Developmental prosopagnosia: a study of three patients

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.

Perceptual heterogeneity in developmental prosopagnosia is continuous, not categorical

Developmental prosopagnosia (DP) is associated with considerable perceptual heterogeneity, though the nature of this heterogeneity and whether there are discrete subgroups versus continuous deficits remains unclear. Bennetts et al. (2022) recently found that holistic versus featural processing deficits distinguished discrete DP subgroups, but their sample was relatively small (N = 37), and subgroups were defined using a single task. To characterize perceptual heterogeneity in DPs more comprehensively, we administered a broad face perception battery to a large sample of 109 DPs and 134 controls, including validated measures of face matching (Cambridge Face Perception Test - CFPT, Computerized Benton Facial Recognition Test, Same/Different Face Matching Task), holistic processing (Part-Whole Task), and feature processing (Georges Task and Part-Whole part trials). When examining face matching measures, DPs exhibited a similar distribution of performance as controls, though shifted towards impairment by an average of 1.4 SD. We next applied Bennetts (2022) hierarchical clustering approach and k-means clustering to the CFPT upright, inverted, and inversion index measures, similarly finding one group of DPs with poorer inverted face performance and another with a decreased face inversion effect (holistic processing). However, these subgroup differences failed to generalize to other measures of feature and holistic processing beyond the CFPT. We finally ran hierarchical and k-means cluster analyses on our larger battery of face matching, feature, and holistic processing measures. Results clearly showed subgroups with generally better versus worse performance across all measures, with the distinction between groups being somewhat arbitrary. Together, these findings support a continuous account of DP perceptual heterogeneity, with performance differing primarily across all aspects of face perception.

Normal colour perception in developmental prosopagnosia

Developmental prosopagnosia (DP) is a selective neurodevelopmental condition defined by lifelong impairments in face recognition. Despite much research, the extent to which DP is associated with broader visual deficits beyond face processing is unclear. Here we investigate whether DP is accompanied by deficits in colour perception. We tested a large sample of 92 DP individuals and 92 sex/age-matched controls using the well-validated Ishihara and Farnsworth–Munsell 100-Hue tests to assess red–green colour deficiencies and hue discrimination abilities. Group-level analyses show comparable performance between DP and control individuals across both tests, and single-case analyses indicate that the prevalence of colour deficits is low and comparable to that in the general population. Our study clarifies that DP is not linked to colour perception deficits and constrains theories of DP that seek to account for a larger range of visual deficits beyond face 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.

Bayesian regression-based developmental norms for the Benton Facial Recognition Test in males and females

Face identity recognition is important for social interaction and is impaired in a range of clinical disorders, including several neurodevelopmental disorders. The Benton Facial Recognition Test (BFRT; Benton & Van Allen, 1968), a widely used assessment of identity recognition, is the only standardized test of face identity perception, as opposed to face memory, that has been normed on children and adolescents. However, the existing norms for the BFRT are suboptimal, with several ages not represented and no established time limit (which can lead to inflated scores by allowing individuals with prosopagnosia to use feature matching). Here we address these issues with a large normative dataset of children and adolescents (ages 5-17, N = 398) and adults (ages 18-55; N = 120) who completed a time-limited version of the BFRT. Using Bayesian regression, we demonstrate that face identity perception increases asymptotically from childhood through adulthood, and provide continuous norms based on age and sex that can be used to calculate standard scores. We show that our time limit of 16 seconds per item yields scores comparable to the existing norms without time limits from the non-prosopagnostic samples. We also find that females (N = 156) score significantly higher than males (N = 362), supporting the existence of a female superiority effect for face identification. Overall, these results provide more robust norms for the BFRT and promote future research on face identity perception in developmental populations.

The Scanpaths of Subjects with Developmental Prosopagnosia during a Face Memory Task

The scanpaths of healthy subjects show biases towards the upper face, the eyes and the center of the face, which suggests that their fixations are guided by a feature hierarchy towards the regions most informative for face identification. However, subjects with developmental prosopagnosia have a lifelong impairment in face processing. Whether this is reflected in the loss of normal face-scanning strategies is not known. The goal of this study was to determine if subjects with developmental prosopagnosia showed anomalous scanning biases as they processed the identity of faces. We recorded the fixations of 10 subjects with developmental prosopagnosia as they performed a face memorization and recognition task, for comparison with 8 subjects with acquired prosopagnosia (four with anterior temporal lesions and four with occipitotemporal lesions) and 20 control subjects. The scanning of healthy subjects confirmed a bias to fixate the upper over the lower face, the eyes over the mouth, and the central over the peripheral face. Subjects with acquired prosopagnosia from occipitotemporal lesions had more dispersed fixations and a trend to fixate less informative facial regions. Subjects with developmental prosopagnosia did not differ from the controls. At a single-subject level, some developmental subjects performed abnormally, but none consistently across all metrics. Scanning distributions were not related to scores on perceptual or memory tests for faces. We conclude that despite lifelong difficulty with faces, subjects with developmental prosopagnosia still have an internal facial schema that guides their scanning behavior.

