False recognition and misidentification of faces following right hemisphere damage

Analysing the brain networks corresponding to the facial contrast-chimeras

How humans recognise faces and objects effortlessly, has become a great point of interest. To understand the underlying process, one of the approaches is to study the facial features, in particular ordinal contrast relations around the eye region, which plays a crucial role in face recognition and perception. Recently the graph-theoretic approaches to electroencephalogram (EEG) analysis are found to be effective in understating the underlying process of human brain while performing various tasks. We have explored this approach in face recognition and perception to know the importance of contrast features around the eye region. We studied functional brain networks, formed using EEG responses, corresponding to four types of visual stimuli with varying contrast relationships: Positive faces, chimeric faces (photo-negated faces, preserving the polarity of contrast relationships around eyes), photo-negated faces and only eyes. We observed the variations in brain networks of each type of stimuli by finding the distribution of graph distances across brain networks of all subjects. Moreover, our statistical analysis shows that positive and chimeric faces are equally easy to recognise in contrast to difficult recognition of negative faces and only eyes.

Lesion-behaviour mapping reveals multifactorial neurocognitive processes in recognition memory for unfamiliar faces

Face recognition abilities, which play a critical role in social interactions, involve face processing and identifying familiar faces, but also remembering one-off encounters with previously unfamiliar faces. Previous functional imaging and lesion studies have found evidence for temporal, frontal, and parietal contributions to episodic recognition memory for previously unfamiliar faces. However, the functional contributions of these regions remain unclear. We, therefore, conducted a systematic group analysis of this memory function using lesion-behavior mapping. 95 first-event stroke patients (53 with right- and 42 with left-hemisphere damage) in the sub-acute phase performed the Wechsler Memory Scale (WMS-III) face recognition memory subtest. We analyzed their performance relative to 75 healthy controls, using signal detection measures. To identify brain lesions specifically implicated in face recognition deficits, we used voxel-based lesion-behavior mapping (VLBM; an analysis comparing the performance of participants with and without damage affecting a given voxel). Behavioral analysis disclosed a pronounced impairment in the performance of patients with right hemisphere damage. Frontal damage was associated with an increased amount of false alarms (i.e., failed rejection of new face items) and overly liberal criterion setting, without affecting the recognition of studied faces. In contrast, parietal damage was associated with impaired recognition of studied faces, which was more pronounced in immediate than in delayed retrieval. These findings suggest the existence of multifactorial neurocognitive processes in recognition memory for unfamiliar faces.

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.

How do our brain hemispheres cooperate to avoid false memories?

Memories are not always as reliable as they may appear. The occurrence of false memories can be reduced, however, by enhancing the cooperation between the two brain hemispheres. Yet is the communication from left to right hemisphere as helpful as the information transfer from right to left? To address this question, 72 participants were asked to learn 16 word lists. Applying the Deese-Roediger-McDermott paradigm, the words in each list were associated with an unpresented prototype word. In the test condition, learned words and corresponding prototypes were presented along with non-associated new words, and participants were asked to indicate which of the words they recognized. Crucially, both study and test words were projected to only one hemisphere in order to stimulate each hemisphere separately. It was found that false recognitions occurred significantly less often when the right hemisphere studied and the left hemisphere recognized the stimuli. Moreover, only the right-to-left direction of interhemispheric communication reduced false memories significantly, whereas left-to-right exchange did not. Further analyses revealed that the observed reduction of false memories was not due to an enhanced discrimination sensitivity, but to a stricter response bias. Hence, the data suggest that interhemispheric cooperation does not improve the ability to tell old and new apart, but rather evokes a conservative response tendency. Future studies may narrow down in which cognitive processing steps interhemispheric interaction can change the response criterion.

