Covert person recognition: its fadeout in a case of temporal lobe degeneration

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.

Right Temporal Lobe Variant of Frontotemporal Dementia: Systematic Review

Frontotemporal dementia corresponds to a heterogenous group of syndromes characterized by progressive changes in behavior and/or language. Approximately 30% of patients with primary progressive aphasia, semantic variant (semantic dementia), present with atrophy in the right cerebral hemisphere, in a rare clinical condition called right temporal variant of frontotemporal dementia (rtvFTD). The objective of the study is to present the main demographic, clinical, neuropsychological, neuroimaging, and pathologic characteristics of rtvFTD patients. A systematic review of the literature was carried out in the PubMed, LILACS, and SCIELO databases between January and March 2022. After the evaluation process, 41 articles were selected, published between 1993 and 2021. We found that rtvFTD presents with severe and progressive prosopagnosia (related to anterior temporal lobe injury) associated with behavioral symptoms-desinibition (51%), apathy (39%), obsessive-compulsive symptoms (37%), changes in eating habits (33%), and depression (28%), which is different from semantic dementia. The most common pathologic pattern is TDP-43, type C. This field of knowledge has few studies (mainly reports and case series) and heterogenous nomenclature, which is a limitation. A multinational longitudinal registry of people with rtvFTD, with standardized assessment and description of symptoms, is necessary to elucidate the characteristics of this entity.

Frontotemporal dementia: A unique window on the functional role of the temporal lobes

Frontotemporal dementia (FTD) is an umbrella term covering a plethora of progressive changes in executive functions, motor abilities, behavior, and/or language. Different clinical syndromes have been described in relation to localized atrophy, informing on the functional networks that underlie these specific cognitive, emotional, and behavioral processes. These functional declines are linked with the underlying neurodegeneration of frontal and/or temporal lobes due to diverse molecular pathologies. Initially, the accumulation of misfolded proteins targets specifically susceptible cell assemblies, leading to relatively focal neurodegeneration that later spreads throughout large-scale cortical networks. Here, we discuss the most recent clinical, neuropathological, imaging, and genetics findings in FTD-spectrum syndromes affecting the temporal lobe. We focus on the semantic variant of primary progressive aphasia and its mirror image, the right temporal variant of FTD. Incipient focal atrophy of the left anterior temporal lobe (ATL) manifests with predominant naming, word comprehension, reading, and object semantic deficits, while cases of predominantly right ATL atrophy present with impairments of socioemotional, nonverbal semantic, and person-specific knowledge. Overall, the observations in FTD allow for crucial clinical-anatomic inferences, shedding light on the role of the temporal lobes in both cognition and complex behaviors. The concerted activity of both ATLs is critical to ensure that percepts are translated into concepts, yet important hemispheric differences should be acknowledged. On one hand, the left ATL attributes meaning to linguistic, external stimuli, thus supporting goal-oriented, action-related behaviors (e.g., integrating sounds and letters into words). On the other hand, the right ATL assigns meaning to emotional, visceral stimuli, thus guiding socially relevant behaviors (e.g., integrating body sensations into feelings of familiarity).

Visual adaptation and 7T fMRI reveal facial identity processing in the human brain under shallow interocular suppression

Face identity is represented at a high level of the visual hierarchy. Whether the human brain can process facial identity information in the absence of visual awareness remains unclear. In this study, we investigated potential face identity representation through face-identity adaptation with the adapting faces interocularly suppressed by Continuous Flash Suppression (CFS) noise, a modified binocular rivalry paradigm. The strength of interocular suppression was manipulated by varying the contrast of CFS noise. While obeservers reported the face images subjectively unperceived and the face identity objectively unrecognizable, a significant face identity aftereffect was observed under low but not high contrast CFS noise. In addition, the identity of face images under shallow interocular suppression can be decoded from multi-voxel patterns in the right fusiform face area (FFA) obtained with high-resolution 7T fMRI. Thus the comined evidence from visual adaptation and 7T fMRI suggest that face identity can be represented in the human brain without explicit perceptual recognition. The processing of interocularly suppressed faces could occur at different levels depending on how "deep" the information is suppressed.

