spared in prosopagnosic subjects. Patients with other types of face processing difficulties have been described, including impaired expression processing, impaired lip-reading, false familiarity for faces, and a people-specific amnesia. Recent rehabilitative studies have shown some modest ability to improve face perception in prosopagnosic subjects through perceptual training protocols.

Contributions of nonhuman primate research to understanding the consequences of human brain injury during development

In this introductory review we first present a theoretical framework as well as a clinical perspective regarding the effects of early brain injury on the development of cognitive and behavioral functions in humans. Next, we highlight the contributions that nonhuman primate research make toward identifying some of the variables that influence long-term cognitive outcome after developmental disease, or damage. We start our review by arguing that in contrast to adult-onset injury, developmental brain insults alter the ontogenetic pattern of brain organization and circuit specialization depending on the variables of age at injury, the focality of the lesion, and the potential for reorganization. We then introduce the 2 nonhuman primate studies in this section (Kiorpes on vision; Bachevalier on cognitive memory), and highlight the relevance of their findings to our understanding of developmental conditions or injuries in humans, with the ultimate goal of improving the health and development of the young.

Damasio's error - Prosopagnosia with intact within-category object recognition

The sudden inability to recognize individual faces following brain damage was first reported in a scientific journal 150 years ago and termed 'prosopagnosia' 70 years ago. While the term originally identified a face-selective neurological condition, it is now obscured by a sequence of imprecisions. First, prosopagnosia is routinely used to define symptoms of individual face recognition (IFR) difficulties in the context of visual object agnosia or other neurological conditions, or even in the normal population. Second, this over-expansive definition has lent support to a long-standing within-category recognition account of prosopagnosia, that is, that the impairment of IFR reflects a general impairment in recognizing within-category objects. However, stringent experimental studies of classical cases of prosopagnosia following brain damage show that their core impairment is not in recognizing physically similar exemplars within non-face object categories. Instead, the impairment presents specifically for recognizing exemplars of the category of faces. Moreover, compared to typical observers, the impairment appears even more severe for recognizing individual faces against physically dissimilar than similar distractors. Here, I argue that we need to limit accordingly our definition of prosopagnosia to a clinical (i.e., neurological) condition in which there is no basic-level object recognition impairment. Other criteria for prosopagnosia are proposed, with the hope that this conservative definition enables the study of human IFR processes in isolation, and supports progress in understanding the nature of these processes.

Preliminary normative data on the BORB for children aged 3-8

The Birmingham Object Recognition Battery (BORB) is a theoretically based test battery that is used in adult cognitive neuropsychology in research and for clinical assessment. It allows a detailed analysis of underlying impairments in individuals with brain injury who have visual object recognition difficulties. The BORB's usefulness in pediatrics is supported by numerous research studies. However, there is no published normative data for children, making clinical use of the test difficult. The aim of this brief report is to publish some preliminary normative data in 70 children aged between 3 and 8 years to assist both researchers and clinicians with interpretation of test scores. Results indicate that children's performance on individual BORB subtests varies according to task demands and age. For some subtests there is improvement in performance with increasing age. However, very young children (age 3-4 years) perform at adult levels on some subtests, or alternatively on other subtests they perform at the level of chance. The current paper supports the need for pediatric data for the BORB due to large normal individual variation in performance and varying age-related performance on individual BORB subtests.

The contribution of facial dynamics to subtle expression recognition in typical viewers and developmental visual agnosia

Facial expressions are inherently dynamic cues that develop and change over time, unfolding their affective signal. Although facial dynamics are assumed important for emotion recognition, testing often involves intense and stereotypical expressions and little is known about the role of temporal information in the recognition of subtle, non-stereotypical expressions. In Experiment 1 we demonstrate that facial dynamics are critical for recognizing subtle and non-stereotypical facial expressions, but not for recognizing intense and stereotypical displays of emotion. In Experiment 2 we further examined whether the facilitative effect of motion can lead to improved emotion recognition in LG, an individual with developmental visual agnosia and prosopagnosia, who has poor emotion recognition when tested with static facial expressions. LG's emotion recognition improved when subtle, non-stereotypical faces were dynamic rather than static. However, compared to controls, his relative gain from temporal information was diminished. Furthermore, LG's eye-tracking data demonstrated atypical visual scanning of the dynamic faces, consisting of longer fixations and lower fixation rates for the dynamic-subtle facial expressions, comparing to the dynamic-intense facial expressions. We suggest that deciphering subtle dynamic expressions strongly relies on integrating broad facial regions across time, rather than focusing on local emotional cues, skills which are impaired in developmental visual agnosia.

