Congenital prosopagnosia: face-blind from birth

Humans' extreme face recognition abilities challenge the well-established familiarity effect

Classification performance is better for learned than unlearned stimuli. This was also reported for faces, where identity matching of unfamiliar faces is worse than for familiar faces. This familiarity advantage led to the conclusion that variability across appearances of the same identity is partly idiosyncratic and cannot be generalized from familiar to unfamiliar identities. Recent advances in machine vision challenge this claim by showing that the performance for untrained (unfamiliar) identities reached the level of trained identities as the number of identities that the algorithm is trained with increases. We therefore asked whether humans who reportedly can identify a vast number of identities, such as super recognizers, may close the gap between familiar and unfamiliar face classification. Consistent with this prediction, super recognizers classified unfamiliar faces just as well as typical participants who are familiar with the same faces, on a task that generates a sizable familiarity effect in controls. Additionally, prosopagnosics' performance for familiar faces was as bad as that of typical participants who were unfamiliar with the same faces, indicating that they struggle to learn even identity-specific information. Overall, these findings demonstrate that by studying the extreme ends of a system's ability we can gain novel insights into its actual capabilities.

Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses

The Diagnostic Statistical Manual of Mental Disorders (DSM-5) recommends diagnosing neurocognitive disorders (i.e., cognitive impairment) when a patient scores beyond - 1 SD below neurotypical norms on two tests. I review how this approach will fail due to cognitive tests' power limitations, validity issues, imperfect reliabilities, and biases, before summarizing their resulting negative consequences. As a proof of concept, I use developmental prosopagnosia, a condition characterized by difficulties recognizing faces, to show the DSM-5 only diagnoses 62-70% (n1 = 61, n2 = 165) versus 100% (n1 = 61) through symptoms alone. Pooling the DSM-5 missed cases confirmed the presence of group-level impairments on objective tests, which were further evidenced through meta-analyses, thus validating their highly atypical symptoms. These findings support a paradigm shift towards bespoke diagnostic approaches for distinct cognitive impairments, including a symptom-based method when validated effective. I reject dogmatic adherence to the DSM-5 approach to neurocognitive disorders, and underscore the importance of a data driven, transdiagnostic approach to understanding patients' subjective cognitive impairments. This will ultimately benefit patients, their families, clinicians, and scientific progress.

Poor face recognition predicts social anxiety in autism: A short report

LAY ABSTRACT

Research has shown that some autistic people have severe difficulties in recognising other people's faces. However, little is understood about how these difficulties impact the daily life and the mental well-being of autistic people. In this study, we asked 60 autistic adults with varying degrees of face recognition ability to complete two tests of face recognition, a questionnaire about social anxiety and a bespoke survey which asked participants about their experiences of face recognition and social interaction. We found that participants who had poor face recognition reported experiencing higher levels of social anxiety compared to those with average or better face recognition skills. More than half felt that their face recognition difficulties affected their social interactions, and over a third believed it hindered their ability to make friends. These findings suggest that face recognition difficulties may contribute to social anxiety among autistic individuals.

Autistic adults have insight into their relative face recognition ability

The PI20 is a self-report questionnaire that assesses the presence of lifelong face recognition difficulties. The items on this scale ask respondents to assess their face recognition ability relative to the rest of the population, either explicitly or implicitly. Recent reports suggest that the PI20 scores of autistic participants exhibit little or no correlation with their performance on the Cambridge Face Memory Test-a key measure of face recognition ability. These reports are suggestive of a meta-cognitive deficit whereby autistic individuals are unable to infer whether their face recognition is impaired relative to the wider population. In the present study, however, we observed significant correlations between the PI20 scores of 77 autistic adults and their performance on two variants of the Cambridge Face Memory Test. These findings indicate that autistic individuals can infer whether their face recognition ability is impaired. Consistent with previous research, we observed a wide spread of face recognition abilities within our autistic sample. While some individuals approached ceiling levels of performance, others met the prevailing diagnostic criteria for developmental prosopagnosia. This variability showed little or no association with non-verbal intelligence, autism severity, or the presence of co-occurring alexithymia or ADHD.

White matter connections of human ventral temporal cortex are organized by cytoarchitecture, eccentricity, and category-selectivity from birth

Category-selective regions in ventral temporal cortex (VTC) have a consistent anatomical organization, which is hypothesized to be scaffolded by white matter connections. However, it is unknown how white matter connections are organized from birth. Here, we scanned newborn to 6-month-old infants and adults and used a data-driven approach to determine the organization of the white matter connections of VTC. We find that white matter connections are organized by cytoarchitecture, eccentricity, and category from birth. Connectivity profiles of functional regions in the same cytoarchitectonic area are similar from birth and develop in parallel, with decreases in endpoint connectivity to lateral occipital, and parietal, and somatosensory cortex, and increases to lateral prefrontal cortex. Additionally, connections between VTC and early visual cortex are organized topographically by eccentricity bands and predict eccentricity biases in VTC. These data have important implications for theories of cortical functional development and open new possibilities for understanding typical and atypical white matter development.

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.

The neuropsychological evaluation of face identity recognition

Facial identity recognition (FIR) is arguably the ultimate form of recognition for the adult human brain. Even if the term prosopagnosia is reserved for exceptionally rare brain-damaged cases with a category-specific abrupt loss of FIR at adulthood, subjective and objective impairments or difficulties of FIR are common in the neuropsychological population. Here we provide a critical overview of the evaluation of FIR both for clinicians and researchers in neuropsychology. FIR impairments occur following many causes that should be identified objectively by both general and specific, behavioral and neural examinations. We refute the commonly used dissociation between perceptual and memory deficits/tests for FIR, since even a task involving the discrimination of unfamiliar face images presented side-by-side relies on cortical memories of faces in the right-lateralized ventral occipito-temporal cortex. Another frequently encountered confusion is between specific deficits of the FIR function and a more general impairment of semantic memory (of people), the latter being most often encountered following anterior temporal lobe damage. Many computerized tests aimed at evaluating FIR have appeared over the last two decades, as reviewed here. However, despite undeniable strengths, they often suffer from ecological limitations, difficulties of instruction, as well as a lack of consideration for processing speed and qualitative information. Taking into account these issues, a recently developed behavioral test with natural images manipulating face familiarity, stimulus inversion, and correct response times as a key variable appears promising. The measurement of electroencephalographic (EEG) activity in the frequency domain from fast periodic visual stimulation also appears as a particularly promising tool to complete and enhance the neuropsychological assessment of FIR.