Mirrored-self misidentification in a patient without dementia: evidence for right hemispheric and bifrontal damage

Mirrored-self misidentification, often referred as the 'mirror sign', is a delusion characterized by the inability to recognize one's own reflected image, often associated with the intact capacity to recognize others in the mirror. It has been described mainly in moderate or severe dementia, especially Alzheimer's disease. In the few reported cases without global cognitive impairment, right hemispheric and frontal dysfunctions have been described. We report a 90-year-old man with abrupt onset of the mirror sign after a minor right hemispheric ischemic stroke. Neuropsychological testing revealed preserved cognitive capacities, except for mild to moderate impairment of visuospatial skills, suggesting right hemisphere dysfunction. Neuroimaging showed a small right dorsolateral frontal infarct, and bifrontal encephalomalacia, consistent with a past history of head trauma. Scattered ischemic white matter lesions in posterior periventricular regions were also seen. It seems that the mirror sign is a multifactorial phenomenon that usually requires right hemispheric dysfunction (perceptual abnormalities, loss of familiarity) and frontal damage (loss of judgement and inability to correct wrong beliefs). The right frontal dorsolateral prefrontal cortex seems to have a crucial role in self-recognition.

Disorders of color and object recognition: syndromes of the ventral occipitotemporal pathway

Although lesions of the striate cortex are associated with hemifield defects, lesions of the inferior and medial occipitotemporal cortex often are associated with disorders of more high-level and complex visual processing. These disorders of the ventral processing stream can be considered as impairing the perception of color and recognition of objects, in contrast to the problems with motion and spatial localization seen with lesions of the dorsal occipitoparietal stream. Dysfunction in the ventral stream leads to the prototypic syndromes of achromatopsia, general visual agnosia, prosopagnosia, alexia without agraphia, and some forms of topographagnosia. Most of these are not single entities but families of disorders in which dysfunction in different cognitive and perceptual processes can lead to the same symptom. Continuum Lifelong Learning Neurol 2010;16(4):111-127.

The misidentification syndromes as mindreading disorders

The patient with Capgras' syndrome claims that people very familiar to him have been replaced by impostors. I argue that this disorder is due to the destruction of a representation that the patient has of the mind of the familiar person. This creates the appearance of a familiar body and face, but without the familiar personality, beliefs, and thoughts. The posterior site of damage in Capgras' is often reported to be the temporoparietal junction, an area that has a role in the mindreading system, a connected system of cortical areas that allow us to attribute mental states to others. Just as the Capgras' patient claims that that man is not his father, the patient with asomatognosia claims that his arm is not really his. A similar account applies here, in that a nearby brain area, the supramarginal gyrus, is damaged. This area works in concert with the temporoparietal junction and other areas to produce a large representation of a mind inside a body situated in an environment. Damage to the mind-representing part of this system (coupled with damage to executive processes in the prefrontal lobes) causes Capgras' syndrome, whereas damage to the body-representing part of this system (also coupled with executive damage) causes asomatognosia.

In what sense 'familiar'? Examining experiential differences within pathologies of facial recognition

Explanations of Capgras delusion and prosopagnosia typically incorporate a dual-route approach to facial recognition in which a deficit in overt or covert processing in one condition is mirror-reversed in the other. Despite this double dissociation, experiences of either patient-group are often reported in the same way--as lacking a sense of familiarity toward familiar faces. In this paper, deficits in the facial processing of these patients are compared to other facial recognition pathologies, and their experiential characteristics mapped onto the dual-route model in order to provide a less ambiguous link between facial processing and experiential content. The paper concludes that the experiential states of Capgras delusion, prosopagnosia, and related facial pathologies are quite distinct, and that this descriptive distinctiveness finds explanatory equivalence at the level of anatomical and functional disruption within the face recognition system. The role of skin conductance response (SCR) as a measure of 'familiarity' is also clarified.