Face perception in pure alexia: Complementary contributions of the left fusiform gyrus to facial identity and facial speech processing

Recent concepts of cerebral visual processing predict from overlapping patterns of face and word activation in cortex that left fusiform lesions will not only cause pure alexia but also lead to mild impairments of face processing. Our goal was to determine if alexic subjects had deficits in facial identity processing similar to those seen after right fusiform lesions, or complementary deficits affecting different aspects of face processing. We studied four alexic patients whose lesions involved the left fusiform gyrus and one prosopagnosic subject with a right fusiform lesion, on standard tests of face perception and recognition. We evaluated their ability first to process faces in linear contour images, and second to detect, discriminate, identify and integrate facial speech patterns into perception. We found that all five patients were impaired in face matching across viewpoint, but the alexic subjects performed worse with line-drawn faces, while the prosopagnosic subject did not. Alexic subjects could detect facial speech patterns but had trouble identifying them and did not integrate facial speech patterns with speech sounds, whereas identification and integration was intact in the prosopagnosic subject. We conclude that, in addition to their role in reading, the left-sided regions damaged in alexic subjects participate in the perception of facial identity but in a non-redundant fashion, focusing on the information in linear contours at higher spatial frequencies. In addition they have a dominant role in processing facial speech patterns, another visual aspect of language processing.

Functional outcomes following lesions in visual cortex: Implications for plasticity of high-level vision

Understanding the nature and extent of neural plasticity in humans remains a key challenge for neuroscience. Importantly, however, a precise characterization of plasticity and its underlying mechanism has the potential to enable new approaches for enhancing reorganization of cortical function. Investigations of the impairment and subsequent recovery of cognitive and perceptual functions following early-onset cortical lesions in humans provide a unique opportunity to elucidate how the brain changes, adapts, and reorganizes. Specifically, here, we focus on restitution of visual function, and we review the findings on plasticity and re-organization of the ventral occipital temporal cortex (VOTC) in published reports of 46 patients with a lesion to or resection of the visual cortex early in life. Findings reveal that a lesion to the VOTC results in a deficit that affects the visual recognition of more than one category of stimuli (faces, objects and words). In addition, the majority of pediatric patients show limited recovery over time, especially those in whom deficits in low-level vision also persist. Last, given that neither the equipotentiality nor the modularity view on plasticity was clearly supported, we suggest some intermediate possibilities in which some plasticity may be evident but that this might depend on the area that was affected, its maturational trajectory as well as its structural and functional connectivity constraints. Finally, we offer suggestions for future research that can elucidate plasticity further.

The definition and diagnosis of developmental prosopagnosia

Over the last 20 years much attention in the field of face recognition has been directed towards the study of developmental prosopagnosia (DP), with some authors investigating the behavioural characteristics of the condition, and many others using these individuals to further our theoretical understanding of the typical face-processing system. It is broadly agreed that the term "DP" refers to people who have failed to develop the ability to recognize faces in the absence of neurological illness or injury, yet more precise terminology in relation to potential subtypes of the population are yet to be confirmed. Furthermore, specific diagnostic techniques and inclusion and exclusion criteria have yet to be uniformly accepted across the field, making cross-paper comparisons and meta-analyses very difficult. This paper presents an overview of the current challenges that face research into DP and introduces a series of papers that attempt to further our understanding of the condition's characteristics. It is hoped that this special issue will provide a springboard for further research addressing these issues, improving the current state of the art by ensuring the quality of theoretical investigations into DP, and by posing advances that will assist those who have the condition.