Geschwind Syndrome in frontotemporal lobar degeneration: Neuroanatomical and neuropsychological features over 9 years

Geschwind Syndrome, a characteristic behavioral syndrome frequently described in patients affected by temporal lobe epilepsy (TLE), consists of the following features: hyper-religiosity, hypergraphia, hyposexuality, and irritability. Here we report the 9-year-clinical course of a case of Geschwind Syndrome that developed as a first and salient clinical expression of right temporal lobe variant of frontotemporal lobar degeneration (FTLD). Only one patient affected by frontotemporal dementia has previously been shown to present with Geschwind Syndrome. MS presented at age 73 with 3 years of personality and behavioral symptoms. Her early symptoms primarily included hyper-religiosity, hypergraphia, and poor emotional regulation (irritability, impulsivity, disinhibition, egocentric behavior). Over nine years, other cognitive functions (word retrieval, memory coding and recall, set-shifting, famous face and building recognition) became affected; however, hyper-religiosity, hypergraphia, and scarce emotional control remained her most prominent deficits. Longitudinal cortical thickness and volumetric analyses revealed early atrophy in the right temporal pole, right amygdala, and right hippocampus, which progressively affected homologous regions in the left hemisphere. The present case describes an unusual clinical picture associated with frontotemporal dementia (FTD), in which the most salient symptoms originated and remained consistent with Geschwind Syndrome.

Deficits in long-term recognition memory reveal dissociated subtypes in congenital prosopagnosia

The study investigates long-term recognition memory in congenital prosopagnosia (CP), a lifelong impairment in face identification that is present from birth. Previous investigations of processing deficits in CP have mostly relied on short-term recognition tests to estimate the scope and severity of individual deficits. We firstly report on a controlled test of long-term (one year) recognition memory for faces and objects conducted with a large group of participants with CP. Long-term recognition memory is significantly impaired in eight CP participants (CPs). In all but one case, this deficit was selective to faces and didn't extend to intra-class recognition of object stimuli. In a test of famous face recognition, long-term recognition deficits were less pronounced, even after accounting for differences in media consumption between controls and CPs. Secondly, we combined test results on long-term and short-term recognition of faces and objects, and found a large heterogeneity in severity and scope of individual deficits. Analysis of the observed heterogeneity revealed a dissociation of CP into subtypes with a homogeneous phenotypical profile. Thirdly, we found that among CPs self-assessment of real-life difficulties, based on a standardized questionnaire, and experimentally assessed face recognition deficits are strongly correlated. Our results demonstrate that controlled tests of long-term recognition memory are needed to fully assess face recognition deficits in CP. Based on controlled and comprehensive experimental testing, CP can be dissociated into subtypes with a homogeneous phenotypical profile. The CP subtypes identified align with those found in prosopagnosia caused by cortical lesions; they can be interpreted with respect to a hierarchical neural system for face perception.

Rapid categorization of faces and objects in a patient with impaired object recognition

We tested rapid-categorization in a patient who was impaired in face and object recognition. Photographs of natural scenes were displayed for 100 ms. Participants had to press a key when they saw an animal among various objects as distractors or human faces among animal faces as distractors. Though the patient was impaired at figure/ground segregation, recognized very few objects and faces, she categorized animals and faces with a performance ranging between 70 and 86% correct. Displaying pictures in isolation did not improve performance. The results suggest that rapid categorization can be accomplished on the basis of coarse information without overt recognition.

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.