Face familiarity feelings, the right temporal lobe and the possible underlying neural mechanisms

A comprehensive review was made of the relationships between right hemisphere and face familiarity feelings, taking separately into account: (a) studies of patients with unilateral lesions of the anterior or the posterior parts of the right and left temporal lobes, who showed a familiar people recognition disorder, (b) studies of right and left brain-damaged patients, presenting an increased familiarity for unknown persons or abnormal familiarity feelings for well known people, (c) results of studies conducted in normal subjects to evaluate the lateralization of face familiarity feelings. In this last section, we separately reviewed: results obtained by means of separate presentation of familiar and unfamiliar faces to the right and left visual fields; lateralization of event-related potentials evoked by familiar vs unfamiliar faces; results of activation studies presenting familiar and unfamiliar faces. Taken together, results of this review have shown that face familiarity feelings are specifically generated by the right hemisphere. Clinical and neurophysiological data suggest that familiarity feelings: (1) are probably due to a lateralized subcortical route, allowing a first, unconscious, global recognition of familiar faces and (2) facilitate the subsequent distinction of known faces (unconsciously detected) from unfamiliar faces. Results of the review have also shown that the right frontal areas play an important role in the production or monitoring of inappropriate familiarity decisions.

The recognition of emotional expression in prosopagnosia: decoding whole and part faces

Prosopagnosia is currently viewed within the constraints of two competing theories of face recognition, one highlighting the analysis of features, the other focusing on configural processing of the whole face. This study investigated the role of feature analysis versus whole face configural processing in the recognition of facial expression. A prosopagnosic patient, SC made expression decisions from whole and incomplete (eyes-only and mouth-only) faces where features had been obscured. SC was impaired at recognizing some (e.g., anger, sadness, and fear), but not all (e.g., happiness) emotional expressions from the whole face. Analyses of his performance on incomplete faces indicated that his recognition of some expressions actually improved relative to his performance on the whole face condition. We argue that in SC interference from damaged configural processes seem to override an intact ability to utilize part-based or local feature cues.

The acquisition of face and person identity information following anterior temporal lobectomy

Thirty unilateral anterior temporal lobectomy (ATL) subjects (15 right and 15 left) and 15 controls were presented a multitrial learning task in which unfamiliar faces were paired with biographical information (occupation, city location, and a person's name). Face recognition hits were similar between groups, but the right ATL group committed more false-positive errors to face foils. Both left and right ATL groups were impaired relative to controls in acquiring biographical information, but the deficit was more pronounced for the left ATL group. Recall levels also varied for the different types of biographical information; occupation was most commonly recalled followed by city name and person name. In addition, city and person name recall was more likely when occupation was also recalled. Overall, recall of biographical information was positively correlated with clinical measures of anterograde episodic memory. Findings are discussed in terms of the role of the temporal lobe and associative learning ability in the successful acquisition of new face semantic (biographical) representations.

Memory for faces dissociates from memory for location following anterior temporal lobectomy

It has been suggested that the right and left mesial temporal lobes are specialized for processing different types of information for long-term memory (LTM). Although findings have been consistent in regard to the dominant role of the left mesial temporal lobe (MTL) in verbal memory, the role of the right MTL in non-verbal memory remains debatable. Given the existence of two cortical pathways specialized for processing different types of visuospatial information, we examined whether memory processing for these two types of information might also be differentially localized. The effect of unilateral anterior temporal lobectomy (ATL) was compared for memory for unfamiliar faces and a novel sequence of spatial locations in 86 ATL patients (left ATL (LATL) = 35; right ATL (RATL) = 51) pre- and post-surgery to examine the contributions of right and left MTL structures to LTM for pattern and spatial information. Memory for spatial location was not related to side of ATL or time of testing. On the facial memory task, RATL patients showed impairments relative to LATL patients prior to surgery, which became magnified after surgery. These results extend the proposed dissociation between an occipitotemporal and an occipitoparietal pathway for processing visuospatial information by demonstrating dissociations in LTM systems for these two types of information. Lesions in the right MTL, adjacent to the cortical structures believed to be specialized for facial recognition, specifically impair the memory encoding of new faces, but not spatial locations.