Human genetics of face recognition: discovery of MCTP2 mutations in humans with face blindness (congenital prosopagnosia)

Face recognition is important for both visual and social cognition. While prosopagnosia or face blindness has been known for seven decades and face-specific neurons for half a century, the molecular genetic mechanism is not clear. Here we report results after 17 years of research with classic genetics and modern genomics. From a large family with 18 congenital prosopagnosia (CP) members with obvious difficulties in face recognition in daily life, we uncovered a fully cosegregating private mutation in the MCTP2 gene which encodes a calcium binding transmembrane protein expressed in the brain. After screening through cohorts of 6589, we found more CPs and their families, allowing detection of more CP associated mutations in MCTP2. Face recognition differences were detected between 14 carriers with the frameshift mutation S80fs in MCTP2 and 19 noncarrying volunteers. Six families including one with 10 members showed the S80fs-CP correlation. Functional magnetic resonance imaging found association of impaired recognition of individual faces by MCTP2 mutant CPs with reduced repetition suppression to repeated facial identities in the right fusiform face area. Our results have revealed genetic predisposition of MCTP2 mutations in CP, 76 years after the initial report of prosopagnosia and 47 years after the report of the first CP. This is the first time a gene required for a higher form of visual social cognition was found in humans.

Relationship between face recognition ability and anxiety tendencies in healthy young individuals: A prosopagnosia index and state-trait anxiety inventory study

Developmental prosopagnosia (DP) is a condition that indicates the inability to recognize individuals by their faces from birth, without any history of brain damage. The assessment of face recognition ability and diagnosis of DP involve the use of face tests such as the Cambridge Face Memory Test (CFMT) and the Cambridge Face Perception Test, along with self-reported measures like the 20-Item Prosopagnosia Index (PI20). Face recognition accuracy is affected by anxiety. However, previous studies on the relationship between face recognition ability and anxiety have not used the PI20 measure. This study aimed to investigate the relationship between self-reported measures of face recognition ability and anxiety tendencies among healthy young individuals for DP diagnosis and its implications. We used a face recognition test, involving the PI20, CFMT, Visual Perception Test for Agnosia-Famous Face Test (VPTA-FFT), and State-Trait Anxiety Inventory (STAI). We assessed the performance of 116 Japanese young adults (75 females, median age of 20.7 years, with a standard deviation of 1.2). Subsequently, we conducted a statistical analysis to examine the relationship between the outcomes of the face recognition tests and STAI scores using Pearson correlation analysis and single correlation coefficients. The results showed a positive correlation between state anxiety and PI20 (r = 0.308, p = 0.007), and a weak positive correlation was also observed between trait anxiety and PI20 (r = 0.268, p = 0.04). In contrast, there was no correlation between CFMT and VPTA-FFT with respect to STAI. The results of the hierarchical multiple regression analysis also suggested that the correlation between the performance on the PI20 (self-report) and objective measures of face recognition performance (the CFMT and the VPTA-FFT) are driven by differences in anxiety. This study is the first to explore the relationship between face recognition abilities and anxiety using the PI20 self-report measure. There are implications for future research on the diagnosis of DP and the relationship between anxiety and face recognition.

Reduced categorical learning of faces in dyslexia

The perception of phonological categories in dyslexia is less refined than in typically developing (TD) individuals. Traditionally, this characteristic was considered unique to phonology, yet many studies showed non-phonological perceptual difficulties. Importantly, measuring the dynamics of cortical adaptation, associated with category acquisition, revealed a broadly distributed faster decay of cortical adaptation. Taken together, these observations suggest that the acquisition of perceptual categories in dyslexia may be slower across modalities. To test this, we tested adult individuals with developmental dyslexia (IDDs) and TDs on learning of two unknown faces, yielding face-specific categorization. Initial accuracy was similar in the two groups, yet practice-induced increase in accuracy was significantly larger in TDs. Modeling the learning process (using Drift Diffusion Model) revealed that TDs' steeper learning results from a larger increase in their effective face-specific signal. We propose that IDDs' slower item-specific categorical learning of unknown faces indicates that slower categorical learning in dyslexia is a core, domain-general difficulty.

Familial Transmission of Developmental Prosopagnosia: New Case Reports from an Extended Family and Identical Twins

Existing evidence suggests that developmental prosopagnosia (DP) is a surprisingly prevalent condition, with some individuals describing lifelong difficulties with facial identity recognition. Together with case reports of multiple family members with the condition, this evidence suggests that DP is inherited in at least some instances. Here, we offer some novel case series that further support the heritability of the condition. First, we describe five adult siblings who presented to our lab with symptoms of DP. Second, for the first known time in the literature, we describe a pair of adult identical twins who contacted us in the belief that they both experience DP. The condition was confirmed in three of the five siblings (with minor symptoms observed in the remaining two) and in both twins. Supplementary assessments suggested that all individuals also experienced some degree of difficulty with facial identity perception, but that object recognition was preserved. These findings bolster the evidence supporting the heritability of DP and suggest that it can be a specific impairment in some cases.

Longitudinal development of category representations in ventral temporal cortex predicts word and face recognition

Regions in ventral temporal cortex that are involved in visual recognition of categories like words and faces undergo differential development during childhood. However, categories are also represented in distributed responses across high-level visual cortex. How distributed category representations develop and if this development relates to behavioral changes in recognition remains largely unknown. Here, we used functional magnetic resonance imaging to longitudinally measure the development of distributed responses across ventral temporal cortex to 10 categories in school-age children over several years. Our results reveal both strengthening and weakening of category representations with age, which was mainly driven by changes across category-selective voxels. Representations became particularly more distinct for words in the left hemisphere and for faces bilaterally. Critically, distinctiveness for words and faces across category-selective voxels in left and right lateral ventral temporal cortex, respectively, predicted individual children's word and face recognition performance. These results suggest that the development of distributed representations in ventral temporal cortex has behavioral ramifications and advance our understanding of prolonged cortical development during childhood.