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

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

The contribution of single case studies to the neuroscience of vision

Visual neuroscience is concerned with the neurobiological foundations of visual perception, that is, the morphological, physiological, and functional organization of the visual brain and its co-operative partners. One important approach for understanding the functional organization of the visual brain is the study of visual perception from the pathological perspective. The study of patients with focal injury to the visual brain allows conclusions about the representation of visual perceptual functions in the framework of association and dissociation of functions. Selective disorders have been reported for more "elementary" visual capabilities, for example, color and movement vision, but also for visuo-cognitive capacities, such as visual agnosia or the visual field of attention. Because these visual disorders occur rather seldom as selective and specific dysfunctions, single cases have always played, and still play, a significant role in gaining insights into the functional organization of the visual brain.

Impairments in the Face-Processing Network in Developmental Prosopagnosia and Semantic Dementia

BACKGROUND

Developmental prosopagnosia (DP) and semantic dementia (SD) may be the two most common neurologic disorders of face processing, but their main clinical and pathophysiologic differences have not been established. To identify those features, we compared patients with DP and SD.

METHODS

Five patients with DP, five with right temporal-predominant SD, and ten normal controls underwent cognitive, visual perceptual, and face-processing tasks.

RESULTS

Although the patients with SD were more cognitively impaired than those with DP, the two groups did not differ statistically on the visual perceptual tests. On the face-processing tasks, the DP group had difficulty with configural analysis and they reported relying on serial, feature-by-feature analysis or awareness of salient features to recognize faces. By contrast, the SD group had problems with person knowledge and made semantically related errors. The SD group had better face familiarity scores, suggesting a potentially useful clinical test for distinguishing SD from DP.

CONCLUSIONS

These two disorders of face processing represent clinically distinguishable disturbances along a right hemisphere face-processing network: DP, characterized by early configural agnosia for faces, and SD, characterized primarily by a multimodal person knowledge disorder. We discuss these preliminary findings in the context of the current literature on the face-processing network; recent studies suggest an additional right anterior temporal, unimodal face familiarity-memory deficit consistent with an "associative prosopagnosia."

Altered spontaneous neural activity in the occipital face area reflects behavioral deficits in developmental prosopagnosia

Individuals with developmental prosopagnosia (DP) exhibit severe difficulties in recognizing faces and to a lesser extent, also exhibit difficulties in recognizing non-face objects. We used fMRI to investigate whether these behavioral deficits could be accounted for by altered spontaneous neural activity. Two aspects of spontaneous neural activity were measured: the intensity of neural activity in a voxel indexed by the fractional amplitude of spontaneous low-frequency fluctuations (fALFF), and the connectivity of a voxel to neighboring voxels indexed by regional homogeneity (ReHo). Compared with normal adults, both the fALFF and ReHo values within the right occipital face area (rOFA) were significantly reduced in DP subjects. Follow-up studies on the normal adults revealed that these two measures indicated further functional division of labor within the rOFA. The fALFF in the rOFA was positively correlated with behavioral performance in recognition of non-face objects, whereas ReHo in the rOFA was positively correlated with processing of faces. When considered together, the altered fALFF and ReHo within the same region (rOFA) may account for the comorbid deficits in both face and object recognition in DPs, whereas the functional division of labor in these two measures helps to explain the relative independency of deficits in face recognition and object recognition in DP.

The problem of being bad at faces

Developmental prosopagnosia has received increased attention in recent years, but as yet has no confirmed genetic or structural markers. It is not certain whether this condition reflects simply the low-end of the spectrum of normal face recognition, an 'under-development', or a pathologic failure to develop such mechanisms, a 'mal-development'. This difference in views creates challenges for the diagnosis of developmental prosopagnosia by behavioural criteria alone, which also vary substantially between studies, with secondary effects on issues such as determining its prevalence. After review of the literature and the problems inherent to diagnoses based solely on behavioural data, we propose as a starting discussion point a set of two primary and four secondary criteria for the diagnosis of developmental prosopagnosia.