Distinct Visual Processing of Real Objects and Pictures of Those Objects in 7- to 9-month-old Infants

The present study examined 7- and 9-month-old infants' visual habituation to real objects and pictures of the same objects and their preferences between real and pictorial versions of the same objects following habituation. Different hypotheses would predict that infants may habituate faster to pictures than real objects (based on proposed theoretical links between behavioral habituation in infants and neuroimaging adaptation in adults) or to real objects vs. pictures (based on past infant electrophysiology data). Sixty-one 7-month-old infants and fifty-nine 9-month-old infants were habituated to either a real object or a picture of the same object and afterward preference tested with the habituation object paired with either the novel real object or its picture counterpart. Infants of both age groups showed basic information-processing advantages for real objects. Specifically, during the initial presentations, 9-month-old infants looked longer at stimuli in both formats than the 7-month olds but more importantly both age groups looked longer at real objects than pictures, though with repeated presentations, they habituated faster for real objects such that at the end of habituation, they looked equally at both types of stimuli. Surprisingly, even after habituation, infants preferred to look at the real objects, regardless of whether they had habituated to photos or real objects. Our findings suggest that from as early as 7-months of age, infants show strong preferences for real objects, perhaps because real objects are visually richer and/or enable the potential for genuine interactions.

Neural mechanisms of face perception, their emergence over development, and their breakdown

Face perception is probably the most developed visual perceptual skill in humans, most likely as a result of its unique evolutionary and social significance. Much recent research has converged to identify a host of relevant psychological mechanisms that support face recognition. In parallel, there has been substantial progress in uncovering the neural mechanisms that mediate rapid and accurate face perception, with specific emphasis on a broadly distributed neural circuit, comprised of multiple nodes whose joint activity supports face perception. This article focuses specifically on the neural underpinnings of face recognition, and reviews recent structural and functional imaging studies that elucidate the neural basis of this ability. In addition, the article covers some of the recent investigations that characterize the emergence of the neural basis of face recognition over the course of development, and explores the relationship between these changes and increasing behavioural competence. This paper also describes studies that characterize the nature of the breakdown of face recognition in individuals who are impaired in face recognition, either as a result of brain damage acquired at some point or as a result of the failure to master face recognition over the course of development. Finally, information regarding similarities between the neural circuits for face perception in humans and in nonhuman primates is briefly covered, as is the contribution of subcortical regions to face perception. WIREs Cogn Sci 2016, 7:247-263. doi: 10.1002/wcs.1388 For further resources related to this article, please visit the WIREs website.

Getting lost: Topographic skills in acquired and developmental prosopagnosia

Previous studies report that acquired prosopagnosia is frequently associated with topographic disorientation. Whether this is associated with a specific anatomic subtype of prosopagnosia, how frequently it is seen with the developmental variant, and what specific topographic function is impaired to account for this problem are not known. We studied ten subjects with acquired prosopagnosia from either occipitotemporal or anterior temporal (AT) lesions and seven with developmental prosopagnosia. Subjects were given a battery of topographic tests, including house and scene recognition, the road map test, a test of cognitive map formation, and a standardized self-report questionnaire. House and/or scene recognition were frequently impaired after either occipitotemporal or AT lesions in acquired prosopagnosia. Subjects with occipitotemporal lesions were also impaired in cognitive map formation: an overlap analysis identified right fusiform and parahippocampal gyri as a likely correlate. Only one subject with acquired prosopagnosia had mild difficulty with directional orientation on the road map test. Only one subject with developmental prosopagnosia had difficulty with cognitive map formation, and none were impaired on the other tests. Scores for house and scene recognition correlated most strongly with the results of the questionnaire. We conclude that topographic disorientation in acquired prosopagnosia reflects impaired place recognition, with a contribution from poor cognitive map formation when there is occipitotemporal damage. Topographic impairments are less frequent in developmental prosopagnosia.

The neural network associated with lexical-semantic knowledge about social groups

A person can be appraised as an individual or as a member of a social group. In the present study we tested whether the knowledge about social groups is represented independently of the living and non-living things. Patients with frontal and temporal lobe tumors involving either the left or the right hemisphere performed three tasks--picture naming, word-to-picture matching and picture sorting--tapping the lexical semantic knowledge of living things, non-living things and social groups. Both behavioral and voxel-based lesion-symptom mapping (VLSM) analyses suggested that social groups might be represented differently from other categories. VLSM analysis carried out on naming errors revealed that left-lateralized lesions in the inferior frontal gyrus, amygdala, insula and basal ganglia were associated with the lexical-semantic processing of social groups. These findings indicate that the social group representation may rely on areas associated with affective processing.