Investigating the Influence of Autism Spectrum Traits on Face Processing Mechanisms in Developmental Prosopagnosia

Autism traits are common exclusionary criteria in developmental prosopagnosia (DP) studies. We investigated whether autism traits produce qualitatively different face processing in 43 DPs with high vs. low autism quotient (AQ) scores. Compared to controls (n = 27), face memory and perception were similarly deficient in the high- and low-AQ DPs, with the high-AQ DP group additionally showing deficient face emotion recognition. Task-based fMRI revealed reduced occipito-temporal face selectivity in both groups, with high-AQ DPs additionally demonstrating decreased posterior superior temporal sulcus selectivity. Resting-state fMRI showed similar reduced face-selective network connectivity in both DP groups compared with controls. Together, this demonstrates that high- and low-AQ DP groups have very similar face processing deficits, with additional facial emotion deficits in high-AQ DPs.

Are people with autism prosopagnosic?

Difficulties in various face processing tasks have been well documented in autism spectrum disorder (ASD). Several meta-analyses and numerous case-control studies have indicated that this population experiences a moderate degree of impairment, with a small percentage of studies failing to detect any impairment. One possible account of this mixed pattern of findings is heterogeneity in face processing abilities stemming from the presence of a subpopulation of prosopagnosic individuals with ASD alongside those with normal face processing skills. Samples randomly drawn from such a population, especially relatively smaller ones, would vary in the proportion of participants with prosopagnosia, resulting in a wide range of group-level deficits from mild (or none) to severe across studies. We test this prosopagnosic subpopulation hypothesis by examining three groups of participants: adults with ASD, adults with developmental prosopagnosia (DP), and a comparison group. Our results show that the prosopagnosic subpopulation hypothesis does not account for the face impairments in the broader autism spectrum. ASD observers show a continuous and graded, rather than categorical, heterogeneity that span a range of face processing skills including many with mild to moderate deficits, inconsistent with a prosopagnosic subtype account. We suggest that pathogenic origins of face deficits for at least some with ASD differ from those of DP.

The role of visual imagery in face recognition and the construction of facial composites. Evidence from Aphantasia

People with aphantasia have a markedly impaired ability to form visual images in the mind's eye. Here, by testing people with and without aphantasia, we examine the relationship between visual imagery and face processing. We show that aphantasics have weaker face recognition than people with visual imagery, using both self-report (Prosopagnosia Index) and behavioural measures (Cambridge Face Memory Test). However, aphantasics nonetheless have a fully intact ability to construct facial composites from memory (i.e., composites produced using EFIT6 by aphantasics and imagers were rated as equally accurate in terms of their resemblance to a target face). Additionally, we show that aphantasics were less able than imagers to see the resemblance between composites and a target face, suggestive of potential issues with face matching (perception). Finally, we show that holistic and featural methods of composite construction using EFIT6 produce equally accurate composites. Our results suggest that face recognition, but not face composite construction, is facilitated by the ability to represent visual properties as 'pictures in the mind'. Our findings have implications for the study of aphantasia, and also for forensic settings, where face composite systems are commonly used to aid criminal investigations.

Explicit face memory abilities are positively related to the non-intentional encoding of faces: Behavioral and ERP evidence

Individual differences in face memory abilities have been shown to be related to individual differences in brain activity. The present study investigated brain-behavior relationships for the N250 component in event-related brain potentials, which is taken as a neural sign of face familiarity. We used a task in which a designated, typical target face and several (high- and low-distinctive) nontarget faces had to be distinguished during multiple presentations across a session. Separately, face memory/recognition abilities were measured with easy versus difficult tasks. We replicated an increase of the N250 amplitude to the target face across the session and observed a similar increase for the non-target faces, indicating the build-up of memory representations also for these faces. On the interindividual level, larger across-session N250 amplitude increases to low-distinctive non-target faces were related to faster face recognition as measured in an easy task. These findings indicate that non-intentional encoding of non-target faces into memory is associated with the swift recognition of explicitly learned faces; that is, there is shared variance of incidental and intentional face memory.

The Neural Correlates of Developmental Prosopagnosia: Twenty-Five Years on

Faces play a crucial role in social interactions. Developmental prosopagnosia (DP) refers to the lifelong difficulty in recognizing faces despite the absence of obvious signs of brain lesions. In recent decades, the neural substrate of this condition has been extensively investigated. While early neuroimaging studies did not reveal significant functional and structural abnormalities in the brains of individuals with developmental prosopagnosia (DPs), recent evidence identifies abnormalities at multiple levels within DPs' face-processing networks. The current work aims to provide an overview of the convergent and contrasting findings by examining twenty-five years of neuroimaging literature on the anatomo-functional correlates of DP. We included 55 original papers, including 63 studies that compared the brain structure (MRI) and activity (fMRI, EEG, MEG) of healthy control participants and DPs. Despite variations in methods, procedures, outcomes, sample selection, and study design, this scoping review suggests that morphological, functional, and electrophysiological features characterize DPs' brains, primarily within the ventral visual stream. Particularly, the functional and anatomical connectivity between the Fusiform Face Area and the other face-sensitive regions seems strongly impaired. The cognitive and clinical implications as well as the limitations of these findings are discussed in light of the available knowledge and challenges in the context of DP.

No increased prevalence of prosopagnosia in aphantasia: Visual recognition deficits are small and not restricted to faces

Aphantasia and prosopagnosia are both rare conditions with impairments in visual cognition. While prosopagnosia refers to a face recognition deficit, aphantasics exhibit a lack of mental imagery. Current object recognition theories propose an interplay of perception and mental representations, making an association between recognition performance and visual imagery plausible. While the literature assumes a link between aphantasia and prosopagnosia, other impairments in aphantasia have been shown to be rather global. Therefore, we assumed that aphantasics do not solely exhibit impairments in face recognition but rather in general visual recognition performance, probably moderated by stimulus complexity. To test this hypothesis, 65 aphantasics were compared to 55 controls in a face recognition task, the Cambridge Face Memory Test, and a corresponding object recognition task, the Cambridge Car Memory Test. In both tasks, aphantasics performed worse than controls, indicating mild recognition deficits without face-specificity. Additional correlations between imagery vividness and performance in both tasks were found, suggesting that visual imagery influences visual recognition not only in imagery extremes. Stimulus complexity produced the expected moderation effect but only for the whole imagery-spectrum and only with face stimuli. Overall, the results imply that aphantasia is linked to a general but mild deficit in visual recognition.