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

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

Getting lost: Topographic skills in acquired and developmental prosopagnosia

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

Greater sensitivity of the cortical face processing system to perceptually-equated face detection

Face detection, the perceptual capacity to identify a visual stimulus as a face before probing deeper into specific attributes (such as its identity or emotion), is essential for social functioning. Despite the importance of this functional capacity, face detection and its underlying brain mechanisms are not well understood. This study evaluated the roles that the cortical face processing system, which is identified largely through studying other aspects of face perception, play in face detection. Specifically, we used functional magnetic resonance imaging (fMRI) to examine the activations of the fusifom face area (FFA), occipital face area (OFA) and superior temporal sulcus (STS) when face detection was isolated from other aspects of face perception and when face detection was perceptually-equated across individual human participants (n=20). During face detection, FFA and OFA were significantly activated, even for stimuli presented at perceptual-threshold levels, whereas STS was not. During tree detection, however, FFA and OFA were responsive only for highly salient (i.e., high contrast) stimuli. Moreover, activation of FFA during face detection predicted a significant portion of the perceptual performance levels that were determined psychophysically for each participant. This pattern of result indicates that FFA and OFA have a greater sensitivity to face detection signals and selectively support the initial process of face vs. non-face object perception.

Guidelines for studying developmental prosopagnosia in adults and children

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by severe face identity recognition problems that results from a failure to develop the mechanisms necessary for adequate face processing (Duchaine BC, Nakayama K. Developmental prosopagnosia: a window to content-specific face processing. Curr Opin Neurobiol 2006, 16:166-173.). It occurs in children and adults with normal visual acuity, and without intellectual impairments or known brain injuries. Given the importance of face recognition in daily life, and the detrimental effects of impaired face recognition, DP is an important area of study. Yet conventions for classifying individuals as DP for research purposes are poorly defined. In this focus paper, we discuss: (1) criteria for an operational definition of DP; 2) tests of face recognition and conventions for classifying individuals as DP; and 3) important considerations regarding common associations and dissociations, and cognitive heterogeneity in DP. We also highlight issues unique to studying DP in children, a relatively new endeavor that is proving to be an important complement to the work with adults. Ultimately, we hope to identify challenges researchers face when studying DP, and offer guidelines for others to consider when embarking on their own research pursuits on the topic. For further resources related to this article, please visit the WIREs website.

The processing of voice identity in developmental prosopagnosia

BACKGROUND

Developmental prosopagnosia is a disorder of face recognition that is believed to reflect impairments of visual mechanisms. However, voice recognition has rarely been evaluated in developmental prosopagnosia to clarify if it is modality-specific or part of a multi-modal person recognition syndrome.

OBJECTIVE

Our goal was to examine whether voice discrimination and/or recognition are impaired in subjects with developmental prosopagnosia.

DESIGN/METHODS

73 healthy controls and 12 subjects with developmental prosopagnosia performed a match-to-sample test of voice discrimination and a test of short-term voice familiarity, as well as a questionnaire about face and voice identification in daily life.

RESULTS

Eleven subjects with developmental prosopagnosia scored within the normal range for voice discrimination and voice recognition. One was impaired on discrimination and borderline for recognition, with equivalent scores for face and voice recognition, despite being unaware of voice processing problems.

CONCLUSIONS

Most subjects with developmental prosopagnosia are not impaired in short-term voice familiarity, providing evidence that developmental prosopagnosia is usually a modality-specific disorder of face recognition. However, there may be heterogeneity, with a minority having additional voice processing deficits. Objective tests of voice recognition should be integrated into the diagnostic evaluation of this disorder to distinguish it from a multi-modal person recognition syndrome.

Do congenital prosopagnosia and the other-race effect affect the same face recognition mechanisms?

Congenital prosopagnosia (CP), an innate impairment in recognizing faces, as well as the other-race effect (ORE), a disadvantage in recognizing faces of foreign races, both affect face recognition abilities. Are the same face processing mechanisms affected in both situations? To investigate this question, we tested three groups of 21 participants: German congenital prosopagnosics, South Korean participants and German controls on three different tasks involving faces and objects. First we tested all participants on the Cambridge Face Memory Test in which they had to recognize Caucasian target faces in a 3-alternative-forced-choice task. German controls performed better than Koreans who performed better than prosopagnosics. In the second experiment, participants rated the similarity of Caucasian faces that differed parametrically in either features or second-order relations (configuration). Prosopagnosics were less sensitive to configuration changes than both other groups. In addition, while all groups were more sensitive to changes in features than in configuration, this difference was smaller in Koreans. In the third experiment, participants had to learn exemplars of artificial objects, natural objects, and faces and recognize them among distractors of the same category. Here prosopagnosics performed worse than participants in the other two groups only when they were tested on face stimuli. In sum, Koreans and prosopagnosic participants differed from German controls in different ways in all tests. This suggests that German congenital prosopagnosics perceive Caucasian faces differently than do Korean participants. Importantly, our results suggest that different processing impairments underlie the ORE and CP.

