Normal acquisition of expertise with greebles in two cases of acquired prosopagnosia

Imagery and perception in acquired prosopagnosia: Functional variants and their relation to structure

Current models of face perception and the face-processing network suggest that acquired prosopagnosia may not be a single disorder but rather a family of variants differing in mechanism. It has been proposed that tests of face perception and face imagery can probe component processes to support apperceptive, associative, and amnestic distinctions. However, validating this proposal is hampered by the rarity of this condition. Here we report observations gathered over two-and-a-half decades on the perception of facial shape and the imagery for famous faces of twenty-three patients. Patients with lesions limited to the occipitotemporal lobes had an apperceptive profile, with impaired perception of facial shape but no or mild deficits for face imagery. The apperceptive defect affected not just configuration but also feature size and external contour, especially in the upper face, and was more severe when subjects attended to multiple aspects of the face. An amnestic profile, with severely impaired imagery and minimally affected perception, was seen in two patients, one with right and one with bilateral anterior temporal damage. Four patients had an apperceptive/amnestic combination, all with bilateral occipitotemporal and right anterior temporal damage. Right anterior temporal damage alone often caused only mild imagery deficits: along with their relatively intact face perception, these subjects came closest to meeting proposed exclusionary criteria for an associative variant, i.e., relative preservation of both imagery and perception. These results confirm a link between apperceptive prosopagnosia and occipitotemporal lesions. Damage to the right anterior temporal lobe was common to all with a severe amnestic deficit, but often requiring additional damage.

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

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

The rehabilitation of object agnosia and prosopagnosia: A systematic review

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Accurate but inefficient: Standard face identity matching tests fail to identify prosopagnosia

In recent years, the number of face identity matching tests in circulation has grown considerably and these are being increasingly utilized to study individual differences in face cognition. Although many of these tests were designed for testing typical observers, recent studies have begun to utilize general-purpose tests for studying specific, atypical populations (e.g., super-recognizers and individuals with prosopagnosia). In this study, we examined the capacity of four tests requiring binary face-matching decisions to study individual differences between healthy observers. Uniquely, we used performance of the patient PS (Rossion, 2018), a well-documented case of acquired prosopagnosia (AP), as a benchmark. Two main findings emerged: (i) PS could exhibit typical rates of accuracy in all tests; (ii) compared to age-matched controls and when considering both accuracy and speed to account for potential trade-offs, only the KFMT - but not the EFCT, PICT or GFMT - was able to detect PS's severe impairment. These findings reflect the importance of considering both accuracy and response times to measure individual differences in face matching, and the need for comparing tests in terms of their sensitivity, when used as a measure of human cognition and brain functioning.

Theta-burst TMS to the posterior superior temporal sulcus decreases resting-state fMRI connectivity across the face processing network

Humans process faces by using a network of face-selective regions distributed across the brain. Neuropsychological patient studies demonstrate that focal damage to nodes in this network can impair face recognition, but such patients are rare. We approximated the effects of damage to the face network in neurologically normal human participants by using theta burst transcranial magnetic stimulation (TBS). Multi-echo functional magnetic resonance imaging (fMRI) resting-state data were collected pre- and post-TBS delivery over the face-selective right superior temporal sulcus (rpSTS), or a control site in the right motor cortex. Results showed that TBS delivered over the rpSTS reduced resting-state connectivity across the extended face processing network. This connectivity reduction was observed not only between the rpSTS and other face-selective areas, but also between nonstimulated face-selective areas across the ventral, medial, and lateral brain surfaces (e.g., between the right amygdala and bilateral fusiform face areas and occipital face areas). TBS delivered over the motor cortex did not produce significant changes in resting-state connectivity across the face processing network. These results demonstrate that, even without task-induced fMRI signal changes, disrupting a single node in a brain network can decrease the functional connectivity between nodes in that network that have not been directly stimulated.

Human behavior is dependent on brain networks that perform different cognitive functions. We combined theta burst transcranial magnetic stimulation (TBS) with resting-state fMRI to study the face processing network. Disruption of the face-selective right posterior superior temporal sulcus (rpSTS) reduced fMRI connectivity across the face network. This impairment in connectivity was observed not only between the rpSTS and other face-selective areas, but also between nonstimulated face-selective areas on the ventral and medial brain surfaces (e.g., between the right amygdala and bilateral fusiform face areas and occipital face areas). Thus, combined TBS/fMRI can be used to approximate and measure the effects of focal brain damage on brain networks, and suggests such an approach may be useful for mapping intrinsic network organization.