Laterality and hemispheric specialization of self-face recognition

Inspired by the pioneering work of Eran Zaidel beginning in the early 1970's on the role of the two cerebral hemispheres of the human brain in self-related cognition, we review research on self-face recognition from a laterality perspective. The self-face is an important proxy of the self, and self-face recognition has been used as an indicator of self-awareness more broadly. Over the last half century, behavioral and neurological data, along with over two decades of neuroimaging research evidence have accumulated on this topic, generally concluding a right-hemisphere dominance for self-face recognition. In this review, we briefly revisit the pioneering roots of this work by Sperry, Zaidel & Zaidel, and focus on the important body of neuroimaging literature on self-face recognition it has inspired. We conclude with a brief discussion of current models of self-related processing and future directions for research in this area.

Why can people with developmental prosopagnosia recognise some familiar faces? Insights from subjective experience

Developmental prosopagnosia is a relatively common visuo-cognitive condition, characterised by impaired facial identity recognition. Impairment severity appears to reside on a continuum, however, it is unknown whether instances of milder deficits reflect the successful use of spontaneous (typical) face recognition strategies, or the application of extraneous compensatory cues to recognition. Here, we explore this issue in two studies. First, 23 adults with developmental prosopagnosia were asked about their use of spontaneous versus compensatory face recognition techniques in everyday life, using a series of closed- and open-ended questions. Second, the same participants performed a computerised famous face recognition task where they were asked to provide reasons why they could make any successful identifications. Findings from both studies suggest that people with developmental prosopagnosia can successfully, and quite frequently, use compensatory strategies to recognition, and that these cues support the majority of instances of preserved familiar face recognition. In contrast, 16 of the 23 participants were able to spontaneously recognise familiar faces on at least some occasions, but there were vast individual differences in frequencies of success. These findings have important implications for our conceptualisation of the condition, as well as for diagnostic practice.

Provoked overt recognition in acquired prosopagnosia using multiple different images of famous faces

Provoked overt recognition refers to the fact that patients with acquired prosopagnosia can sometimes recognize faces when presented in arrays of individuals from the same category (e.g., actors or politicians). We ask whether a prosopagnosic patient might experience recognition when presented with multiple different images of the same face simultaneously. Over two sessions, patient Herschel, a 66-year-old British man with acquired prosopagnosia, viewed face images individually or in arrays. On several occasions he failed to recognize single photos of an individual but successfully identified that person when the same photos were presented together. For example, Herschel failed to recognize any individual images of King Charles or Paul McCartney but recognised both in arrays of the same photos. Like reports based on category membership, overt recognition was transient and inconsistent. These findings are discussed in terms of models of covert recognition, alongside more recent research on within-person variability for face perception.

Intracerebral Electrophysiological Recordings to Understand the Neural Basis of Human Face Recognition

Understanding how the human brain recognizes faces is a primary scientific goal in cognitive neuroscience. Given the limitations of the monkey model of human face recognition, a key approach in this endeavor is the recording of electrophysiological activity with electrodes implanted inside the brain of human epileptic patients. However, this approach faces a number of challenges that must be overcome for meaningful scientific knowledge to emerge. Here we synthesize a 10 year research program combining the recording of intracerebral activity (StereoElectroEncephaloGraphy, SEEG) in the ventral occipito-temporal cortex (VOTC) of large samples of participants and fast periodic visual stimulation (FPVS), to objectively define, quantify, and characterize the neural basis of human face recognition. These large-scale studies reconcile the wide distribution of neural face recognition activity with its (right) hemispheric and regional specialization and extend face-selectivity to anterior regions of the VOTC, including the ventral anterior temporal lobe (VATL) typically affected by magnetic susceptibility artifacts in functional magnetic resonance imaging (fMRI). Clear spatial dissociations in category-selectivity between faces and other meaningful stimuli such as landmarks (houses, medial VOTC regions) or written words (left lateralized VOTC) are found, confirming and extending neuroimaging observations while supporting the validity of the clinical population tested to inform about normal brain function. The recognition of face identity - arguably the ultimate form of recognition for the human brain - beyond mere differences in physical features is essentially supported by selective populations of neurons in the right inferior occipital gyrus and the lateral portion of the middle and anterior fusiform gyrus. In addition, low-frequency and high-frequency broadband iEEG signals of face recognition appear to be largely concordant in the human association cortex. We conclude by outlining the challenges of this research program to understand the neural basis of human face recognition in the next 10 years.

Multiple-stage impairments of unfamiliar face learning in developmental prosopagnosia: Evidence from fMRI repetition suppression and multi-voxel pattern stability

Individuals with developmental prosopagnosia (DP) are characterized by severe face recognition deficits, yet it remains unknown how they are hindered in the process of unfamiliar face learning. Here we tracked the changes of neural activation during unfamiliar face repetition in DP with fMRI to reveal their neural deficits in learning unfamiliar faces. At the perceptual level, we found that the bilateral fusiform face area (FFA) in individuals with DP showed attenuated repetition suppression for faces, suggesting an inefficient perceptual analysis for learned faces. At the mnemonic level, individuals with DP showed decreased multi-voxel pattern stability for repeated faces in bilateral medial temporal lobe (MTL), suggesting an unstable mnemonic representation for learned faces. In addition, resting-state functional connectivity between the FFA and MTL was also disrupted in individuals with DP. Finally, the MTL's unstable mnemonic representation was associated with the impaired face recognition performance in DP. In sum, our study provides evidence that individuals with DP showed multi-stage neural deficits in unfamiliar face learning and sheds new light on how unfamiliar faces are learned in normal population.