Real-world objects are more memorable than photographs of objects

Research studies in psychology typically use two-dimensional (2D) images of objects as proxies for real-world three-dimensional (3D) stimuli. There are, however, a number of important differences between real objects and images that could influence cognition and behavior. Although human memory has been studied extensively, only a handful of studies have used real objects in the context of memory and virtually none have directly compared memory for real objects vs. their 2D counterparts. Here we examined whether or not episodic memory is influenced by the format in which objects are displayed. We conducted two experiments asking participants to freely recall, and to recognize, a set of 44 common household objects. Critically, the exemplars were displayed to observers in one of three viewing conditions: real-world objects, colored photographs, or black and white line drawings. Stimuli were closely matched across conditions for size, orientation, and illumination. Surprisingly, recall and recognition performance was significantly better for real objects compared to colored photographs or line drawings (for which memory performance was equivalent). We replicated this pattern in a second experiment comparing memory for real objects vs. color photos, when the stimuli were matched for viewing angle across conditions. Again, recall and recognition performance was significantly better for the real objects than matched color photos of the same items. Taken together, our data suggest that real objects are more memorable than pictorial stimuli. Our results highlight the importance of studying real-world object cognition and raise the potential for applied use in developing effective strategies for education, marketing, and further research on object-related cognition.

Developmental disorders: what can be learned from cognitive neuropsychology?

The discipline of cognitive neuropsychology has been important for informing theories of cognition and describing the nature of acquired cognitive disorders, but its applicability in a developmental context has been questioned. Here, we revisit this issue, asking whether the cognitive neuropsychological approach can be helpful for exploring the nature and causes of developmental disorders and, if so, how. We outline the key features of the cognitive neuropsychological approach, and then consider how some of the major challenges to this approach from a developmental perspective might be met. In doing so, we distinguish between challenges to the methods of cognitive neuropsychology and those facing its deeper conceptual underpinnings. We conclude that the detailed investigation of patterns of both associations and dissociations, and across both developmental and acquired cases, can assist in describing the cognitive deficits within developmental disorders and in delineating possible causal pathways to their acquisition.

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.

Early commitment of neural substrates for face recognition

We present evidence of a striking failure of plasticity in the neural substrates of face recognition, which suggests that the distinction between faces and other objects, and the localisation of faces relative to other objects, is fully determined prior to any postnatal experience. A boy who sustained brain damage at 1 day of age has the classic lesions and behavioural profile of adult-acquired prosopagnosia. He has profoundly impaired face recognition, whereas his recognition of objects is much less impaired. This implies that the human genome contains sufficiently explicit information about faces and nonface objects, or visual features by which they can be distinguished, that experience with these categories is not necessary for their functional delineation and differential brain localisation.

Development of a vocabulary of object shapes in a child with a very-early-acquired visual agnosia: A unique case

We report a longitudinal study of an exceptional child (S.R.) whose early-acquired visual agnosia, following encephalitis at 8 weeks of age, did not prevent her from learning to construct an increasing vocabulary of visual object forms (drawn from different categories), albeit slowly. S.R. had problems perceiving subtle differences in shape; she was unable to segment local letters within global displays; and she would bring complex scenes close to her eyes: a symptom suggestive of an attempt to reduce visual crowding. Investigations revealed a robust ability to use the gestalt grouping factors of proximity and collinearity to detect fragmented forms in noisy backgrounds, compared with a very weak ability to segment fragmented forms on the basis of contrasts of shape. When contrasts in spatial grouping and shape were pitted against each other, shape made little contribution, consistent with problems in perceiving complex scenes, but when shape contrast was varied, and spatial grouping was held constant, S.R. showed the same hierarchy of difficulty as the controls, although her responses were slowed. This is the first report of a child's visual–perceptual development following very early neurological impairments to the visual cortex. Her ability to learn to perceive visual shape following damage at a rudimentary stage of perceptual development contrasts starkly with the loss of such ability in childhood cases of acquired visual agnosia that follow damage to the established perceptual system. Clearly, there is a critical period during which neurological damage to the highly active, early developing visual–perceptual system does not prevent but only impairs further learning.

Fallacies or analyses?

To demonstrate that a fallacy is committed, Block needs to convince us of two things: first, that theconceptof phenomenal consciousness is distinct from that of access consciousness, and second, that it picks out a different property from that of access consciousness. I raise doubt about both of these claims, suggesting that the concept of a phenomenal property is the concept of a property to which we have a special sort of access.

The path not taken

The differences Block attempts to capture with his putative distinction between P-consciousness and A-consciousness are more directly and perspicuously handled in terms of differences in richness of content and degree of influence. Block's critiques, based on his misbegotten distinction, evaporate on closer inspection.

