Perceptual functions in prosopagnosia

Social Interaction Anxiety in Developmental Prosopagnosia: Prevalence, Severity, and Individual Differences

OBJECTIVE

Although elevated social anxiety in developmental prosopagnosia (DP) has been reported in anecdotal and qualitative studies, the current study sought to better quantify the prevalence, severity, and moderators of social anxiety in a large DP sample.

METHOD

A total of 88 DPs and 58 controls completed the validated Social Interaction Anxiety Scale and assessments of face recognition, autism traits, personality (Big Five Inventory), and coping strategies.

RESULTS

DPs reported greater social anxiety symptoms (M = 30.25) than controls (M = 17.19), with 44% of DPs above a probable clinical cutoff compared with 14% of controls. Exploratory analyses revealed that DPs' social anxiety was more specific to items pertaining to mixing socially or interacting with unfamiliar people. Notably, several DPs reported minimal social anxiety, which was associated with being more extraverted and having fewer autism traits. A follow-up survey revealed that extraverted DPs more openly disclosed face recognition inabilities than introverted DPs, which may be a factor in their reduced social anxiety.

CONCLUSION

These results better quantify the potential serious psychosocial consequences of DP and highlight the importance of individual differences as well as targeted intervention.

A review of the impairments, preserved visual functions, and neuropathology in 21 patients with visual form agnosia - A unique defect with line drawings

We present a comprehensive review of the rare syndrome visual form agnosia (VFA). We begin by documenting its history, including the origins of the term, and the first case study labelled as VFA. The defining characteristics of the syndrome, as others have previously defined it, are then described. The impairments, preserved aspects of visual perception, and areas of brain damage in 21 patients who meet these defining characteristics are described in detail, including which tests were used to verify the presence or absence of key symptoms. From this, we note important similarities along with notable areas of divergence between patients. Damage to the occipital lobe (20/21), an inability to recognise line drawings (19/21), preserved colour vision (14/21), and visual field defects (16/21) were areas of consistency across most cases. We found it useful to distinguish between shape and form as distinct constructs when examining perceptual abilities in VFA patients. Our observations suggest that these patients often exhibit difficulties in processing simplified versions of form. Deficits in processing orientation and size were uncommon. Motion perception and visual imagery were not widely tested for despite being typically cited as defining features of the syndrome - although in the sample described, motion perception was never found to be a deficit. Moreover, problems with vision (e.g., poor visual acuity and the presence of hemianopias/scotomas in the visual fields) are more common than we would have thought and may also contribute to perceptual impairments in patients with VFA. We conclude that VFA is a perceptual disorder where the visual system has a reduced ability to synthesise lines together for the purposes of making sense of what images represent holistically.

Contributions of low- and high-level contextual mechanisms to human face perception

Contextual modulations at primary stages of visual processing depend on the strength of local input. Contextual modulations at high-level stages of (face) processing show a similar dependence to local input strength. Namely, the discriminability of a facial feature determines the amount of influence of the face context on that feature. How high-level contextual modulations emerge from primary mechanisms is unclear due to the scarcity of empirical research systematically addressing the functional link between the two. We tested (62) young adults' ability to process local input independent of the context using contrast detection and (upright and inverted) morphed facial feature matching tasks. We first investigated contextual modulation magnitudes across tasks to address their shared variance. A second analysis focused on the profile of performance across contextual conditions. In upright eye matching and contrast detection tasks, contextual modulations only correlated at the level of their profile (averaged Fisher-Z transformed r = 1.18, BF10 > 100), but not magnitude (r = .15, BF10 = .61), suggesting the functional independence but similar working principles of the mechanisms involved. Both the profile (averaged Fisher-Z transformed r = .32, BF10 = 9.7) and magnitude (r = .28, BF10 = 4.58) of the contextual modulations correlated between inverted eye matching and contrast detection tasks. Our results suggest that non-face-specialized high-level contextual mechanisms (inverted faces) work in connection to primary contextual mechanisms, but that the engagement of face-specialized mechanisms for upright faces obscures this connection. Such combined study of low- and high-level contextual modulations sheds new light on the functional relationship between different levels of the visual processing hierarchy, and thus on its functional organization.