Congenital lack and extraordinary ability in object and spatial imagery: An investigation on sub-types of aphantasia and hyperphantasia

Studies that have shown a distinction between object and spatial imagery suggest more than one type of aphantasia and hyperphantasia, yet this has not been systematically investigated in studies on imagery ability extremes. Also, if the involuntary imagery is preserved in aphantasia and how this condition affects other skills is not fully clear. We collected data on spatial and object imagery, retrospective, and prospective memory, face recognition, and sense of direction (SOD), suggesting a distinction between two subtypes of aphantasia/hyperphantasia. Spatial aphantasia is associated with difficulties in visuo-spatial mental imagery and SOD. Instead, in object aphantasia there are difficulties in imaging single items and events - with no mental visualization of objects, out-of-focus, and black-and-white mental images more frequent than expected - in SOD and face recognition. Furthermore, associative involuntary imagery can be spared in aphantasia. The opposite pattern of performance was found in spatial and object hyperphantasia.

New evidence of impaired expression recognition in developmental prosopagnosia

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by lifelong face recognition difficulties. To date, it remains unclear whether or not individuals with DP experience impaired recognition of facial expressions. It has been proposed that DPs may have sufficient perceptual ability to correctly interpret facial expressions when tasks are relatively easy (e.g., the stimuli are unambiguous and viewing conditions are optimal), but exhibit subtle impairments when tested under more challenging conditions. In the present study, we sought to take advantage of the COVID-19 pandemic to test this view. It is well-established that the surgical-type masks worn during the pandemic hinder the recognition and interpretation of facial emotion in typical participants. Relative to typical participants, we hypothesized that DPs may be disproportionately impaired when asked to interpret the facial emotion of people wearing face masks. We compared the ability of 34 DPs and 60 age-matched typical controls to recognize facial emotions i) when the whole face is visible, and ii) when the lower portion of the face is covered with a surgical mask. When expression stimuli were viewed without a mask, the DPs and typical controls exhibited similar levels of performance. However, when expression stimuli were shown with a mask, the DPs showed signs of subtle expression recognition deficits. The DPs were particularly prone to mislabeling masked expressions of happiness as emotion neutral. These results add to a growing body of evidence that under some conditions, DPs do exhibit subtle deficits of expression recognition.

Atypical prosopagnosia following right hemispheric stroke: A 23-year follow-up study with M.T

Most findings on prosopagnosia to date suggest preserved voice recognition in prosopagnosia (except in cases with bilateral lesions). Here we report a follow-up examination on M.T., suffering from acquired prosopagnosia following a large unilateral right-hemispheric lesion in frontal, parietal, and anterior temporal areas excluding core ventral occipitotemporal face areas. Twenty-three years after initial testing we reassessed face and object recognition skills [Henke, K., Schweinberger, S. R., Grigo, A., Klos, T., & Sommer, W. (1998). Specificity of face recognition: Recognition of exemplars of non-face objects in prosopagnosia. Cortex, 34(2), 289-296]; [Schweinberger, S. R., Klos, T., & Sommer, W. (1995). Covert face recognition in prosopagnosia - A dissociable function? Cortex, 31(3), 517-529] and additionally studied voice recognition. Confirming the persistence of deficits, M.T. exhibited substantial impairments in famous face recognition and memory for learned faces, but preserved face matching and object recognition skills. Critically, he showed substantially impaired voice recognition skills. These findings are congruent with the ideas that (i) prosopagnosia after right anterior temporal lesions can persist over long periods > 20 years, and that (ii) such lesions can be associated with both facial and vocal deficits in person recognition.

The rehabilitation of object agnosia and prosopagnosia: A systematic review

BACKGROUND

Agnosia for objects is often overlooked in neuropsychology, especially with respect to rehabilitation. Prosopagnosia has been studied more extensively, yet there have been few attempts at training it. The lack of training protocols may partially be accounted for by their relatively low incidence and specificity to sensory modality. However, finding effective rehabilitations for such deficits may help to reduce their impact on the social and psychological functioning of individuals.

OBJECTIVE

Our aim in this study was to provide clinicians and researchers with useful information with which to conduct new studies on the rehabilitation of object agnosia and prosopagnosia. To accomplish this, we performed a systematic and comprehensive review of the effect of neuropsychological rehabilitation on visual object and prosopagnosia.

METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. In addition, the Single-Case Experimental Design (SCED) and the Critical Appraisal Skills Programme (CASP) scales were used to assess the quality of reporting.

RESULTS

Seven articles regarding object agnosia, eight articles describing treatments for prosopagnosia, and two articles describing treatments for both deficits were included.

CONCLUSIONS

In the light of the studies reviewed, treatments based on analysis of parts seem effective for object agnosia, while prosopagnosia appears to benefit most from treatments relying on holistic/configural processing. However, more attempts at rehabilitation of face and object agnosia are needed to clarify the mechanisms of these processes and possible rehabilitations. Moreover, a publication bias could mask a broader attempt to find effective treatments for visual agnosia and leaving out studies that are potentially more informative.

Modular community structure of the face network supports face recognition

Face recognition is dependent on computations conducted in specialized brain regions and the communication among them, giving rise to the face-processing network. We examined whether modularity of this network may underlie the vast individual differences found in human face recognition abilities. Modular networks, characterized by strong within and weaker between-network connectivity, were previously suggested to promote efficacy and reduce interference among cognitive systems and also correlated with better cognitive abilities. The study was conducted in a large sample (n = 409) with diffusion-weighted imaging, resting-state fMRI, and a behavioral face recognition measure. We defined a network of face-selective regions and derived a novel measure of communication along with structural and functional connectivity among them. The modularity of this network was positively correlated with recognition abilities even when controlled for age. Furthermore, the results were specific to the face network when compared with the place network or to spatially permuted null networks. The relation to behavior was also preserved at the individual-edge level such that a larger correlation to behavior was found within hemispheres and particularly within the right hemisphere. This study provides the first evidence of modularity-behavior relationships in the domain of face processing and more generally in visual perception.