How many concepts of consciousness?

With some help from the commentators, a few adjustments to the characterizations of A-consciousness and P-consciousness can avoid some trivial cases of one without the other. But it still seems that the case for the existence of P without A is stronger than that for A without P. If indeed there can be P without A, but not A without P, this would be a remarkable result that would need explanation.

Consciousness is not a natural kind

Blocks distinction between “phenomenal feel” consciousness and “thought/cognition” consciousness is a cultural construction. Consciousness (and its “subspecies”) is not a natural kind. Some crosscultural data are presented to support this.

Is consciousness of perception really separable from perception?

Although not the main point of his target article, Block defends the view that perception and awareness of perception could be functions of different brain systems. I will argue that the available data do not support this view, and that Block's defense of the view rests on problematic eonstruals of the “executive system” and of the components of information-processing models.

Evidence that phenomenal consciousness is the same as access consciousness

Block seems to propose untested answers to empirical questions. Whether consciousness is a “mongrel problem,” rather than a single core fact with many facets, is an empirical issue. Likewise, the intimate relationship between personal consciousness and global access functions cannot be decided pretheoretically. This point is demonstrated by the reader's private experience of foveal versus parafoveal vision, and for conscious versus unconscious representation of the many meanings of common words.

More empirical cases to break the accord of phenomenal and access-consciousness

Additional experiments show that P-consciousness and A consciousness can be empirically dissociated for the theoretically so phisticated observer. Phenomenal consciousness can have several degrees that are indirectly measurable.

Guilty consciousness

Should we distinguish between access and phenomenal consciousness? Block says yes and that various pathologies of consciousness support and clarify the distinction. The commentary charge that the distinction is neither supported nor clarified by the clinical data. It recommends an alternative reading of the data and urges Block to clarify the distinction.

On a confusion about a function of consciousness

Consciousness is a mongrel concept: there are a number of very different “consciousnesses.” Phenomenal consciousness is experience; the phenomenally conscious aspect of a state is what it is like to be in that state. The mark of access-consciousness, by contrast, is availability for use in reasoning and rationally guiding speech and action. These concepts are often partly or totally conflated, with bad results. This target article uses as an example a form of reasoning about a function of “consciousness” based on the phenomenon of blindsight. Some information about stimuli in the blind field is represented in the brains of blindsight patients, as shown by their correct “guesses.” They cannot harness this information in the service of action, however, and this is said to show that a function of phenomenal consciousness is somehow to enable information represented in the brain to guide action. But stimuli in the blind field arebothaccess-unconscious and phenomenally unconscious. The fallacy is: an obvious function of the machinery of accessconsciousness is illicitly transferred to phenomenal consciousness.

Conscious and nonconscious control of action

I criticize Block's examples of P-consciousness and A-consciousness for being flawed and the notion of A-consciousness for not being a notion of consciousness at all. I argue that an empirically important distinction can be made between behavior that is supported by an underlying conscious experience and behavior that is brought about by nonconscious action-control mechanisms. This distinction is different from that made by Block.

Access and what it is like

Block's cases of superblindsight, the pneumatic drill, and the Sperling experiments do not show that P-consciousness and Aconsciousness can come apart. On certain tendentious but not implausible construals of the concepts of P- and A-consciousness, they refer to the same psychological phenomenon.

Blocking out the distinction between sensation and perception: Superblindsight and the case of Helen

Block's notion of P-consciousness catches too much in its net. He would do better to exclude all states that do not have a sensory component. I question what he says about my work with the “blind” monkey, Helen.

Blindsight, orgasm, and representational overlap

It is argued that there is no fallacy in the reasoning in the example of the thirsty blindsight subject, on one reconstruction of that reasoning. Neither the case of orgasm nor the case of a visual versus an auditory experience as of something overheard shows that phenomenal content is not representational.

Visuoperceptive impairment in adult patients with occipital lobe epilepsies

The aim of the study was to verify whether adult patients with occipital lobe epilepsy (OLE) are at risk for cognitive impairment compared with controls. Twenty patients with OLE and 20 controls, matched as closely as possible to the epilepsy group in terms of gender, age, education, and intelligence, were administered a battery of tests based on visuoperceptive domains. None of the participants was affected by progressive pathologies, received any medication other than antiepileptic drugs, nor had a psychiatric background. We noted a statistically significant difference between patients with OLE and controls in the following tasks: Perceptive Differences Test, and Object Denomination Test, and Famous Faces Test (P<0.05). No difference was noted between symptomatic and nonsymptomatic patients with respect to neuropsychological results (P>0.05). The linear regression analysis performed did not show any statistically significant contribution by clinical variables. Our data confirm that patients with OLE manifest subtle difficulties in processing and mental manipulation of visual spatial data.