Disorders of face perception and recognition

Face recognition is one of the most complex visual tasks performed by the human brain. Data from monkeys suggest that area IT may play a key role in identifying faces, and functional imaging research suggests that the human homologue of IT may be located in the medial occipitotemporal cortex, where a FFA has been located. Damage to medial occipitotemporal structures on the right or bilaterally leads to prosopagnosia, the failure to recognize facial identity. Prosopagnosia is not a single functional disorder but a family of dysfunctions, with different patients having different degrees of impairments to various perceptual and memory stages involved in face processing. Understanding the perceptual basis of this disorder and epiphenomena, such as covert recognition, is a goal of current research. Deficits in face perception also may contribute to Capgras syndrome and may be related to the impaired social development of patients with Asperger syndrome. More recently, identified deficits in face processing include the false recognition of unfamiliar faces and the impaired extraction of social information from faces, independent of the recognition of identity. Many of these prosopagnosia and other face processing deficits can be placed in the context of cognitive models of face processing stages, which are being refined continually by data from neurologic patients and functional imaging in normal subjects.

The emergence of delusional companions in Alzheimer's disease: an unusual misidentification syndrome

INTRODUCTION

Misidentifications in the course of organic diseases, including Alzheimer's disease (AD), have been associated with right sided brain dysfunction. The reasons for this association might be clarified by investigating the contribution of neurobiological, cognitive and emotional factors to distinctive types of misidentification.

METHODS

This study reports the cases of three patients with AD presenting a novel misidentification delusion in which objects with intrinsically comforting associations, soft toys, were experienced as sentient and triggered associated behaviours. Investigations included regional cerebral blood flow (rCBF) measurements with HMPAO SPECT and a comprehensive clinical and neuropsychological assessment.

RESULTS

All three patients showed a distinctive pattern of rCBF with dysfunction centred in the right parietal area and severe visuospatial and visuoperceptive processing deficits, with relatively preserved memory and language abilities.

CONCLUSION

These findings support the hypothesis that this type of misidentification delusion may be facilitated by right sided regional brain dysfunction involving visuoperceptual processing. Other historical and cognitive data from these patients suggests that the appearance of the symptom may be determined by the coexistence of a more widespread disorder of reality processing, which interacts with cognitive and psychogenic factors.

On the neural correlates of object recognition awareness: relationship to computational activities and activities mediating perceptual awareness

Based on theoretical considerations of Aurell (1979) and Block (1995), we argue that object recognition awareness is distinct from purely sensory awareness and that the former is mediated by neuronal activities in areas that are separate and distinct from cortical sensory areas. We propose that two of the principal functions of neuronal activities in sensory cortex, which are to provide sensory awareness and to effect the computations that are necessary for object recognition, are dissociated. We provide examples of how this dissociation might be achieved and argue that the components of the neuronal activities which carry the computations do not directly enter the awareness of the subject. The results of these computations are sparse representations (i.e., vector or distributed codes) which are activated by the presentation of particular sensory objects and are essentially engrams for the recognition of objects. These final representations occur in the highest order areas of sensory cortex; in the visual analyzer, the areas include the anterior part of the inferior temporal cortex and the perirhinal cortex. We propose, based on lesion and connectional data, that the two areas in which activities provide recognition awareness are the temporopolar cortex and the medial orbitofrontal cortex. Activities in the temporopolar cortex provide the recognition awareness of objects learned in the remote past (consolidated object recognition), and those in the medial orbitofrontal cortex provide the recognition awareness of objects learned in the recent past. The activation of the sparse representation for a particular sensory object in turn activates neurons in one or both of these regions of cortex, and it is the activities of these neurons that provide the awareness of recognition of the object in question. The neural circuitry involved in the activation of these representations is discussed.