Is human face recognition lateralized to the right hemisphere due to neural competition with left-lateralized visual word recognition? A critical review

The right hemispheric lateralization of face recognition, which is well documented and appears to be specific to the human species, remains a scientific mystery. According to a long-standing view, the evolution of language, which is typically substantiated in the left hemisphere, competes with the cortical space in that hemisphere available for visuospatial processes, including face recognition. Over the last decade, a specific hypothesis derived from this view according to which neural competition in the left ventral occipito-temporal cortex with selective representations of letter strings causes right hemispheric lateralization of face recognition, has generated considerable interest and research in the scientific community. Here, a systematic review of studies performed in various populations (infants, children, literate and illiterate adults, left-handed adults) and methodologies (behavior, lesion studies, (intra)electroencephalography, neuroimaging) offers little if any support for this reading lateralized neural competition hypothesis. Specifically, right-lateralized face-selective neural activity already emerges at a few months of age, well before reading acquisition. Moreover, consistent evidence of face recognition performance and its right hemispheric lateralization being modulated by literacy level during development or at adulthood is lacking. Given the absence of solid alternative hypotheses and the key role of neural competition in the sensory-motor cortices for selectivity of representations, learning, and plasticity, a revised language-related neural competition hypothesis for the right hemispheric lateralization of face recognition should be further explored in future research, albeit with substantial conceptual clarification and advances in methodological rigor.

Implicit evidence on the dissociation of identity and emotion recognition

Recognition of identity and of emotional facial expressions of individuals are both based on processing of the human face. While most studies show these abilities to be dissociated, some others find evidence of a connection. One possible explanation for these contradictory results comes from neurological evidence, which points to identity recognition being mostly based on holistic processing, while emotion recognition seems to be based on both an explicit, fine-grained process, and an implicit, mostly-holistic one. Our main hypothesis, that would explain the contradictory findings, is that holistic implicit emotion recognition, specifically, would be related to identity recognition, while explicit emotion recognition would be a process separate to identity recognition. To test this hypothesis, we employed an experimental paradigm in which spatial frequencies of visual stimuli are manipulated so that automatic, holistic-based, implicit emotion recognition influences perceived friendliness of unfamiliar faces. We predicted the effect to be related to identity recognition ability, since they both require holistic face processing. After a successful replication study, we employed the paradigm with 140 participants, measuring also identity recognition ability and explicit emotion recognition ability. Results showed that the effect is not moderated by these two variables (p = .807 and .373, respectively), suggesting that the independence of identity and emotion recognition holds even when considering, specifically, implicit emotion recognition.

Critical information thresholds underlying generic and familiar face categorisation at the same face encounter

Seeing a face in the real world provokes a host of automatic categorisations related to sex, emotion, identity, and more. Such individual facets of human face recognition have been extensively examined using overt categorisation judgements, yet their relative informational dependencies during the same face encounter are comparatively unknown. Here we used EEG to assess how increasing access to sensory input governs two ecologically relevant brain functions elicited by seeing a face: Distinguishing faces and nonfaces, and recognising people we know. Observers viewed a large set of natural images that progressively increased in either image duration (experiment 1) or spatial frequency content (experiment 2). We show that in the absence of an explicit categorisation task, the human brain requires less sensory input to categorise a stimulus as a face than it does to recognise whether that face is familiar. Moreover, where sensory thresholds for distinguishing faces/nonfaces were remarkably consistent across observers, there was high inter-individual variability in the lower informational bound for familiar face recognition, underscoring the neurofunctional distinction between these categorisation functions. By i) indexing a form of face recognition that goes beyond simple low-level differences between categories, and ii) tapping multiple recognition functions elicited by the same face encounters, the information minima we report bear high relevance to real-world face encounters, where the same stimulus is categorised along multiple dimensions at once. Thus, our finding of lower informational requirements for generic vs. familiar face recognition constitutes some of the strongest evidence to date for the intuitive notion that sensory input demands should be lower for recognising face category than face identity.

The part-whole effect in super-recognisers and typical-range-ability controls

Face recognition skills are distributed on a continuum, with developmental prosopagnosics and super-recognisers at the bottom and top ends, respectively. Holistic processing propensity is associated with face recognition ability and may be impaired in some developmental prosopagnosics and enhanced in some super-recognisers. Across two experiments we compared holistic processing of 75 super-recognisers and 89 typical-range ability controls using The Part-Whole Effect (PWE) paradigm. A subgroup of super-recognisers demonstrated enhanced PWEs in the nose region, suggesting they integrate the nose into the holistic face percept more effectively than controls. Focussed processing of the nose region, an optimal viewing position to extract the holistic properties of faces, has previously been associated with superior face recognition, and this may partly explain the superiority of some super-recognisers. However, a few super-recognisers generated extreme nose region performance patterns in an opposite direction across both experiments, suggesting their superiority is driven by alternative mechanisms. These results support proposals that super-recognition is associated with heterogeneous underlying processes.

Separate and Shared Neural Basis of Face Memory and Face Perception in Developmental Prosopagnosia

Developmental prosopagnosia (DP), also known as face blindness, is a cognitive disorder with a severe deficit in recognizing faces. However, the heterogeneous nature of DP leads to a longstanding debate on which stages the deficit occurs, face perception (e.g., matching two consecutively presented faces) or face memory (e.g., matching a face to memorized faces). Here, we used the individual difference approach with functional magnetic resonance imaging to explore the neural substrates of DPs' face perception and face memory that may illuminate DPs' heterogeneity. Specifically, we measured the behavioral performance of face perception and face memory in a large sample of individuals suffering DP (N = 64) and then associated the behavioral performance with their face-selective neural responses in the core face network (CFN) and the extended face network (EFN), respectively. Behaviorally, we found that DP individuals were impaired in both face perception and face memory; however, there was only a weak correlation between the performances of two tasks. Consistent with this observation, the neural correlate of DPs' performance in face memory task was localized in the bilateral fusiform face area, whereas DPs' performance in face perception task was correlated with the face selectivity in the right posterior superior temporal sulcus, suggesting that the neural substrates in the CFN for face memory and face perception were separate in DP. In contrast, shared neural substrates of deficits in face perception and face memory tasks were identified in the EFN, including the right precuneus and the right orbitofrontal cortex. In summary, our study provides one of the first empirical evidence that the separate and shared neural substrates of face perception and face memory were identified in the CFN and EFN, respectively, which may help illuminating DP's heterogeneous nature.