Structure and function in acquired prosopagnosia: lessons from a series of 10 patients with brain damage

Acquired prosopagnosia varies in both behavioural manifestations and the location and extent of underlying lesions. We studied 10 patients with adult-onset lesions on a battery of face-processing tests. Using signal detection methods, we found that discriminative power for the familiarity of famous faces was most reduced by bilateral occipitotemporal lesions that involved the fusiform gyri, and better preserved with unilateral right-sided lesions. Tests of perception of facial structural configuration showed severe deficits with lesions that included the right fusiform gyrus, whether unilateral or bilateral. This deficit was most consistent for eye configuration, with some patients performing normally for mouth configuration. Patients with anterior temporal lesions had better configuration perception, though at least one patient showed a more subtle failure to integrate configural data from different facial regions. Facial imagery, an index of facial memories, was severely impaired by bilateral lesions that included the right anterior temporal lobe and marginally impaired by fusiform lesions alone; unilateral right fusiform lesions tended to spare imagery for facial features. These findings suggest that (I) prosopagnosia is more severe with bilateral than unilateral lesions, indicating a minor contribution of the left hemisphere to face recognition, (2) perception of facial configuration critically involves the right fusiform gyrus and (3) access to facial memories is most disrupted by bilateral lesions that also include the right anterior temporal lobe. This supports assertions that more apperceptive variants of prosopagnosia are linked to fusiform damage, whereas more associative variants are linked to anterior temporal damage. Next, we found that behavioural indices of covert recognition correlated with measures of overt familiarity, consistent with theories that covert behaviour emerges from the output of damaged neural networks, rather than alternative pathways. Finally, to probe the face specificity of the prosopagnosic defect, we tested recognition of fruits and vegetables: While face specificity was not found in most of our patients, the data of one patient suggested that this may be possible with more focal lesions of the right fusiform gyrus.

Face perception: a very special issue

The perception of a face allows us to recognize the person, infer his or her emotional state, better understand what the person is saying, and derive general information, such as age and gender. This unique visual stimulus has generated a wealth of research, and subsequently theoretical and methodological debate. This special issue brings together 16 original papers that show the extraordinary diversity and fruitfulness of the approaches now being pursued. They are aimed at understanding different aspects of face perception in populations ranging from healthy children to adults with brain lesions and with techniques covering the entire spectrum from paper-and-pencil tests to functional brain imaging. Together, these contributions provide an insightful overview of the current state of research on face perception and exemplify the questions that dominate the field. To one such question, whether 'face perception' is a special issue in the broad field of the cognitive neurosciences, the answer is clearly yes!

Training of familiar face recognition and visual scan paths for faces in a child with congenital prosopagnosia

In the current report we describe a successful training study aimed at improving recognition of a set of familiar face photographs in K., a 4-year-old girl with congenital prosopagnosia (CP). A detailed assessment of K.'s face-processing skills showed a deficit in structural encoding, most pronounced in the processing of facial features within the face. In addition, eye movement recordings revealed that K.'s scan paths for faces were characterized by a large percentage of fixations directed to areas outside the internal core features (i.e., eyes, nose, and mouth), in particular by poor attendance to the eye region. Following multiple baseline assessments, training focused on teaching K. to reliably recognize a set of familiar face photographs by directing visual attention to specific characteristics of the internal features of each face. The training significantly improved K.'s ability to recognize the target faces, with her performance being flawless immediately after training as well as at a follow-up assessment 1 month later. In addition, eye movement recordings following training showed a significant change in K.'s scan paths, with a significant increase in the percentage of fixations directed to the internal features, particularly the eye region. Encouragingly, not only was the change in scan paths observed for the set of familiar trained faces, but it generalized to a set of faces that was not presented during training. In addition to documenting significant training effects, our study raises the intriguing question of whether abnormal scan paths for faces may be a common factor underlying face recognition impairments in childhood CP, an issue that has not been explored so far.