The impact of simulated hemianopia on visual search for faces, words, and cars

Tests of visual search can index the effects of perceptual load and compare the processing efficiency for different object types, particularly when one examines the set-size effect, the increase in search time for each additional stimulus in an array. Previous studies have shown that the set-size effect is increased by manoeuvres that impede object processing, and in patients with object processing impairments. In this study, we examine how the low-level visual impairment of hemianopia affects visual search for complex objects, using a virtual paradigm. Forty-two healthy subjects performed visual search for faces, words, or cars with full-viewing as well as gaze-contingent simulations of complete left or right hemianopia. Simulated hemianopia lowered accuracy and discriminative power and increased response times and set-size effects, similarly for faces, words and cars. A comparison of set-size effects between target absent and target present trials did not show a difference between full-view and simulated hemianopic conditions, and a model of decision-making suggested that simulated hemianopia reduced the rate of accumulation of perceptual data, but did not change decision thresholds. We conclude that simulated hemianopia reduces the efficiency of visual search for complex objects, and that such impairment should be considered when interpreting results from high-level object processing deficits.

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.

Progress in perceptual research: the case of prosopagnosia

Prosopagnosia is an impairment in the ability to recognize faces and can be acquired after a brain lesion or occur as a developmental variant. Studies of prosopagnosia make important contributions to our understanding of face processing and object recognition in the human visual system. We review four areas of advances in the study of this condition in recent years. First are issues surrounding the diagnosis of prosopagnosia, including the development and evaluation of newer tests and proposals for diagnostic criteria, especially for the developmental variant. Second are studies of the structural basis of prosopagnosia, including the application of more advanced neuroimaging techniques in studies of the developmental variant. Third are issues concerning the face specificity of the defect in prosopagnosia, namely whether other object processing is affected to some degree and in particular the status of visual word processing in light of recent predictions from the "many-to-many hypothesis". Finally, there have been recent rehabilitative trials of perceptual learning applied to larger groups of prosopagnosic subjects that show that face impairments are not immutable in this condition.

Object recognition in acquired and developmental prosopagnosia

Whether face and object recognition are dissociated in prosopagnosia continues to be debated: a recent review highlighted deficiencies in prior studies regarding the evidence for such a dissociation. Our goal was to study cohorts with acquired and developmental prosopagnosia with a complementary battery of tests of object recognition that address prior limitations, as well as evaluating for residual effects of object expertise. We studied 15 subjects with acquired and 12 subjects with developmental prosopagnosia on three tests: the Old/New Tests, the Cambridge Bicycle Memory Test, and the Expertise-adjusted Test of Car Recognition. Most subjects with developmental prosopagnosia were normal on the Old/New Tests: for acquired prosopagnosia, subjects with occipitotemporal lesions often showed impairments while those with anterior temporal lesions did not. Ten subjects showed a putative classical dissociation between the Cambridge Face and Bicycle Memory Tests, seven of whom had normal reaction times. Both developmental and acquired groups showed reduced car recognition on the expertise-adjusted test, though residual effects of expertise were still evident. Two subjects with developmental prosopagnosia met criteria for normal object recognition across all tests. We conclude that strong evidence for intact object recognition can be found in a few subjects but the majority show deficits, particularly those with the acquired form. Both acquired and developmental forms show residual but reduced object expertise effects.