Face processing improvements in prosopagnosia: successes and failures over the last 50 years

Clinicians and researchers have widely believed that face processing cannot be improved in prosopagnosia. Though more than a dozen reported studies have attempted to enhance face processing in prosopagnosics over the last 50 years, evidence for effective treatment approaches has only begun to emerge. Here, we review the current literature on spontaneous recovery in acquired prosopagnosia (AP), as well as treatment attempts in acquired and developmental prosopagnosia (DP), differentiating between compensatory and remedial approaches. We find that for AP, rather than remedial methods, strategic compensatory training such as verbalizing distinctive facial features has shown to be the most effective approach (despite limited evidence of generalization). In children with DP, compensatory training has also shown some effectiveness. In adults with DP, two recent larger-scale studies, one using remedial training and another administering oxytocin, have demonstrated group-level improvements and evidence of generalization. These results suggest that DPs, perhaps because of their more intact face processing infrastructure, may benefit more from treatments targeting face processing than APs.

Holistic face training enhances face processing in developmental prosopagnosia

Prosopagnosia has largely been regarded as an untreatable disorder. However, recent case studies using cognitive training have shown that it is possible to enhance face recognition abilities in individuals with developmental prosopagnosia. Our goal was to determine if this approach could be effective in a larger population of developmental prosopagnosics. We trained 24 developmental prosopagnosics using a 3-week online face-training program targeting holistic face processing. Twelve subjects with developmental prosopagnosia were assessed before and after training, and the other 12 were assessed before and after a waiting period, they then performed the training, and were then assessed again. The assessments included measures of front-view face discrimination, face discrimination with view-point changes, measures of holistic face processing, and a 5-day diary to quantify potential real-world improvements. Compared with the waiting period, developmental prosopagnosics showed moderate but significant overall training-related improvements on measures of front-view face discrimination. Those who reached the more difficult levels of training ('better' trainees) showed the strongest improvements in front-view face discrimination and showed significantly increased holistic face processing to the point of being similar to that of unimpaired control subjects. Despite challenges in characterizing developmental prosopagnosics' everyday face recognition and potential biases in self-report, results also showed modest but consistent self-reported diary improvements. In summary, we demonstrate that by using cognitive training that targets holistic processing, it is possible to enhance face perception across a group of developmental prosopagnosics and further suggest that those who improved the most on the training task received the greatest benefits.

Does acquisition of Greeble expertise in prosopagnosia rule out a domain-general deficit?

According to the expertise account of face specialization, a deficit that affects general expertise mechanisms should similarly impair the expert individuation of both faces and other visually homogeneous object classes. To test this possibility, we attempted to train a prosopagnosic patient, LR, to become a Greeble expert using the standard Greeble expertise-training paradigm (Gauthier & Tarr, 2002). Previous research demonstrated that LR's prosopagnosia was related to an inability to simultaneously use multiple features in a speeded face recognition task (Bukach, Bub, Gauthier, & Tarr, 2006). We hypothesized that LR's inability to use multiple face features would manifest in his acquisition of Greeble expertise, even though his basic object recognition is unimpaired according to standard neuropsychological testing. Although LR was eventually able to reach expertise criterion, he took many more training sessions than controls, suggesting use of an abnormal strategy. To further explore LR's Greeble processing strategies, we assessed his ability to use multiple Greeble features both before and after Greeble training. LR's performance in two versions of this task demonstrates that, even after training, he relies heavily on a single feature to identify Greebles. This correspondence between LR's face recognition and post-training Greeble recognition supports the idea that impaired face recognition is simply the most visible symptom of a more general object recognition impairment in acquired prosopagnosia.

Single-case research in neuropsychology: a comparison of five forms of t-test for comparing a case to controls

Five inferential methods employed in single-case studies to compare a case to controls are examined; all of these make use of a t-distribution. It is shown that three of these ostensibly different methods are in fact strictly equivalent and are not fit for purpose; they are associated with grossly inflated Type I errors (these exceed even the error rate obtained when a case's score is converted to a z score and the latter used as a test statistic). When used as significance tests, the two remaining methods (Crawford and Howell's method and a prediction interval method first used by Barton and colleagues) are also equivalent and achieve control of the Type I error rate (the two methods do differ however in other important aspects). A number of broader issues also arise from the present findings, namely: (a) they underline the value of accompanying significance test results with the effect size for the difference between a case and controls, (b) they suggest that less care is often taken over statistical methods than over other aspects of single-case studies, and (c) they indicate that some neuropsychologists have a distorted conception of the nature of hypothesis testing in single-case research (it is argued that this may stem from a failure to distinguish between group studies and single-case studies).