The biasing of figure-ground assignment by shading cues for objects and faces in prosopagnosia

Prosopagnosia is defined by impaired recognition of the identity of specific faces. Whether the perception of faces at the categorical level (recognizing that a face is a face) is also impaired to a lesser degree is unclear. We examined whether prosopagnosia is associated with impaired detection of facial contours in a bistable display, by testing a series of five prosopagnosic patients on a variation of Rubin's vase illusion, in which shading was introduced to bias perception towards either the face or the vase. We also included a control bistable display in which a disc or an aperture were the two possible percepts. With the control disc/aperture test, prosopagnosic patients did not generate a normal sigmoid function, but a U-shaped function, indicating that they perceived the shading but had difficulty in using the shading to make the appropriate figure-ground assignment. While controls still generated a sigmoid function for the vase/face test, prosopagnosic patients showed a severe impairment in using shading to make consistent perceptual assignments. We conclude that prosopagnosic patients have difficulty in using shading to segment figures from background correctly, particularly with complex stimuli like faces. This suggests that a subtler defect in face categorization accompanies their severe defect in face identification, consistent with predictions of computational models and recent data from functional imaging.

The development of visual object recognition in school-age children

This study documents the age-dependent development of visual object recognition abilities in 115 children aged 6 to 11 years, using a battery of neuropsychological tests based on Marrs model (Efron test, Warringtons Figure-Ground Test, Street Completion Test, Poppelreuter-Ghent Test, a selection of stimuli from the Birmingham Object Recognition Battery, a series of color photographs of objects presented from unusual perspectives or illuminated in unusual ways). The results suggest a maturation of complex visual perceptual abilities, possibly related to the development of the cerebral processes involved in object recognition, and could be the starting point for future investigations of these skills in impaired populations.

First report of prevalence of non-syndromic hereditary prosopagnosia (HPA)

Acquired prosopagnosia (PA) is a rare condition after, for example, a stroke or brain injury. The congenital form of PA is generally considered to be even less common. Beside a few single case reports and anecdotal mentioning of familial cases no data on the epidemiology exists. Following a questionnaire-based screening in local secondary schools and at our medical faculty, candidates suspicious for PA underwent a semi-structured interview followed by examinations of first degree relatives. Among 689 local pupils and medical students of our university we found 17 with congenital PA. This corresponds to a prevalence rate of 2.47% (95% CI 1.31-3.63). The frequency is among the highest known for a monogenic disorder. All those index subjects (n = 14) of the target group who agreed to further examinations of their family members had other first degree relatives with the same cognitive disorder. This study provides epidemiological evidence that congenital PA is a very common cognitive disorder which almost always runs in families. The segregation pattern of this hereditary prosopagnosia (HPA) is fully compatible with autosomal dominant inheritance.

Assessment and treatment of childhood topographical disorientation: A case study

Topographical disorientation refers to individuals who are unable to find their way around large-scale environments in a normal manner. Childhood topographical disorientation is rarely investigated or reported. Treatment of topographical disorientation is also rare with only one reported treatment study in an adult (Davis & Coltheart, 1999) and no known description of treatment in a child. This paper reports a detailed case analysis of CA, a 6-year-old child with topographical disorientation, and a description of a treatment programme focused on training orientation in the school environment. Assessment of CA revealed mild to moderate visual agnosia in conjunction with severe impairments in general spatial learning and memory, topographical new learning and memory, and a total inability to learn new topographical routes. CA was also unable to use a mental image of his environment, a simple visual plan of his environment or a simple visual map, but was able to follow verbally mediated topographical instructions. The treatment programme focused on improving CA's topographical orientation in the school environment. The programme first involved training in recognition of major school buildings and landmarks and then focused on practical training in route finding along commonly used routes in the school environment. Clear benefits from treatment were evident. The assessment and treatment methods employed provide practical and useful ideas for management of this condition in other children.

Hereditary prosopagnosia (HPA): the first report outside the Caucasian population

Prosopagnosia (PA) or face blindness is characterized by a deficiency in identifying familiar faces. Almost all reports are single cases or collections of unrelated patients who acquired prosopagnosia after brain injuries, strokes or atrophy of at least the right occipito-temporal cortex. Until 2001, the inborn form - in the absence of any brain lesions - was described in fewer than 20 probands exclusively of Caucasian origin. We recently found that in the German Caucasian population, congenital prosopagnosia has a very high prevalence of at least 2.5% and that it is genetically determined. It is best described by autosomal-dominant inheritance in the more than 50 families investigated. We therefore introduced the term non-syndromic hereditary PA for the congenital form of a monosymptomatic or isolated PA. This surprisingly high frequency in the Caucasian population prompted us to extend our search to other ethnic groups. We performed a questionnaire-based screening among 198 native Indian students at Banaras Hindu University in Varanasi. In a then selected subset, we found after further detailed diagnostic interviews one Bengali female student with visual agnosia for face recognition only. Several other members of her large family reported the same impairment of face recognition. The segregation pattern of PA in this family is also compatible with autosomal-dominant inheritance.