Anomalous Perception of Biological Motion in Autism: A Conceptual Review and Meta-Analysis

Despite its popularity, the construct of biological motion (BM) and its putative anomalies in autism spectrum disorder (ASD) are not completely clarified. In this article, we present a meta-analysis investigating the putative anomalies of BM perception in ASD. Through a systematic literature search, we found 30 studies that investigated BM perception in both ASD and typical developing peers by using point-light display stimuli. A general meta-analysis including all these studies showed a moderate deficit of individuals with ASD in BM processing, but also a high heterogeneity. This heterogeneity was explored in different additional meta-analyses where studies were grouped according to levels of complexity of the BM task employed (first-order, direct and instrumental), and according to the manipulation of low-level perceptual features (spatial vs. temporal) of the control stimuli. Results suggest that the most severe deficit in ASD is evident when perception of BM is serving a secondary purpose (e.g., inferring intentionality/action/emotion) and, interestingly, that temporal dynamics of stimuli are an important factor in determining BM processing anomalies in ASD. Our results question the traditional understanding of BM anomalies in ASD as a monolithic deficit and suggest a paradigm shift that deconstructs BM into distinct levels of processing and specific spatio-temporal subcomponents.

The Acquisition of Person Knowledge

How do we learn what we know about others? Answering this question requires understanding the perceptual mechanisms with which we recognize individuals and their actions, and the processes by which the resulting perceptual representations lead to inferences about people's mental states and traits. This review discusses recent behavioral, neural, and computational studies that have contributed to this broad research program, encompassing both social perception and social cognition.

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.

Tests of whole upright face processing in prosopagnosia: A literature review

Prosopagnosia refers to an acquired or developmental deficit in face recognition. This neuropsychological impairment has received increasing attention over the last decade, in particular because of an increased scientific interest in developmental prosopagnosia. Studies investigating prosopagnosia have used a variety of different clinical and experimental tests to assess face processing abilities. With such a large variety of assessment methods available, test selection can be challenging. Some previous works have aimed to provide an overview of tests used to diagnose prosopagnosia. However, no overview that is based on a structured review of the literature is available. We review the literature to identify tests that have been used to assess the processing of whole upright faces in acquired and developmental prosopagnosia over the last five years (2013-2017). We not only review tests that have been used for diagnostic purposes, but also tests that have been used for experimental purposes. Tests are categorised according to i) their experimental designs and, ii) the stage of face processing that they assess. On this basis, we discuss considerations regarding test designs for future studies. A visual illustration providing a structured overview of paradigms available for testing the processing of whole upright faces is provided. This visual illustration can be used to inform test selection when designing a study and to apply a structured approach to interpreting findings from the literature. The different approaches to assessment of face processing in prosopagnosia have been necessary and fruitful in generating data and hypotheses about the cause of face processing deficits. However, impairments at different levels of face processing have often been interpreted as reflecting a deficit in the recognition stage of face processing. Based on the data now available on prosopagnosia, we advocate for a more structured approach to assessment, which may facilitate a better understanding of the key deficits in prosopagnosia and of the level(s) of face processing that are impaired.

Damasio's error - Prosopagnosia with intact within-category object recognition

The sudden inability to recognize individual faces following brain damage was first reported in a scientific journal 150 years ago and termed 'prosopagnosia' 70 years ago. While the term originally identified a face-selective neurological condition, it is now obscured by a sequence of imprecisions. First, prosopagnosia is routinely used to define symptoms of individual face recognition (IFR) difficulties in the context of visual object agnosia or other neurological conditions, or even in the normal population. Second, this over-expansive definition has lent support to a long-standing within-category recognition account of prosopagnosia, that is, that the impairment of IFR reflects a general impairment in recognizing within-category objects. However, stringent experimental studies of classical cases of prosopagnosia following brain damage show that their core impairment is not in recognizing physically similar exemplars within non-face object categories. Instead, the impairment presents specifically for recognizing exemplars of the category of faces. Moreover, compared to typical observers, the impairment appears even more severe for recognizing individual faces against physically dissimilar than similar distractors. Here, I argue that we need to limit accordingly our definition of prosopagnosia to a clinical (i.e., neurological) condition in which there is no basic-level object recognition impairment. Other criteria for prosopagnosia are proposed, with the hope that this conservative definition enables the study of human IFR processes in isolation, and supports progress in understanding the nature of these processes.