Training with own-race faces can improve processing of other-race faces: evidence from developmental prosopagnosia

Faces of one's own race are discriminated and recognized more accurately than faces of an other race (other-race effect - ORE). Studies have employed several methods to enhance individuation and recognition of other-race faces and reduce the ORE, including intensive perceptual training with other-race faces and explicitly instructing participants to individuate other-race faces. Unfortunately, intensive perceptual training has shown to be specific to the race trained and the use of explicit individuation strategies, though applicable to all races, can be demanding of attention and difficult to consistently employ. It has not yet been demonstrated that a training procedure can foster the automatic individuation of all other-race faces, not just faces from the race trained. Anecdotal evidence from a training procedure used with developmental prosopagnosics (DPs) in our lab, individuals with lifelong face recognition impairments, suggests that this may be possible. To further test this idea, we had five Caucasian DPs perform ten days of configural face training (i.e. attending to small spacing differences between facial features) with own-race (Caucasian) faces to see if training would generalize to improvements with other-race (Korean) faces. To assess training effects and localize potential effects to parts-based or holistic processing, we used the part-whole task using Caucasian and Korean faces (Tanaka, J. W., Kiefer, M., & Bukach, C. M. (2004). A holistic account of the own-race effect in face recognition: evidence from a cross-cultural study. Cognition, 93(1), B1-9). Results demonstrated that after training, DPs showed a disproportionate improvement in holistic processing of other-race faces compared to own-race faces, reducing their ORE. This suggests that configural training with own-race faces boosted DPs' general configural/holistic attentional resources, which they were able to apply to other-race faces. This provides a novel method to reduce the ORE and supports more of an attentional/social-cognitive model of the ORE rather than a strictly expertise model.

The effects of visual degradation on face discrimination

PURPOSE

People with reduced visual acuity (VA) and/or contrast sensitivity have difficulty recognizing faces and facial expressions. We have quantified these difficulties, using a synthetic face discrimination task employing both normal and artificially degraded vision.

METHODS

VA and contrast thresholds were measured using an optimised staircase procedure [Freiburg acuity Test (FrACT)] in 25 young adults (aged 18-24 years) with corrected visual acuity of 0.0 logMAR or better and with four levels of vision degraded with Bangerter occlusion foils. For face discrimination, male face images were synthesised from 37 cardinal points (position of eyes, width of nose, head shape etc) derived from frontal face photographs and manipulated by altering the points as a fraction of the mean head radius. Face discrimination thresholds (% difference) were measured from a simultaneous four-alternative forced choice of 'odd one out' from three identical faces and one that differed. Psychometric functions were measured for four participants with normal and degraded vision. Subsequently, the difference between faces was fixed at twice the discrimination thresholds and the size of the faces manipulated using the FrACT threshold procedure in 25 participants. Data were converted to equivalent face discrimination distances for realistic face dimensions.

RESULTS

With normal vision, face discrimination thresholds ranged from 2.7% to 5.6%; these increased systematically and were more variable with visual degradation. When manipulating face size, face discrimination distance was highly correlated with both acuity and contrast sensitivity (r(2) = 0.77 and 0.80 respectively, p < 0.01). The mean distance with normal vision was 15.3 m (14.5-16.2 ± S.E.M.). With vision degraded to 0.6 logMAR (6/24 Snellen, contrast threshold 15%) the mean face discrimination distance was reduced to 3.9 m (3.7-4.1, ±S.E.M.).

CONCLUSIONS

Poor face discrimination has a profound impact on real-life social communication. Here we report that artificial visual degradation also adversely impacts a synthetic face recognition task. As a rule of thumb, reduction in VA of 0.3 logMAR (halving the decimal VA) reduces the face recognition distance by a factor of 0.6 times. The FrACT-based face discrimination task provides an efficient new tool to quantify and monitor face discrimination ability.

Discrimination of facial features by adults, 10-year-olds, and cataract-reversal patients

In previous studies we created 8 new versions of a single face: 4 differed only in the spacing among features and 4 differed in the shape of the eyes and mouth. Compared to the spacing set, results for this feature set indicated little impairment by inversion, earlier adult-like accuracy (Mondloch et al, 2002 Perception 31 553-566), and normal performance after a history of early visual deprivation from bilateral congenital cataract (Le Grand et al, 2001 Nature 410 890, 412 786). Here we addressed the possibility that this pattern might have resulted from our having inadvertently selected easily discriminated features or including some faces with make-up. We created 20 featural versions of a single female face and asked adults, 10-year-old children, and patients treated for bilateral congenital cataract to make same/different judgments for 120 pairings (half different). The results confirm that adults easily discriminate facial features, even after early visual deprivation from cataract, and that inversion has only a small effect. By the age of 10 years, children are close to, but not quite at, adult levels of accuracy. The previous findings cannot be attributed to our having inadvertently created a feature set that was unusually easy to discriminate.