Neuropsychological Findings in Idiopathic Occipital Lobe Epilepsies

PURPOSE

We reviewed the clinical charts of 22 patients (mean age 12 years) with idiopathic occipital lobe epilepsies (IOLE) to verify the presence of visuoperceptual difficulties.

METHODS

All 22 patients underwent a standard neuropsychiatric examination and had a sleep electroencephalogram (EEG). Eleven had normal development and adequate scholastic achievements, so no formal testing was performed. Psychological assessment was carried out in the remaining 11 patients who had been referred because of learning and behavioral difficulties.

RESULTS AND CONCLUSIONS

IQ was in the average/low-average range in most patients, with a cognitive profile characterized by relatively better verbal than performance abilities (8/11). There was a high incidence of scholastic disabilities (7/11); psychiatric disorders in the form of anxiety and depressive disorders were also frequent (6/11). In the six patients who had neuropsychological assessment with specific visuoperceptual testing, a deficit in facial discrimination was found in four patients, associated with a line orientation deficit in three. Although preliminary, and based on a tertiary-care clinical sample, these data suggest that children with IOLE, are at risk for lower intellectual performance, poor scholastic achievement and psychiatric disorders, as well as for specific deficits in the visuoperceptual domain, probably due to dysfunction of the occipitotemporal circuitries most often involved in seizure spread in epilepsies originating in the posterior brain.

Visual recognition and visually guided action after early bilateral lesion of occipital cortex: a behavioral study of a 4.6-year-old girl

We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It was revealed that the child had non-severely impaired basic visual abilities and ocular motility, a selective perceptual deficit of figure-ground segregation, impaired visual recognition and abnormal navigating through space. Even if the child's visual functioning was not optimal, this was the expression of adaptive anatomic and functional brain modifications that occurred following the early lesion. Anatomic brain structure was studied with anatomic MRI and Diffusor Tensor Imaging (DTI)-MRI. This behavioral study may provide an important contribution to understanding the impact of an early lesion of the visual system on the development of visual functions and on the immature brain's potential for reorganisation related to when the damage occurred.

Prosopagnosia following nonconvulsive status epilepticus associated with a left fusiform gyrus malformation

A 67-year-old, right-handed woman became unable to recognize familiar faces following a period of nonconvulsive status epilepticus. Neuropsychological assessment revealed a relatively selective impairment of familiar face recognition in the absence of low-level visual deficits or widespread cognitive impairment. MRI scanning demonstrated an isolated lesion, probably a venous angioma, involving the left fusiform gyrus, mirror-symmetrical to the site typically linked to prosopagnosia. Potential explanations for the patient's prosopagnosia include seizure-related damage to a left fusiform region required for fully competent face recognition and damage to the contralateral fusiform gyrus via interhemispheric connections. Focal neuropsychological deficits in patients with refractory partial epilepsy who develop nonconvulsive status epilepticus may be underdiagnosed.

Early brain lesions and face-processing development

Studies of functional plasticity after pre- or perinatal brain damage can tell us whether the neural substrate normally involved in the development of a given ability is specific and, if so, when it becomes functionally specified and unique. Development of face processing was investigated in 5- to 17-year-old children who had a unilateral brain injury in the pre-, peri-, or postnatal period. In Studies 1 and 2, patients with a posterior injury involving the temporal regions exhibited a face-processing deficit that was independent of their age at test time. Even though differences were observed between the two hemispheres in face processing during infancy as well as in adults in cases of normal development, no clear differences between right and left injury were observed here in face-processing deficit. Poor postlesional face-processing plasticity seems to contrast with results of several studies on speech development after early unilateral injury. If the difference in the time window for postlesional plasticity between these two areas of competency is confirmed, it would suggest that the two kinds of abilities rely on neural cells which are sensitive to different plasticity factors.