Intracerebral electrical stimulation to understand the neural basis of human face identity recognition

Recognizing people's identity by their faces is a key function in the human species, supported by regions of the ventral occipito-temporal cortex (VOTC). In the last decade, there have been several reports of perceptual face distortion during direct electrical stimulation (DES) with subdural electrodes positioned over a well-known face-selective VOTC region of the right lateral middle fusiform gyrus (LatMidFG; i.e., the "Fusiform Face Area", FFA). However, transient impairments of face identity recognition (FIR) have been extremely rare and only behaviorally quantified during DES with intracerebral (i.e., depth) electrodes in stereo-electroencephalography (SEEG). The three detailed cases reported so far, summarized here, were specifically impaired at FIR during DES inside different anatomical VOTC regions of the right hemisphere: the inferior occipital gyrus (IOG) and the LatMidFG, as well as a region that lies at the heart of a large magnetic susceptibility artifact in functional magnetic resonance imaging (fMRI): the anterior fusiform gyrus (AntFG). In the first two regions, the eloquent electrode contacts were systematically associated with the highest face-selective and (unfamiliar) face individuation responses as measured with intracerebral electrophysiology. Stimulation in the right AntFG did not lead to perceptual changes but also caused an inability to remember having been presented face pictures, as if the episode was never recorded in memory. These observations support the view of an extensive network of face-selective VOTC regions subtending human FIR, with at least three critical nodes in the right hemisphere associated with differential intrinsic and extrinsic patterns of reentrant connectivity.

Computational insights into human perceptual expertise for familiar and unfamiliar face recognition

Humans are generally thought to be experts at face recognition, and yet identity perception for unfamiliar faces is surprisingly poor compared to that for familiar faces. Prior theoretical work has argued that unfamiliar face identity perception suffers because the majority of identity-invariant visual variability is idiosyncratic to each identity, and thus, each face identity must be learned essentially from scratch. Using a high-performing deep convolutional neural network, we evaluate this claim by examining the effects of visual experience in untrained, object-expert and face-expert networks. We found that only face training led to substantial generalization in an identity verification task of novel unfamiliar identities. Moreover, generalization increased with the number of previously learned identities, highlighting the generality of identity-invariant information in face images. To better understand how familiarity builds upon generic face representations, we simulated familiarization with face identities by fine-tuning the network on images of the previously unfamiliar identities. Familiarization produced a sharp boost in verification, but only approached ceiling performance in the networks that were highly trained on faces. Moreover, in these face-expert networks, the sharp familiarity benefit was seen only at the identity-based output probability layer, and did not depend on changes to perceptual representations; rather, familiarity effects required learning only at the level of identity readout from a fixed expert representation. Our results thus reconcile the existence of a large familiar face advantage with claims that both familiar and unfamiliar face identity processing depend on shared expert perceptual representations.

Quantifying aphantasia through drawing: Those without visual imagery show deficits in object but not spatial memory

Congenital aphantasia is a recently characterized variation of experience defined by the inability to form voluntary visual imagery, in individuals who are otherwise high performing. Because of this specific deficit to visual imagery, individuals with aphantasia serve as an ideal group for probing the nature of representations in visual memory, particularly the interplay of object, spatial, and symbolic information. Here, we conducted a large-scale online study of aphantasia and revealed a dissociation in object and spatial content in their memory representations. Sixty-one individuals with aphantasia and matched controls with typical imagery studied real-world scene images, and were asked to draw them from memory, and then later copy them during a matched perceptual condition. Drawings were objectively quantified by 2,795 online scorers for object and spatial details. Aphantasic participants recalled significantly fewer objects than controls, with less color in their drawings, and an increased reliance on verbal scaffolding. However, aphantasic participants showed high spatial accuracy equivalent to controls, and made significantly fewer memory errors. These differences between groups only manifested during recall, with no differences between groups during the matched perceptual condition. This object-specific memory impairment in individuals with aphantasia provides evidence for separate systems in memory that support object versus spatial information. The study also provides an important experimental validation for the existence of aphantasia as a variation in human imagery experience.

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.

The COVID-19 pandemic masks the way people perceive faces

The unprecedented efforts to minimize the effects of the COVID-19 pandemic introduce a new arena for human face recognition in which faces are partially occluded with masks. Here, we tested the extent to which face masks change the way faces are perceived. To this end, we evaluated face processing abilities for masked and unmasked faces in a large online sample of adult observers (n = 496) using an adapted version of the Cambridge Face Memory Test, a validated measure of face perception abilities in humans. As expected, a substantial decrease in performance was found for masked faces. Importantly, the inclusion of masks also led to a qualitative change in the way masked faces are perceived. In particular, holistic processing, the hallmark of face perception, was disrupted for faces with masks, as suggested by a reduced inversion effect. Similar changes were found whether masks were included during the study or the test phases of the experiment. Together, we provide novel evidence for quantitative and qualitative alterations in the processing of masked faces that could have significant effects on daily activities and social interactions.

Normal recognition of famous voices in developmental prosopagnosia

Developmental prosopagnosia (DP) is a condition characterised by lifelong face recognition difficulties. Recent neuroimaging findings suggest that DP may be associated with aberrant structure and function in multimodal regions of cortex implicated in the processing of both facial and vocal identity. These findings suggest that both facial and vocal recognition may be impaired in DP. To test this possibility, we compared the performance of 22 DPs and a group of typical controls, on closely matched tasks that assessed famous face and famous voice recognition ability. As expected, the DPs showed severe impairment on the face recognition task, relative to typical controls. In contrast, however, the DPs and controls identified a similar number of voices. Despite evidence of interactions between facial and vocal processing, these findings suggest some degree of dissociation between the two processing pathways, whereby one can be impaired while the other develops typically. A possible explanation for this dissociation in DP could be that the deficit originates in the early perceptual encoding of face structure, rather than at later, post-perceptual stages of face identity processing, which may be more likely to involve interactions with other modalities.