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

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

Electrical stimulation over bilateral occipito-temporal regions reduces N170 in the right hemisphere and the composite face effect

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can modulate cortical excitability. Although the clinical value of tDCS has been advocated, the potential of tDCS in cognitive rehabilitation of face processing deficits is less understood. Face processing has been associated with the occipito-temporal cortex (OT). The present study investigated whether face processing in healthy adults can be modulated by applying tDCS over the OT. Experiment 1 investigated whether tDCS can affect N170, a face-sensitive ERP component, with a face orientation judgment task. The N170 in the right hemisphere was reduced in active stimulation conditions compared with the sham stimulation condition for both upright faces and inverted faces. Experiment 2 further demonstrated that tDCS can modulate the composite face effect, a type of holistic processing that reflects the obligatory attention to all parts of a face. The composite face effect was reduced in active stimulation conditions compared with the sham stimulation condition. Additionally, the current polarity did not modulate the effect of tDCS in the two experiments. The present study demonstrates that N170 can be causally manipulated by stimulating the OT with weak currents. Furthermore, our study provides evidence that obligatory attention to all parts of a face can be affected by the commonly used tDCS parameter setting.

When apperceptive agnosia is explained by a deficit of primary visual processing

Visual agnosia is a deficit in shape perception, affecting figure, object, face and letter recognition. Agnosia is usually attributed to lesions to high-order modules of the visual system, which combine visual cues to represent the shape of objects. However, most of previously reported agnosia cases presented visual field (VF) defects and poor primary visual processing. The present case-study aims to verify whether form agnosia could be explained by a deficit in basic visual functions, rather that by a deficit in high-order shape recognition. Patient SDV suffered a bilateral lesion of the occipital cortex due to anoxia. When tested, he could navigate, interact with others, and was autonomous in daily life activities. However, he could not recognize objects from drawings and figures, read or recognize familiar faces. He was able to recognize objects by touch and people from their voice. Assessments of visual functions showed blindness at the centre of the VF, up to almost 5°, bilaterally, with better stimulus detection in the periphery. Colour and motion perception was preserved. Psychophysical experiments showed that SDV's visual recognition deficits were not explained by poor spatial acuity or by the crowding effect. Rather a severe deficit in line orientation processing might be a key mechanism explaining SDV's agnosia. Line orientation processing is a basic function of primary visual cortex neurons, necessary for detecting "edges" of visual stimuli to build up a "primal sketch" for object recognition. We propose, therefore, that some forms of visual agnosia may be explained by deficits in basic visual functions due to widespread lesions of the primary visual areas, affecting primary levels of visual processing.

An objective index of individual face discrimination in the right occipito-temporal cortex by means of fast periodic oddball stimulation

We introduce an approach based on fast periodic oddball stimulation that provides objective, high signal-to-noise ratio (SNR), and behavior-free measures of the human brain's discriminative response to complex visual patterns. High-density electroencephalogram (EEG) was recorded for human observers presented with 60s sequences containing a base-face (A) sinusoidally contrast-modulated at a frequency of 5.88 Hz (F), with face size varying every cycle. Different oddball-faces (B, C, D...) were introduced at fixed intervals (every 4 stimuli = F/5 = 1.18 Hz: AAAABAAAACAAAAD...). Individual face discrimination was indexed by responses at this 1.18 Hz oddball frequency. Following only 4 min of recording, significant responses emerged at exactly 1.18 Hz and its harmonics (e.g., 2F/5 = 2.35 Hz, 3F/5 = 3.53 Hz...), with up to a 300% signal increase over the right occipito-temporal cortex. This response was present in all participants, for both color and greyscale faces, providing a robust implicit neural measure of individual face discrimination. Face inversion or contrast-reversal did not affect the basic 5.88 Hz periodic response over medial occipital channels. However, these manipulations substantially reduced the 1.18 Hz oddball discrimination response over the right occipito-temporal region, indicating that this response reflects high-level processes that are partly face-specific. These observations indicate that fast periodic oddball stimulation can be used to rapidly and objectively characterize the discrimination of visual patterns and may become invaluable in characterizing this process in typical adult, developmental, and neuropsychological patient populations.