Super-recognizers: people with extraordinary face recognition ability

We tested 4 people who claimed to have significantly better than ordinary face recognition ability. Exceptional ability was confirmed in each case. On two very different tests of face recognition, all 4 experimental subjects performed beyond the range of control subject performance. They also scored significantly better than average on a perceptual discrimination test with faces. This effect was larger with upright than with inverted faces, and the 4 subjects showed a larger "inversion effect" than did control subjects, who in turn showed a larger inversion effect than did developmental prosopagnosics. This result indicates an association between face recognition ability and the magnitude of the inversion effect. Overall, these "super-recognizers" are about as good at face recognition and perception as developmental prosopagnosics are bad. Our findings demonstrate the existence of people with exceptionally good face recognition ability and show that the range of face recognition and face perception ability is wider than has been previously acknowledged.

Neural and genetic foundations of face recognition and prosopagnosia

Faces are of essential importance for human social life. They provide valuable information about the identity, expression, gaze, health, and age of a person. Recent face-processing models assume highly interconnected neural structures between different temporal, occipital, and frontal brain areas with several feedback loops. A selective deficit in the visual learning and recognition of faces is known as prosopagnosia, which can be found both in acquired and congenital form. Recently, a hereditary sub-type of congenital prosopagnosia with a very high prevalence rate of 2.5% has been identified. Recent research results show that hereditary prosopagnosia is a clearly circumscribed face-processing deficit with a characteristic set of clinical symptoms. Comparing face processing of people of prosopagnosia with that of controls can help to develop a more conclusive and integrated model of face processing. Here, we provide a summary of the current state of face processing research. We also describe the different types of prosopagnosia and present the set of typical symptoms found in the hereditary type. Finally, we will discuss the implications for future face recognition research.

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.

What is Meant by Impaired Configural Processing in Acquired Prosopagnosia?

Apperceptive prosopagnosia is supposedly characterised by impaired configural processing, which could refer to either perception of spatial structure or holistic mechanisms. Ten prosopagnosic patients were tested with (i) dot patterns, to determine if manipulations of complexity, size, orientation, or the regularity of global structure generated effects consistent with the holistic hypothesis; and (ii) hierarchical letters, to probe for a global ‘whole-object’ processing deficit. With dot patterns (experiment 1) patients were impaired even for simple two-dot stimuli, but did better with more complex patterns, when size or orientation varied, or with a regular global structure. In experiment 2, they demonstrated normal latency effects of global-level processing. Apperceptive prosopagnosia, including that from lesions encompassing the right fusiform gyrus, is thus associated with a ‘configural deficit’ that impairs perception of spatial structure, not just for faces but also for non-facial patterns. While it cannot be concluded that holistic processing is entirely normal in these subjects, their performance shows significant modulation by whole-object structure, indicating that some whole-object processing is occurring in these patients.

A bilateral occipitotemporal network mediates face perception

The aim of the present study was to further explore the neuronal mechanisms of face processing in healthy subjects which may help to understand the difficulties experienced by prosopagnosia subjects. A further goal was to compare face specific activation patterns in the right and left occipital face area (OFA) and fusiform face area (FFA) for famous faces, non-famous faces and caricatures of famous faces in four individuals suffering from developmental prosopagnosia (DP) and seven healthy controls, using functional magnetic resonance imaging and psychophysiological interaction analysis (PPI). Control subjects showed higher face related activations in the right compared to the left FFA. Caricatures of faces of famous people and photographs of non-famous faces yielded higher percent signal changes in the OFA and FFA compared to photographs of famous faces. These data support the idea that the OFA and FFA discriminate between familiar and new face representations. The activation patterns of DP subjects were heterogeneous, with none of the patients showing bilateral face related activations in both OFA and FFA. There was no evidence of a left hemispheric activation when the right homologue failed to be activated, supporting the view of a right hemispheric dominance in face perception. PPI analysis indicated a link between activation of the right FFA and the other three tested regions, the left FFA and the right and left OFA. In summary, all four face related brain regions appear to be necessary for successful face processing, and disruption of one component may lead to face recognition deficits.

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

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

Reading trustworthiness in faces without recognizing faces

We show that developmental prosopagnosics with severe impairments in both memory for faces and perception of facial identity can make normal trustworthiness judgements of novel faces. We tested four prosopagnosics on three different face sets. The first set consisted of faces that varied on multiple dimensions and that have been used to demonstrate impairments in trustworthiness judgements of patients with bilateral amygdala damage. The second and third sets consisted of standardized faces with direct gaze, neutral expression, and similar age. On all tests, two prosopagnosics made judgements that closely agreed with control judgements while the other two showed weak agreement but within the normal range. The performance of the tests was correlated suggesting that the tests mapped the same underlying judgement irrespective of the specific face stimuli. The normal performance of two of the prosopagnosics suggests that forming person impressions from faces involves mechanisms functionally independent of mechanisms for encoding the identity of faces.