Different and common brain signals of altered neurocognitive mechanisms for unfamiliar face processing in acquired and developmental prosopagnosia

Neuropsychological studies have shown that prosopagnosic individuals perceive face structure in an atypical way. This might preclude the formation of appropriate face representations and, consequently, hamper effective recognition. The present ERP study, in combination with Bayesian source reconstruction, investigates how information related to both external (E) and internal (I) features was processed by E.C. and I.P., suffering from acquired and developmental prosopagnosia, respectively. They carried out a face-feature matching task with new faces. E.C. showed poor performance and remarkable lack of early face-sensitive P1, N170 and P2 responses on right (damaged) posterior cortex. Although she presented the expected mismatch effect to target faces in the E-I sequence, it was of shorter duration than in Controls, and involved left parietal, right frontocentral and dorsofrontal regions, suggestive of reduced neural circuitry to process face configurations. In turn, I.P. performed efficiently but with a remarkable bias to give "match" responses. His face-sensitive potentials P1-N170 were comparable to those from Controls, however, he showed no subsequent P2 response and a mismatch effect only in the I-E sequence, reflecting activation confined to those regions that sustain typically the initial stages of face processing. Relevantly, neither of the prosopagnosics exhibited conspicuous P3 responses to features acting as primes, indicating that diagnostic information for constructing face representations could not be sufficiently attended nor deeply encoded. Our findings suggest a different locus for altered neurocognitive mechanisms in the face network in participants with different types of prosopagnosia, but common indicators of a deficient allocation of attentional resources for further recognition.

Developmental Prosopagnosia and Elastic Versus Static Face Recognition in an Incidental Learning Task

Previous research on the beneficial effect of motion has postulated that learning a face in motion provides additional cues to recognition. Surprisingly, however, few studies have examined the beneficial effect of motion in an incidental learning task and developmental prosopagnosia (DP) even though such studies could provide more valuable information about everyday face recognition compared to the perception of static faces. In the current study, 18 young adults (Experiment 1) and five DPs and 10 age-matched controls (Experiment 2) participated in an incidental learning task during which both static and elastically moving unfamiliar faces were sequentially presented and were to be recognized in a delayed visual search task during which the faces could either keep their original presentation or switch (from static to elastically moving or vice versa). In Experiment 1, performance in the elastic-elastic condition reached a significant improvement relative to the elastic-static and static-elastic condition, however, no significant difference could be detected relative to the static-static condition. Except for higher scores in the elastic-elastic compared to the static-elastic condition in the age-matched group, no other significant differences were detected between conditions for both the DPs and the age-matched controls. The current study could not provide compelling evidence for a general beneficial effect of motion. Age-matched controls performed generally worse than DPs, which may potentially be explained by their higher rates of false alarms. Factors that could have influenced the results are discussed.

Evidence for normal novel object recognition abilities in developmental prosopagnosia

The issue of the face specificity of recognition deficits in developmental prosopagnosia (DP) is fundamental to the organization of high-level visual memory and has been increasingly debated in recent years. Previous DP investigations have found some evidence of object recognition impairments, but have almost exclusively used familiar objects (e.g. cars), where performance may depend on acquired object-specific experience and related visual expertise. An object recognition test not influenced by experience could provide a better, less contaminated measure of DPs' object recognition abilities. To investigate this, in the current study we tested 30 DPs and 30 matched controls on a novel object memory test (NOMT Ziggerins) and the Cambridge Face Memory Test (CFMT). DPs with severe impairment on the CFMT showed no differences in accuracy or reaction times compared with controls on the NOMT. We found similar results when comparing DPs with a larger sample of 274 web-based controls. Additional individual analyses demonstrated that the rate of object recognition impairment in DPs did not differ from the rate of impairment in either control group. Together, these results demonstrate unimpaired object recognition in DPs for a class of novel objects that serves as a powerful index for broader novel object recognition capacity.

Holistic processing of facial identity in developmental prosopagnosia

The nature of the perceptual deficit seen in developmental prosopagnosia remains poorly understood. One possibility is that these individuals experience face recognition difficulties because they fail to process faces holistically; they may be less able to analyze distal regions in parallel and therefore struggle to integrate information from different regions into a unified perceptual whole. Consequently, developmental prosopagnosics may be forced to base perceptual decisions on a slow, effortful piecemeal analysis of local facial features. In the present study, we sought to test this view by comparing the face recognition of developmental prosopagnosics and typical observers under two viewing conditions: when target faces were briefly presented in their entirety, and when they were inspected region-by-region through a dynamic aperture. If developmental prosopagnosics are forced to base perceptual decisions on information accumulated from a serial piecemeal analysis, one would expect little if any decrement in performance when target faces are viewed through apertures. Contrary to this prediction, however, developmental prosopagnosics showed strong aperture effects comparable with typical observers; their perceptual decisions were more accurate in the whole-face condition than when targets were viewed through the aperture. As expected, the developmental prosopagnosics were less accurate than typical controls when judging briefly presented faces shown in their entirety. Strikingly, however, they were also less able to accumulate perceptual evidence from a serial region-by-region analysis, than typical observers. Our results suggest that the perceptual problems seen in this population arise from imprecise descriptions of local regions, not aberrant holistic processing.

The 4D Space-Time Dimensions of Facial Perception

Facial information is a powerful channel for human-to-human communication. Characteristically, faces can be defined as biological objects that are four-dimensional (4D) patterns, whereby they have concurrently a spatial structure and surface as well as temporal dynamics. The spatial characteristics of facial objects contain a volume and surface in three dimensions (3D), namely breadth, height and importantly, depth. The temporal properties of facial objects are defined by how a 3D facial structure and surface evolves dynamically over time; where time is referred to as the fourth dimension (4D). Our entire perception of another’s face, whether it be social, affective or cognitive perceptions, is therefore built on a combination of 3D and 4D visual cues. Counterintuitively, over the past few decades of experimental research in psychology, facial stimuli have largely been captured, reproduced and presented to participants with two dimensions (2D), while remaining largely static. The following review aims to advance and update facial researchers, on the recent revolution in computer-generated, realistic 4D facial models produced from real-life human subjects. We delve in-depth to summarize recent studies which have utilized facial stimuli that possess 3D structural and surface cues (geometry, surface and depth) and 4D temporal cues (3D structure + dynamic viewpoint and movement). In sum, we have found that higher-order perceptions such as identity, gender, ethnicity, emotion and personality, are critically influenced by 4D characteristics. In future, it is recommended that facial stimuli incorporate the 4D space-time perspective with the proposed time-resolved methods.