Acquired prosopagnosia with spared within-class object recognition but impaired recognition of degraded basic-level objects

We present a new case of acquired prosopagnosia resulting from extensive lesions predominantly in the right occipitotemporal cortex. Functional brain imaging revealed atypical activation of all core face areas in the right hemisphere, with reduced signal difference between faces and objects compared to controls. In contrast, Herschel's lateral occipital complex showed normal activation to objects. Behaviourally, Herschel is severely impaired with the recognition of familiar faces, discrimination between unfamiliar identities, and the perception of facial expression and gender. Notably, his visual recognition deficits are largely restricted to faces, suggesting that the damaged mechanisms are face-specific. He showed normal recognition memory for a wide variety of object classes in several paradigms, normal ability to discriminate between highly similar items within a novel object category, and intact ability to name basic objects (except four-legged animals). Furthermore, Herschel displayed a normal face composite effect and typical global advantage and global interference effects in the Navon task, suggesting spared integration of both face and nonface information. Nevertheless, he failed visual closure tests requiring recognition of basic objects from degraded images. This abnormality in basic object recognition is at odds with his spared within-class recognition and presents a challenge to hierarchical models of object perception.

Complementary neural representations for faces and words: a computational exploration

A key issue that continues to generate controversy concerns the nature of the psychological, computational, and neural mechanisms that support the visual recognition of objects such as faces and words. While some researchers claim that visual recognition is accomplished by category-specific modules dedicated to processing distinct object classes, other researchers have argued for a more distributed system with only partially specialized cortical regions. Considerable evidence from both functional neuroimaging and neuropsychology would seem to favour the modular view, and yet close examination of those data reveals rather graded patterns of specialization that support a more distributed account. This paper explores a theoretical middle ground in which the functional specialization of brain regions arises from general principles and constraints on neural representation and learning that operate throughout cortex but that nonetheless have distinct implications for different classes of stimuli. The account is supported by a computational simulation, in the form of an artificial neural network, that illustrates how cooperative and competitive interactions in the formation of neural representations for faces and words account for both their shared and distinctive properties. We set out a series of empirical predictions, which are also examined, and consider the further implications of this account.

Deficits in face perception in the amnestic form of mild cognitive impairment

The fusiform gyrus is involved pathologically at an early stage of the amnestic form of mild cognitive impairment (aMCI), and is also known to be involved in the perceptual stage of face processing. We assessed face perception in patients with aMCI to determine if this cognitive skill was impaired. We compared 12 individuals (4 men) with aMCI and 12 age- and education-matched healthy controls on the ability to discriminate changes in the spatial configuration or color of the eyes or the mouth in faces. Patients with aMCI performed less quickly and accurately for all changes on trials with limited viewing duration. With unlimited duration, they could achieve normal perceptual accuracy for configural changes to the mouth, but remained impaired for changes to eye color or configuration. Patients with aMCI show deficits in face perception that are more pronounced for the highly salient ocular region, a pattern similar to that seen in acquired prosopagnosia. This form of perceptual impairment may be an early marker of additional cognitive deficits beyond memory in aMCI.

Modeling eye movements in visual agnosia with a saliency map approach: bottom-up guidance or top-down strategy?

Two recent papers (Foulsham, Barton, Kingstone, Dewhurst, & Underwood, 2009; Mannan, Kennard, & Husain, 2009) report that neuropsychological patients with a profound object recognition problem (visual agnosic subjects) show differences from healthy observers in the way their eye movements are controlled when looking at images. The interpretation of these papers is that eye movements can be modeled as the selection of points on a saliency map, and that agnosic subjects show an increased reliance on visual saliency, i.e., brightness and contrast in low-level stimulus features. Here we review this approach and present new data from our own experiments with an agnosic patient that quantifies the relationship between saliency and fixation location. In addition, we consider whether the perceptual difficulties of individual patients might be modeled by selectively weighting the different features involved in a saliency map. Our data indicate that saliency is not always a good predictor of fixation in agnosia: even for our agnosic subject, as for normal observers, the saliency-fixation relationship varied as a function of the task. This means that top-down processes still have a significant effect on the earliest stages of scanning in the setting of visual agnosia, indicating severe limitations for the saliency map model. Top-down, active strategies-which are the hallmark of our human visual system-play a vital role in eye movement control, whether we know what we are looking at or not.