Material-specific memory changes after anterior temporal lobectomy as predicted by the intracarotid amobarbital test

PURPOSE

The intracarotid amobarbital test (IAT) has been shown to predict verbal memory changes after anterior temporal lobectomy (ATL). Seeking to extend these findings, we examined two questions: (a) What is the relationship between material-specific aspects of IAT memory and material-specific memory changes after ATL? and (b) Which IAT memory score(s) optimally predict memory changes after surgery, the memory score after injection ipsilateral to the seizure focus, the memory score after injection contralateral to the seizure focus, or the IAT asymmetry score, comprising the ipsilateral minus contralateral injection scores?

METHODS

Seventy left hemisphere language-dominant patients undergoing ATL for treatment of medically refractory seizures were administered a verbal and visuospatial recognition memory test before surgery and 3 weeks after surgery. IAT memory recognition scores for words and designs were used to predict verbal and visuospatial memory changes after surgery.

RESULTS

After surgery, left ATL patients declined in verbal memory, whereas right ATL patients declined in visuospatial memory. IAT total recognition memory scores (collapsed across all types of materials) and IAT word memory scores were associated with postoperative verbal memory decline. This relationship was significant for the IAT ipsilateral injection memory scores and the IAT hemispheric asymmetry scores. IAT memory performances were not related to visuospatial memory changes.

CONCLUSIONS

Results indicate IAT memory measures to be related to postoperative verbal, but not visuospatial, memory change. A specific relationship was found between postoperative verbal memory change and IAT verbal memory after injection ipsilateral to the seizure focus, when relying primarily on the contralateral hemisphere. This finding is consistent with the functional reserve model of memory change in ATL.

Variations in EEG coherence as an index of the affective content of dreams from REM sleep: relationships with face imagery

EEG coherence was examined in relation to four measures of socioemotional dream content, including a new measure--the proportional representation of a character's face. Twenty-four healthy subjects, recorded for sleep stages and EEG activity, were awakened from REM sleep to report dream mentation and to rate it on these variables. Coherence scores were calculated for homologous interhemispheric electrode pairs (Fp1-Fp2, F3-F4, F7-F8, C3-C4, P3-P4, O1-O2, T3-T4, T5-T6) and for left and right intrahemispheric pairs for delta, theta, alpha, beta1, and beta2 frequencies. These were correlated with the mentation measures. Positive correlations were found between average interhemispheric coherence in most bands and the character face measure. A breakdown by gender revealed that this relationship was most evident for women, whereas for men positive correlations were observed between coherence and negative self-feeling. That similar relationships also obtained for both left and right intrahemispheric coherence is consistent with the hypothesis that dreamed socioemotional interactions reflect the integrative functioning of many brain regions in both hemispheres.

Multiple fregoli delusions after traumatic brain injury

A 61 year old man after a traumatic brain injury resulting in right frontal and left temporoparietal contusions developed florid Fregoli-type misidentifications. Extensive neuropsychological testing demonstrated significant deficits in executive and memory functions. The patient's neuropsychological profile closely resembled that seen in previously reported patients with Capgras syndrome. Our findings are consistent with the hypothesis that a combination of executive and memory deficits may account for cases of delusional misidentification associated with brain lesions. However, the form which the delusion takes may be influenced by other factors including motivation.

Mild traumatic lesion of the right parietal cortex in the rat: characterisation of a conditioned freezing deficit and its reversal by dizocilpine