Familiarity increases the number of remembered Pokémon in visual short-term memory

Long-term memory (LTM) can influence many aspects of short-term memory (STM), including increased STM span. However, it is unclear whether LTM enhances the quantitative or qualitative aspect of STM. That is, do we retain a larger number of representations or more precise representations in STM for familiar stimuli than unfamiliar stimuli? This study took advantage of participants' prior rich multimedia experience with Pokémon, without investing on laboratory training to examine how prior LTM influenced visual STM. In a Pokémon visual STM change detection task, participants remembered more first-generation Pokémon characters that they were more familiar with than recent-generation Pokémon characters that they were less familiar with. No significant difference in memory quality was found when quantitative and qualitative effects of LTM were isolated using receiver operating characteristic (ROC) analyses. Critically, these effects were absent in participants who were unfamiliar with first-generation Pokémon. Furthermore, several alternative interpretations were ruled out, including general video-gaming experience, subjective Pokémon preference, and verbal encoding. Together, these results demonstrated a strong link between prior stimulus familiarity in LTM and visual STM storage capacity.

Does Extensive Training at Individuating Novel Objects in Adulthood Lead to Visual Expertise? The Role of Facelikeness

Human adults have a rich visual experience thanks to seeing human faces since birth, which may contribute to the acquisition of perceptual processes that rapidly and automatically individuate faces. According to a generic visual expertise hypothesis, extensive experience with nonface objects may similarly lead to efficient processing of objects at the individual level. However, whether extensive training in adulthood leads to visual expertise remains debated. One key issue is the extent to which the acquisition of visual expertise depends on the resemblance of objects to faces in terms of the spatial configuration of parts. We therefore trained naive human adults to individuate a large set of novel parametric multipart objects. Critically, one group of participants trained with the objects in a "facelike" stimulus orientation, whereas a second group trained with the same objects but with the objects rotated 180° in the picture plane into a "nonfacelike" orientation. We used a fast periodic visual stimulation EEG protocol to objectively quantify participants' ability to discriminate untrained exemplars before and after training. EEG responses associated with the frequency of identity change in a fast stimulation sequence, which reflects rapid and automatic perceptual processes, were observed over lateral occipital sites for both groups before training. There was a significant, albeit small, increase in these responses after training but only for the facelike group and only to facelike stimuli. Our findings indicate that perceived facelikeness plays a role in visual expertise and highlight how the adult perceptual system exploits familiar spatial configurations when learning new object categories.

Dynamic neural architecture for social knowledge retrieval

Social behavior is often shaped by the rich storehouse of biographical information that we hold for other people. In our daily life, we rapidly and flexibly retrieve a host of biographical details about individuals in our social network, which often guide our decisions as we navigate complex social interactions. Even abstract traits associated with an individual, such as their political affiliation, can cue a rich cascade of person-specific knowledge. Here, we asked whether the anterior temporal lobe (ATL) serves as a hub for a distributed neural circuit that represents person knowledge. Fifty participants across two studies learned biographical information about fictitious people in a 2-d training paradigm. On day 3, they retrieved this biographical information while undergoing an fMRI scan. A series of multivariate and connectivity analyses suggest that the ATL stores abstract person identity representations. Moreover, this region coordinates interactions with a distributed network to support the flexible retrieval of person attributes. Together, our results suggest that the ATL is a central hub for representing and retrieving person knowledge.

Face-specific and domain-general visual processing deficits in children with developmental prosopagnosia

Evidence suggests that face and object recognition depend on distinct neural circuitry within the visual system. Work with adults with developmental prosopagnosia (DP) demonstrates that some individuals have preserved object recognition despite severe face recognition deficits. This face selectivity in adults with DP indicates that face- and object-processing systems can develop independently, but it is unclear at what point in development these mechanisms are separable. Determining when individuals with DP first show dissociations between faces and objects is one means to address this question. In the current study, we investigated face and object processing in six children with DP (5-12-years-old). Each child was assessed with one face perception test, two different face memory tests, and two object memory tests that were matched to the face memory tests in format and difficulty. Scores from the DP children on the matched face and object tasks were compared to within-subject data from age-matched controls. Four of the six DP children, including the 5-year-old, showed evidence of face-specific deficits, while one child appeared to have more general visual-processing deficits. The remaining child had inconsistent results. The presence of face-specific deficits in children with DP suggests that face and object perception depend on dissociable processes in childhood.