Are faces special? A case of pure prosopagnosia

The ability to recognize individual faces is of crucial social importance for humans and evolutionarily necessary for survival. Consequently, faces may be "special" stimuli, for which we have developed unique modular perceptual and recognition processes. Some of the strongest evidence for face processing being modular comes from cases of prosopagnosia, where patients are unable to recognize faces whilst retaining the ability to recognize other objects. Here we present the case of an acquired prosopagnosic whose poor recognition was linked to a perceptual impairment in face processing. Despite this, she had intact object recognition, even at a subordinate level. She also showed a normal ability to learn and to generalize learning of nonfacial exemplars differing in the nature and arrangement of their parts, along with impaired learning and generalization of facial exemplars. The case provides evidence for modular perceptual processes for faces.

Role of features and second-order spatial relations in face discrimination, face recognition, and individual face skills: behavioral and functional magnetic resonance imaging data

We compared the contribution of featural information and second-order spatial relations (spacing between features) in face processing. A fully factorial design has the same or different "features" (eyes, mouth, and nose) across two successive displays, whereas, orthogonally, the second-order spatial relations between those features were the same or different. The range of such changes matched the possibilities within the population of natural face images. Behaviorally, we found that judging whether two successive faces depicted the same person was dominated by features, although second-order spatial relations also contributed. This influence of spatial relations correlated, for individual subjects, with their skill at recognition of faces (as famous, or as previously exposed) in separate behavioral tests. Using the same repetition design in functional magnetic resonance imaging, we found feature-dependent effects in the lateral occipital and right fusiform regions. In addition, there were spatial relation effects in the bilateral inferior occipital gyrus and right fusiform that correlated with individual differences in (separately measured) behavioral sensitivity to those changes. The results suggest that featural and second-order spatial relation aspects of faces make distinct contributions to behavioral discrimination and recognition, with features contributing most to face discrimination and second-order spatial relational aspects correlating best with recognition skills. Distinct neural responses to these aspects were found with functional magnetic resonance imaging, particularly when individual skills were taken into account for the impact of second-order spatial relations.

Functional Plasticity in Ventral Temporal Cortex following Cognitive Rehabilitation of a Congenital Prosopagnosic

We used functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to measure neural changes associated with training configural processing in congenital prosopagnosia, a condition in which face identification abilities are not properly developed in the absence of brain injury or visual problems. We designed a task that required discriminating faces by their spatial configuration and, after extensive training, prosopagnosic MZ significantly improved at face identification. Event-related potential results revealed that although the N170 was not selective for faces before training, its selectivity after training was normal. fMRI demonstrated increased functional connectivity between ventral occipital temporal face-selective regions (right occipital face area and right fusiform face area) that accompanied improvement in face recognition. Several other regions showed fMRI activity changes with training; the majority of these regions increased connectivity with face-selective regions. Together, the neural mechanisms associated with face recognition improvements involved strengthening early face-selective mechanisms and increased coordination between face-selective and nonselective regions, particularly in the right hemisphere.

Event-related potentials reflect heterogeneity of developmental prosopagnosia

Event-related potential (ERP) studies of developmental prosopagnosia (DP) are rare. Previous ERP investigations have reported smaller N170 amplitude differences between faces and objects in at least three prosopagnosics. The present study is based on a combination of behavioural and electrophysiological assessment of face processing. The aim was to investigate the face-specificity of the N170 in both healthy subjects and a group of DP individuals (N = 4), using famous and nonfamous faces, caricatures and houses as stimuli. All prosopagnosic subjects showed impairments in recognition of famous faces, memory for faces and learning new faces in behavioural assessment. In healthy subjects the largest effects were found at parieto-occipital electrode positions (PO7 and PO8), along with a familiarity effect at these electrode positions. Thus, parieto-occipital areas appear to play an important role in face processing. Three prosopagnosics showed reliable N170 amplitude differences between faces and nonface stimuli, whereas one DP individual showed significantly reduced amplitude differences between faces and nonface objects. The behavioural and electrophysiological data support the idea that DP reflects a heterogeneous impairment and that face processing deficits are not necessarily correlated with a lack of face-specific N170.

Scan patterns during the processing of facial identity in prosopagnosia

The scan patterns of ocular fixations made by prosopagnosic patients while they attempt to identify faces may provide insights into how they process the information in faces. Contrasts between their scanning of upright versus inverted faces may index the presence of a hypothesized orientation-dependent expert mechanism for processing faces, while contrasts between their scanning of familiar versus novel faces may index the influence of residual facial memories on their search for meaningful facial information. We recorded the eye movements of two prosopagnosics while they viewed faces. One patient, with acquired prosopagnosia from a right occipitotemporal lesion, showed degraded orientation effects but still with a normal distribution of fixations to more salient facial features. However, the dynamics of his global scan patterns were more chaotic for novel faces, suggesting degradation of an internal facial schema, and consistent with other evidence of impaired face configuration perception in this patient. His global scan patterns for famous faces differed from novel faces, suggesting the influence of residual facial memories, as indexed previously by his relatively good imagery for famous faces. The other patient, with a developmental prosopagnosia, showed anomalous orientation effects, abnormal distribution of fixations to less salient regions, and chaotic global scan patterns, in keeping with a more severe loss of face-expert mechanisms. The effects of fame on her scanning were weaker than those in the first subject and non-existent in her global scan patterns. We conclude that scan patterns in prosopagnosia can both reflect the loss of orientation-dependent expert mechanisms and index the covert influence of residual facial memories. In these two subjects the scanning data were consistent with other results from tests of configuration perception, imagery, and covert recognition.