Implicit familiarity processing in congenital prosopagnosia

A particularly interesting and somewhat puzzling finding in the face-processing literature is that, despite the absence of overt recognition of most faces, many patients with acquired prosopagnosia (AP) exhibit evidence of intact covert face recognition of the very same faces. This phenomenon has important implications for the understanding of the mechanism underlying AP and, by extension, the mechanism underlying normal face processing. Here, we set out to examine whether individuals with congenital prosopagnosia (CP) exhibit a similar dissociation between overt and covert face recognition. We first confirmed that all six of our CP individuals were significantly impaired in face recognition in comparison with controls. Participants then completed a matching task with both famous and unknown faces in which they decided whether two consecutive images have the same identity or not. Critically, the level of face familiarity was orthogonal to the task at hand and this enabled us to examine whether the familiarity of a face enhanced identity matching, a finding which would implicate implicit face processing. As expected, the CP individuals were slower and less accurate than the control participants. More importantly, like the controls, the CP individuals were faster and more accurate at matching famous compared with unknown faces. Also, for both groups, matching performance on unrecognized famous faces fell at an intermediate level between performance on explicitly recognized famous faces and faces which are unknown. These results provide the first solid evidence for the existence of implicit familiarity processing in CP and suggest that, despite the marked impairment in explicit face recognition, these individuals still have some familiarity representation which manifests in the form of covert recognition. We discuss possible models to account for the apparent dissociation of overt and covert face processing in CPR.

Who is who: areas of the brain associated with recognizing and naming famous faces

OBJECT

It has been hypothesized that specific brain regions involved in face naming may exist in the brain. To spare these areas and to gain a better understanding of their organization, the authors studied patients who underwent surgery by using direct electrical stimulation mapping for brain tumors, and they compared an object-naming task to a famous face-naming task.

METHODS

Fifty-six patients with brain tumors (39 and 17 in the left and right hemispheres, respectively) and with no significant preoperative overall language deficit were prospectively studied over a 2-year period. Four patients who had a partially selective famous face anomia and 2 with prosopagnosia were not included in the final analysis.

RESULTS

Face-naming interferences were exclusively localized in small cortical areas (< 1 cm2). Among 35 patients whose dominant left hemisphere was studied, 26 face-naming specific areas (that is, sites of interference in face naming only and not in object naming) were found. These face naming-specific sites were significantly detected in 2 regions: in the left frontal areas of the superior, middle, and inferior frontal gyri (p < 0.001) and in the anterior part of the superior and middle temporal gyri (p < 0.01). Variable patterns of interference were observed (speech arrest, anomia, phonemic, or semantic paraphasia) probably related to the different stages in famous face processing. Only 4 famous face-naming interferences were found in the right hemisphere.

CONCLUSIONS

Relative anatomical segregation of naming categories within language areas was detected. This study showed that famous face naming was preferentially processed in the left frontal and anterior temporal gyri. The authors think it is necessary to adapt naming tasks in neurosurgical patients to the brain region studied.

Aberrant pattern of scanning in prosopagnosia reflects impaired face processing

Visual scanpath recording was used to investigate the information processing strategies used by a prosopagnosic patient, SC, when viewing faces. Compared to controls, SC showed an aberrant pattern of scanning, directing attention away from the internal configuration of facial features (eyes, nose) towards peripheral regions (hair, forehead) of the face. The results suggest that SC's face recognition deficit can be linked to an inability to assemble an accurate and unified face percept due to an abnormal allocation of attention away from the internal face region. Extraction of stimulus attributes necessary for face identity recognition is compromised by an aberrant face scanning pattern.

The case of lost Wilma: a clinical report of Capgras delusion

This detailed clinical report of a typical Capgras delusion (CD) in a demented patient is presented in order to foster future descriptions in neurological cases. In the framework of a recently developed model of familiar person processing, it is suggested that CD might be due to a dysfunction at the level of Person Identity Nodes. Prefrontal impairment is held to represent a critical factor leading to a failure of belief evaluation.

The anatomy of category-specific object naming in neurodegenerative diseases

Neuropsychological studies suggest that knowledge about living and nonliving objects is processed in separate brain regions. However, lesion and functional neuroimaging studies have implicated different areas. To address this issue, we used voxel-based morphometry to correlate accuracy in naming line drawings of living and nonliving objects with gray matter volumes in 152 patients with various neurodegenerative diseases. The results showed a significant positive correlation between gray matter volumes in bilateral temporal cortices and total naming accuracy regardless of category. Naming scores for living stimuli correlated with gray matter volume in the medial portion of the right anterior temporal pole, whereas naming accuracy for familiarity-matched nonliving items correlated with the volume of the left posterior middle temporal gyrus. A previous behavioral study showed that the living stimuli used here also had in common the characteristic that they were defined by shared sensory semantic features, whereas items in the nonliving group were defined by their action-related semantic features. We propose that the anatomical segregation of living and nonliving categories is the result of their defining semantic features and the distinct neural subsystems used to process them.