Holistic face categorization in higher order visual areas of the normal and prosopagnosic brain: toward a non-hierarchical view of face perception

How a visual stimulus is initially categorized as a face in a network of human brain areas remains largely unclear. Hierarchical neuro-computational models of face perception assume that the visual stimulus is first decomposed in local parts in lower order visual areas. These parts would then be combined into a global representation in higher order face-sensitive areas of the occipito-temporal cortex. Here we tested this view in fMRI with visual stimuli that are categorized as faces based on their global configuration rather than their local parts (two-tones Mooney figures and Arcimboldo's facelike paintings). Compared to the same inverted visual stimuli that are not categorized as faces, these stimuli activated the right middle fusiform gyrus (“Fusiform face area”) and superior temporal sulcus (pSTS), with no significant activation in the posteriorly located inferior occipital gyrus (i.e., no “occipital face area”). This observation is strengthened by behavioral and neural evidence for normal face categorization of these stimuli in a brain-damaged prosopagnosic patient whose intact right middle fusiform gyrus and superior temporal sulcus are devoid of any potential face-sensitive inputs from the lesioned right inferior occipital cortex. Together, these observations indicate that face-preferential activation may emerge in higher order visual areas of the right hemisphere without any face-preferential inputs from lower order visual areas, supporting a non-hierarchical view of face perception in the visual cortex.

Holistic perception of the individual face is specific and necessary: evidence from an extensive case study of acquired prosopagnosia

We present an extensive investigation (24 experiments) of a new case of prosopagnosia following right unilateral damage, GG, with the aim of addressing two classical issues: (1) Can a visual recognition impairment truly be specific to faces? (2) What is the nature of acquired prosopagnosia? We show that GG recognizes nonface objects perfectly and quickly, even when it requires fine-grained analysis to individualize these objects. He is also capable of perceiving objects and faces as integrated wholes, as indicated by normal Navon effect, 3D-figures perception and perception of Mooney and Arcimboldo face stimuli. However, the patient could not perceive individual faces holistically, showing no inversion, composite, or whole-part advantage effects for faces. We conclude that an occipito-temporal right hemisphere lesion may lead to a specific impairment of holistic perception of individual items, a function that appears critical for normal face recognition but not for object recognition.

Relating visual to verbal semantic knowledge: the evaluation of object recognition in prosopagnosia

Assessment of face specificity in prosopagnosia is hampered by difficulty in gauging pre-morbid expertise for non-face object categories, for which humans vary widely in interest and experience. In this study, we examined the correlation between visual and verbal semantic knowledge for cars to determine if visual recognition accuracy could be predicted from verbal semantic scores. We had 33 healthy subjects and six prosopagnosic patients first rated their own knowledge of cars. They were then given a test of verbal semantic knowledge that presented them with the names of car models, to which they were to match the manufacturer. Lastly, they were given a test of visual recognition, presenting them with images of cars to which they were to provide information at three levels of specificity: model, manufacturer and decade of make. In controls, while self-ratings were only moderately correlated with either visual recognition or verbal semantic knowledge, verbal semantic knowledge was highly correlated with visual recognition, particularly for more specific levels of information. Item concordance showed that less-expert subjects were more likely to provide the most specific information (model name) for the image when they could also match the manufacturer to its name. Prosopagnosic subjects showed reduced visual recognition of cars after adjusting for verbal semantic scores. We conclude that visual recognition is highly correlated with verbal semantic knowledge, that formal measures of verbal semantic knowledge are a more accurate gauge of expertise than self-ratings, and that verbal semantic knowledge can be used to adjust tests of visual recognition for pre-morbid expertise in prosopagnosia.