Abnormal configural face perception in a patient with right anterior temporal lobe atrophy

Face perception is a vital aspect of human social functioning and involves specialized cognitive and neural mechanisms. For example, configural face processing involves determining the relationship between the parts of the face, and this process enables us to differentiate between different faces. Here, we report an unusual case in which right anterior temporal lobe atrophy resulted in a profound deficit in the ability to recognize faces. We demonstrate that this patient is not able to process faces via configural information, raising the possibility that the right anterior temporal lobe has a role in configural face processing.

What aspects of face processing are impaired in developmental prosopagnosia?

Developmental prosopagnosia (DP) is a severe impairment in identifying faces that is present from early in life and that occurs despite no apparent brain damage and intact visual and intellectual function. Here, we investigated what aspects of face processing are impaired/spared in developmental prosopagnosia by examining a relatively large group of individuals with DP (n = 8) using an extensive battery of well-established tasks. The tasks included measures of sensitivity to global motion and to global form, detection that a stimulus is a face, determination of its sex, holistic face processing, processing of face identity based on features, contour, and the spacing of features, and judgments of attractiveness. The DP cases showed normal sensitivity to global motion and global form and performed normally on our tests of face detection and holistic processing. On the other tasks, many DP cases were impaired but there was no systematic pattern. At least half showed deficits in processing of facial identity based on either the outer contour or spacing of the internal features, and/or on judgments of attractiveness. Three of the eight were impaired in processing facial identify based on the shape of internal features. The results show that DP is a heterogeneous condition and that impairment in recognizing faces cannot be predicted by poor performance on any one measure of face processing.

Specialized Face Perception Mechanisms Extract Both Part and Spacing Information: Evidence from Developmental Prosopagnosia

It is well established that faces are processed by mechanisms that are not used with other objects. Two prominent hypotheses have been proposed to characterize how information is represented by these special mechanisms. The spacing hypothesis suggests that face-specific mechanisms primarily extract information about spacing among parts rather than information about the shape of the parts. In contrast, the holistic hypothesis suggests that faces are processed as nondecomposable wholes and, therefore, claims that both parts and spacing among them are integral aspects of face representation. Here we examined these hypotheses by testing a group of developmental prosopagnosics (DPs) who suffer from deficits in face recognition. Subjects performed a face discrimination task with faces that differed either in the spacing of the parts but not the parts (spacing task), or in the parts but not the spacing of the parts (part task). Consistent with the holistic hypothesis, DPs showed lower performance than controls on both the spacing and the part tasks, as long as salient contrast differences between the parts were minimized. Furthermore, by presenting similar spacing and part tasks with houses, we tested whether face-processing mechanisms are specific to faces, or whether they are used to process spacing information from any stimulus. DPs' normal performance on the tasks of two houses indicates that their deficit does not result from impairment in a general-purpose spacing mechanism. In summary, our data clearly support face-specific holistic hypothesis by showing that face perception mechanisms extract both part and spacing information.

Developmental prosopagnosia: a window to content-specific face processing

Developmental prosopagnosia is characterized by severely impaired face recognition. Individuals with this disorder, which often runs in families, have no history of brain damage and intact early visual processing systems. Recent research has also demonstrated that many developmental prosopagnosics have normal or relatively good object recognition, indicating that their impairments are not the result of deficits to a unitary visual recognition mechanism. To investigate the nature of the impaired mechanisms, extensive testing was done on an individual with especially pure face processing deficits. The results ruled out all extant explanations of prosopagnosia except one that proposed that faces are recognized by a content-specific face processing mechanism. fMRI and MEG studies show that there are a variety of neural profiles in developmental prosopagnosia, which is consistent with behavioral studies demonstrating that it is a heterogeneous disorder.

A model of preverbal social development and its application to social dysfunctions in autism

Studies of early face perception are used to develop a model of how face expressions might be transduced to initiate consonant internal affect, related outward expressions and other behaviours. Underlying neural mechanisms and processes are identified. The model is generalised to offer an account of aspects of typical preverbal social development. It is then used to develop aetiological hypotheses about the lack of social interest and motivation in autism and to provide a framework for evaluating other theories of autism. Although derived from existing literature, the model offers a distinctive account.