We have previously demonstrated that traumatic injury of the lateral aspect of the right parietal cortex results in reduced acquisition of the passive avoidance task but enhanced learning in an active avoidance procedure. In order to try to explain the apparent dichotomy between these findings a series of experiments examined the effect of fluid percussion-induced traumatic brain injury (FP-TBI) on the conditioned freezing response to a context previously paired with an aversive stimulus. Rats subjected to FP-TBI displayed less conditioned freezing than the sham-operated controls. This effect was particularly marked when the delay between context exposure and footshock was short (< or = 30 s) and was no longer significant when this delay was 3 min, indicating that the injured animals did not have an impaired freezing response per se. This phenomenon was enduring such that it could still be observed 2 months following the surgery. There was no significant freezing deficit after FP-TBI of the motor cortex, demonstrating that the site of injury is important and that the freezing deficit is not a general response to CNS trauma. The NMDA receptor antagonist dizocilpine (MK-801, 1 mg/kg i.v.) significantly reduced the trauma-induced freezing deficit when administered as a single bolus 15 min prior to the surgery, or as three repeated treatments (3 x 0.33 mg/kg) 15 min, and 6 and 24 h following lesion. The trauma-induced deficit in conditioned freezing can explain the differences in active and passive avoidance behaviours and appears to be specific to lesion of the lateral parietal cortex. In addition, the behavioural deficit can be attenuated using the neuroprotective agent dizocilpine, suggesting that it may prove useful as a sensitive and specific measure of cortical damage following traumatic injury.

Internal consistency of the Warrington Recognition Memory Test

The Recognition Memory Test is frequently used to assess memory; however, one of the commonly cited limitations is a lack of data on reliability. The current study was undertaken to estimate the internal consistency reliability of the test with a sample of 72 persons with traumatic brain injury. Acceptable estimates of internal consistency for both subtests were obtained.

The cognitive neuroscience of constructive memory

Numerous empirical and theoretical observations point to the constructive nature of human memory. This paper reviews contemporary research pertaining to two major types of memory distortions that illustrate such constructive processes: (a) false recognition and (b) intrusions and confabulations. A general integrative framework that outlines the types of problems that the human memory system must solve in order to produce mainly accurate representations of past experience is first described. This constructive memory framework (CMF) emphasizes processes that operate at encoding (initially binding distributed features of an episode together as a coherent trace; ensuring sufficient pattern separation of similar episodes) and also at retrieval (formation of a sufficiently focused retrieval description with which to query memory; postretrieval monitoring and verification). The framework is applied to findings from four different areas of research: cognitive studies of young adults, neuropsychological investigations of brain-damaged patients, neuroimaging studies, and studies of cognitive aging.

Face-specific responses from the human inferior occipito-temporal cortex

Whole-head neuromagnetic responses were recorded from seven subjects to pictures of faces and to various control stimuli. Four subjects displayed signals specific to faces. The combination of functional information from magnetoencephalography and anatomical data from magnetic resonance images suggests that the face-specific activity was generated in the inferior occipitotemporal cortex. All four subjects showed the face-specific response in the right hemisphere, one of them also in the left. Our results, together with recent position emission tomography and lesion studies, suggest a right-hemisphere preponderance of face processing in the inferior occipitotemporal cortex.

False recognition of unfamiliar faces following right hemisphere damage: neuropsychological and anatomical observations

False recognition of unfamiliar faces was investigated in patients with focal right hemisphere damage (RHD) in order to define the neuropsychological and anatomical correlates of the recognition impairment and examine its relationship to prosopagnosia. Findings are discussed within the framework of the Bruce and Young (1986) model of face processing. Although false recognition and prosopagnosia were both present in some RHD patients, the two types of face recognition impairments were dissociable in others. Processing deficits in subjects with both false recognition and prosopagnosia were associated with posterior right hemisphere lesion sites and included severe face perception impairment and partial damage to face recognition units (FRUs). Prosopagnosia without false recognition was seen following near complete destruction of FRUs, but this type of dissociation could also occur when FRUs become disconnected. The opposite dissociation, false recognition without prosopagnosia, was observed following right prefrontal damage. We propose that false recognition in frontal patients results from the breakdown of strategic decision making and monitoring functions critical for determining whether a face is indeed that of a familiar person or whether there is merely a resemblance to a known individual. False recognition following prefrontal damage may also be related to confabulation, in which case familiarity or even specific identity are erroneously attributed to facial stimuli without the activation of an underlying memory representation.