The anatomy of object recognition--visual form agnosia caused by medial occipitotemporal stroke

The influential model on visual information processing by Milner and Goodale (1995) has suggested a dissociation between action- and perception-related processing in a dorsal versus ventral stream projection. It was inspired substantially by the observation of a double dissociation of disturbed visual action versus perception in patients with optic ataxia on the one hand and patients with visual form agnosia (VFA) on the other. Unfortunately, almost all cases with VFA reported so far suffered from inhalational intoxication, the majority with carbon monoxide (CO). Since CO induces a diffuse and widespread pattern of neuronal and white matter damage throughout the whole brain, precise conclusions from these patients with VFA on the selective role of ventral stream structures for shape and orientation perception were difficult. Here, we report patient J.S., who demonstrated VFA after a well circumscribed brain lesion due to stroke etiology. Like the famous patient D.F. with VFA after CO intoxication studied by Milner, Goodale, and coworkers (Goodale et al., 1991, 1994; Milner et al., 1991; Servos et al., 1995; Mon-Williams et al., 2001a,b; Wann et al., 2001; Westwood et al., 2002; McIntosh et al., 2004; Schenk and Milner, 2006), J.S. showed an obvious dissociation between disturbed visual perception of shape and orientation information on the one side and preserved visuomotor abilities based on the same information on the other. In both hemispheres, damage primarily affected the fusiform and the lingual gyri as well as the adjacent posterior cingulate gyrus. We conclude that these medial structures of the ventral occipitotemporal cortex are integral for the normal flow of shape and of contour information into the ventral stream system allowing to recognize objects.

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

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

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.

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.

Aberrant pattern of scanning in prosopagnosia reflects impaired face processing

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

The contribution of the fusiform gyrus and superior temporal sulcus in processing facial attractiveness: neuropsychological and neuroimaging evidence

Current cognitive models suggest that the processing of dynamic facial attributes, including social signals such as gaze direction and facial expression, involves the superior temporal sulcus, whereas the processing of invariant facial structure such as the individuals' identity involves the fusiform face area. Where facial attractiveness, a social signal that may emerge from invariant facial structure, is processed within this dual-route model of face perception is uncertain. Here, we present two studies. First, we investigated the explicit judgments of facial attractiveness and attractiveness-motivated behavior in patients with acquired prosopagnosia, a deficit in familiar face recognition usually associated with damage to medial occipitotemporal cortex. We found that both abilities were impaired in these patients, with some weak residual ability for attractiveness judgments found only in those patients with unilateral right occipitotemporal or bilateral anterior temporal lesions. Importantly, deficits in attractiveness perception correlated with the severity of the face recognition deficit. Second, we performed a functional magnetic resonance imaging study in healthy subjects that included an implicit and explicit processing of facial attractiveness. We found increased neural activity when explicitly judging facial attractiveness within a number of cortical regions including the fusiform face area, but not the superior temporal sulcus, indicating a potential contribution of the fusiform face area to this judgment. Thus, converging neuropsychological and neuroimaging evidence points to a critical role of the inferior occipitotemporal cortex in the processing of facial attractiveness.

Prosopagnosia associated with a left occipitotemporal lesion

Acquired prosopagnosia is usually associated with bilateral or right-sided lesions of the occipital or temporal lobes. In rare cases of prosopagnosia after left-sided lesions in left-handed subjects, it is attributed to a reversed hemispheric specialization for face processing. This study examines the face-processing functions of a left-handed prosopagnosic patient with a left-sided lesion affecting the region of the occipital face area and possibly the fusiform face area, to contrast his deficits with those of prosopagnosic patients with right-hemispheric lesions. Similar to those patients, he has a moderately severe reduction in familiarity judgments, is impaired in processing face configuration, and shares with some of those patients a greater failure to process eye than mouth information, indicating an altered pattern of facial saliency. He has a mild reduction in the identification of exemplars of non-face objects. Unlike those patients, he has better residual familiarity on a two-alternative forced-choice task and can processing facial configuration if given more time, indicating a reduction in efficiency rather than a severe limitation. He has more difficulty accessing semantic-biographic information from names. He has trouble with facial feature imagery but not imagery for global face shape. Thus this subject's deficits represent a combination of impaired familiarity and configuration processing (normally right-sided functions in right-handed subjects), and impaired feature processing and access to semantic-biographic information (normally left-sided functions). His prosopagnosia likely reflects partially anomalous rather than reversed lateralization of hemispheric perceptual functions.

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.