How Berlusconi keeps his face: a neuropsychological study in a case of semantic dementia

A patient (V.Z.) is described as being affected by progressive bilateral atrophy of the mesial temporal lobes resulting in semantic dementia. Vis-a-vis virtually nil recognition of even the most familiar faces (including those of her closest relatives) as well as of objects and animals, V.Z. could nevertheless consistently recognize and name the face of Silvio Berlusconi, the mass media tycoon and current Italian Prime Minister. The experimental investigation led to the conclusion that Mr Berlusconi's face was seen as an icon rather than as a face. This telling effect of Mr Berlusconi's pervasive propaganda constitutes an unprecedented case in the neuropsychological literature.

Better the devil you know? Nonconscious processing of identity and affect of famous faces

The nonconscious recognition of facial identity was investigated in two experiments featuring brief (17-msec) masked stimulus presentation to prevent conscious recognition. Faces were presented in simultaneous pairs of one famous face and one unfamiliar face, and participants attempted to select the famous face. Subsequently, participants rated the famous persons as "good" or "evil" (Experiment 1) or liked or disliked (Experiment 2). In Experiments 1 and 2, responses were less accurate to faces of persons rated evil/disliked than to faces of persons rated good/liked, and faces of persons rated evil/disliked were selected significantly below chance. Experiment 2 showed the effect in a within-items analysis: A famous face was selected less often by participants who disliked the person than by participants who liked the person, and the former were selected below chance accuracy. The within-items analysis rules out possible confounding factors based on variations in physical characteristics of the stimulus faces and confirms that the effects are due to participants' attitudes toward the famous persons. The results suggest that facial identity is recognized preconsciously, and that responses may be based on affect rather than familiarity.

Covert recognition and the neural system for face processing

In this viewpoint, we discuss the new evidence on covert face recognition in prosopagnosia presented by Bobes et al. (2003, this issue) and by Sperber and Spinnler (2003, this issue). Contrary to earlier hypotheses, both papers agree that covert and overt face recognition are based on the same mechanism. In line with this suggestion, an analysis of reported cases with prosopagnosia indicates that a degree of successful encoding of facial representations is a prerequisite for covert recognition to occur. While we agree with this general conclusion as far as Bobes et al.'s and Sperber and Spinnler's data are concerned, we also discuss evidence for a dissociation between different measures of covert recognition. Specifically, studies in patients with Capgras delusion and patients with prosopagnosia suggest that skin conductance and behavioural indexes of covert face recognition are mediated by partially different mechanisms. We also discuss implications of the new data for models of normal face recognition that have been successful in simulating covert recognition phenomena (e.g., Young and Burton, 1999, and O'Reilly et al., 1999). Finally, in reviewing recent neurophysiological and brain imaging evidence concerning the neural system for face processing, we argue that the relationship between ERP components (specifically, N170, N250r, and N400) and different cognitive processes in face recognition is beginning to emerge.

Perspectives on prosopagnosia and models of face recognition

The two papers by Bobes et al. (2003, this issue) and by Sperber and Spinnler (2003, this issue) add to the large body of literature demonstrating covert face recognition in prosopagnosia. This viewpoint will offer some perspectives on this interesting phenomenon. First, a re-analysis of the empirical literature will indicate an important misconception concerning the preserved abilities of prosopagnosics. The second section will briefly assess the contribution of Bobes et al. (2003, this issue) and Sperber and Spinnler (2003, this issue) to the debate about the locus, in cognitive terms, of the underlying causal deficit in prosopagnosia with covert face recognition. Both papers make reference to the two main models seeking to explain this phenomenon: the model proposed by Burton and colleagues (Burton et al., 1991; Burton and Young, 1999; Young and Burton, 1999) and that proposed by Farah and colleagues (Farah et al., 1993; O'Reilly and Farah, 1999). Finally, an observation will be offered concerning representations of faces in the Burton et al. (1991) model.