Understanding the functional neuroanatomy of acquired prosopagnosia

One of the most remarkable disorders following brain damage is prosopagnosia, the inability to recognize faces. While a number of cases of prosopagnosia have been described at the behavioral level, the functional neuroanatomy of this face recognition impairment, and thus the brain regions critically involved in normal face recognition, has never been specified in great detail. Here, we used anatomical and functional magnetic resonance imaging (fMRI) to present the detailed functional neuroanatomy of a single case of acquired prosopagnosia (PS; Rossion, B., Caldara, R., Seghier, M., Schuller, A.-M., Lazeyras, F., Mayer, E., 2003a. A network of occipito-temporal face-sensitive areas besides the right middle fusiform gyrus is necessary for normal face processing. Brain 126, 2381-95; Rossion, B., Joyce, C.A., Cottrell, G.W., Tarr, M.J., 2003b. Early lateralization and orientation tuning for face, word, and object processing in the visual cortex. Neuroimage 20, 1609-24) with normal object recognition. First, we clarify the exact anatomical location and extent of PS' lesions in relation to (a) retinotopic cortex, (b) face-preferring regions, and (c) other classical visual regions. PS' main lesion - most likely causing her prosopagnosia - is localized in the posterior part of the right ventral occipitotemporal cortex. This lesion causes a left superior paracentral scotoma, as frequently observed in cases of prosopagnosia. While the borders of the early visual areas in the left hemisphere could be delineated well, the extensive posterior right-sided lesion hampered a full specification of the cortical representation of the left visual field. Using multiple scanning runs, face-preferring activation was detected within the right middle fusiform gyrus (MFG) in the so-called 'fusiform face area' ('FFA'), but also in the left inferior occipital gyrus (left 'OFA'), and in the right posterior superior temporal sulcus (STS). The dorsal part of the lateral occipital complex (LOC) and the human middle temporal cortex (hMT+/V5) were localized bilaterally. The color-preferring region V4/V8 was localized only in the left hemisphere. In the right hemisphere, the posterior lesion spared the ventral part of LOC, a region that may be critical for the preserved object recognition abilities of the patient, and the restriction of her deficit to the category of faces. The presumptive functions of both structurally damaged and preserved regions are discussed and new hypotheses regarding the impaired and preserved abilities of the patient during face and non-face object processing are derived. Fine-grained neurofunctional analyses of brain-damaged single cases with isolated recognition deficits may considerably improve our knowledge of the brain regions critically involved in specific visual functions, such as face recognition.

Structural imaging reveals anatomical alterations in inferotemporal cortex in congenital prosopagnosia

Congenital prosopagnosia (CP) refers to the lifelong impairment in face recognition in individuals who have intact low-level visual processing, normal cognitive abilities, and no known neurological disorder. Although the face recognition impairment is profound and debilitating, its neural basis remains elusive. To investigate this, we conducted detailed morphometric and volumetric analyses of the occipitotemporal (OT) cortex in a group of CP individuals and matched control subjects using high-spatial resolution magnetic resonance imaging. Although there were no significant group differences in the depth or deviation from the midline of the OT or collateral sulci, the CP individuals evince a larger anterior and posterior middle temporal gyrus and a significantly smaller anterior fusiform (aF) gyrus. Interestingly, this volumetric reduction in the aF gyrus is correlated with the behavioral decrement in face recognition. These findings implicate a specific cortical structure as the neural basis of CP and, in light of the familial history of CP, target the aF gyrus as a potential site for further, focused genetic investigation.

Too Many Trees to See the Forest: Performance, Event-related Potential, and Functional Magnetic Resonance Imaging Manifestations of Integrative Congenital Prosopagnosia

Neuropsychological, event-related potential (ERP), and functional magnetic resonance imaging (fMRI) methods were combined to provide a comprehensive description of performance and neurobiological profiles for K.W., a case of congenital prosopagnosia. We demonstrate that K.W.'s visual perception is characterized by almost unprecedented inability to identify faces, a large bias toward local features, and an extreme deficit in global/configural processing that is not confined to faces. This pattern could be appropriately labeled congenital integrative prosopagnosia, and accounts for some, albeit not all, cases of face recognition impairments without identifiable brain lesions. Absence of face selectivity is evident in both biological markers of face processing, fMRI (the fusiform face area [FFA]), and ERPs (N170). Nevertheless, these two neural signatures probably manifest different perceptual mechanisms. Whereas the N170 is triggered by the occurrence of physiognomic stimuli in the visual field, the deficient face-selective fMRI activation in the caudal brain correlates with the severity of global processing deficits. This correlation suggests that the FFA might be associated with global/configural computation, a crucial part of face identification.

“Sequence Agnosia” in Bálint's Syndrome: Defects in Visuotemporal Processing after Bilateral Parietal Damage

Bálint's syndrome is characterized by visuospatial dysfunction, with failure to attend to multiple objects in space and poor spatial localization manifested as impaired reaching and saccadic targeting. Less investigated in this disorder is perceptual processing along the dimension of time. We studied the performance of a patient with Bálint's syndrome on two oddity paradigms in which she had to indicate which of three objects was different in color, shape, or structure. Her initial difficulty with processing multiple objects present simultaneously in different locations recovered, but she had persistent difficulty processing objects seen sequentially at the same location. Further studies showed that this deficit was not due to impairments in sustained attention or in distributing attention over time, but to impaired processing of temporal sequences. The deficit was also present with auditory stimuli, indicating a multimodal failure of temporal sequencing. These findings show that bilateral parietal lesions affect not only the spatial but also the temporal organization of perception.

Faces are "spatial"--holistic face perception is supported by low spatial frequencies

Faces are perceived holistically, a phenomenon best illustrated when the processing of a face feature is affected by the other features. Here, the authors tested the hypothesis that the holistic perception of a face mainly relies on its low spatial frequencies. Holistic face perception was tested in two classical paradigms: the whole-part advantage (Experiment 1) and the composite face effect (Experiments 2-4). Holistic effects were equally large or larger for low-pass filtered faces as compared to full-spectrum faces and significantly larger than for high-pass filtered faces. The disproportionate composite effect found for low-pass filtered faces was not observed when holistic perception was disrupted by inversion (Experiment 3). Experiment 4 showed that the composite face effect was enhanced only for low spatial frequencies, but not for intermediate spatial frequencies known be critical for face recognition. These findings indicate that holistic face perception is largely supported by low spatial frequencies. They also suggest that holistic processing precedes the analysis of local features during face perception.

Does Prosopagnosia Take the Eyes Out of Face Representations? Evidence for a Defect in Representing Diagnostic Facial Information following Brain Damage

One of the most impressive disorders following brain damage to the ventral occipitotemporal cortex is prosopagnosia, or the inability to recognize faces. Although acquired prosopagnosia with preserved general visual and memory functions is rare, several cases have been described in the neuropsychological literature and studied at the functional and neural level over the last decades. Here we tested a brain-damaged patient (PS) presenting a deficit restricted to the category of faces to clarify the nature of the missing and preserved components of the face processing system when it is selectively damaged. Following learning to identify 10 neutral and happy faces through extensive training, we investigated patient PS's recognition of faces using Bubbles, a response classification technique that sampled facial information across the faces in different bandwidths of spatial frequencies [Gosselin, F., & Schyns, P. E., Bubbles: A technique to reveal the use of information in recognition tasks. Vision Research, 41, 2261-2271, 2001]. Although PS gradually used less information (i.e., the number of bubbles) to identify faces over testing, the total information required was much larger than for normal controls and decreased less steeply with practice. Most importantly, the facial information used to identify individual faces differed between PS and controls. Specifically, in marked contrast to controls, PS did not use the optimal eye information to identify familiar faces, but instead the lower part of the face, including the mouth and the external contours, as normal observers typically do when processing unfamiliar faces. Together, the findings reported here suggest that damage to the face processing system is characterized by an inability to use the information that is optimal to judge identity, focusing instead on suboptimal information.