The Superior Temporal Sulcus Is Causally Connected to the Amygdala: A Combined TBS-fMRI Study

Nonhuman primate neuroanatomical studies have identified a cortical pathway from the superior temporal sulcus (STS) projecting into dorsal subregions of the amygdala, but whether this same pathway exists in humans is unknown. Here, we addressed this question by combining theta burst transcranial magnetic stimulation (TBS) with fMRI to test the prediction that the STS and amygdala are functionally connected during face perception. Human participants (N = 17) were scanned, over two sessions, while viewing 3 s video clips of moving faces, bodies, and objects. During these sessions, TBS was delivered over the face-selective right posterior STS (rpSTS) or over the vertex control site. A region-of-interest analysis revealed results consistent with our hypothesis. Namely, TBS delivered over the rpSTS reduced the neural response to faces (but not to bodies or objects) in the rpSTS, right anterior STS (raSTS), and right amygdala, compared with TBS delivered over the vertex. By contrast, TBS delivered over the rpSTS did not significantly reduce the neural response to faces in the right fusiform face area or right occipital face area. This pattern of results is consistent with the existence of a cortico-amygdala pathway in humans for processing face information projecting from the rpSTS, via the raSTS, into the amygdala. This conclusion is consistent with nonhuman primate neuroanatomy and with existing face perception models.

SIGNIFICANCE STATEMENT

Neuroimaging studies have identified multiple face-selective regions in the brain, but the functional connections between these regions are unknown. In the present study, participants were scanned with fMRI while viewing movie clips of faces, bodies, and objects before and after transient disruption of the face-selective right posterior superior temporal sulcus (rpSTS). Results showed that TBS disruption reduced the neural response to faces, but not to bodies or objects, in the rpSTS, right anterior STS (raSTS), and right amygdala. These results are consistent with the existence of a cortico-amygdala pathway in humans for processing face information projecting from the rpSTS, via the raSTS, into the amygdala. This conclusion is consistent with nonhuman primate neuroanatomy and with existing face perception models.

Prosopagnosia: current perspectives

Prosopagnosia is a selective visual agnosia characterized by the inability to recognize the identity of faces. There are both acquired forms secondary to brain damage and developmental forms without obvious structural lesions. In this review, we first discuss the diagnosis of acquired and developmental prosopagnosia, and the challenges present in the latter case. Second, we discuss the evidence regarding the selectivity of the prosopagnosic defect, particularly in relation to the recognition of other objects, written words (another visual object category requiring high expertise), and voices. Third, we summarize recent findings about the structural and functional basis of prosopagnosia from studies using magnetic resonance imaging, functional magnetic resonance imaging, and event-related potentials. Finally, we discuss recent attempts at rehabilitation of face recognition in prosopagnosia.

A Revised Neural Framework for Face Processing

Face perception relies on computations carried out in face-selective cortical areas. These areas have been intensively investigated for two decades, and this work has been guided by an influential neural model suggested by Haxby and colleagues in 2000. Here, we review new findings about face-selective areas that suggest the need for modifications and additions to the Haxby model. We suggest a revised framework based on (a) evidence for multiple routes from early visual areas into the face-processing system, (b) information about the temporal characteristics of these areas, (c) indications that the fusiform face area contributes to the perception of changeable aspects of faces, (d) the greatly elevated responses to dynamic compared with static faces in dorsal face-selective brain areas, and (e) the identification of three new anterior face-selective areas. Together, these findings lead us to suggest that face perception depends on two separate pathways: a ventral stream that represents form information and a dorsal stream driven by motion and form information.

Acquired prosopagnosia without word recognition deficits

It has long been suggested that face recognition relies on specialized mechanisms that are not involved in visual recognition of other object categories, including those that require expert, fine-grained discrimination at the exemplar level such as written words. But according to the recently proposed many-to-many theory of object recognition (MTMT), visual recognition of faces and words are carried out by common mechanisms [Behrmann, M., & Plaut, D. C. ( 2013 ). Distributed circuits, not circumscribed centers, mediate visual recognition. Trends in Cognitive Sciences, 17, 210-219]. MTMT acknowledges that face and word recognition are lateralized, but posits that the mechanisms that predominantly carry out face recognition still contribute to word recognition and vice versa. MTMT makes a key prediction, namely that acquired prosopagnosics should exhibit some measure of word recognition deficits. We tested this prediction by assessing written word recognition in five acquired prosopagnosic patients. Four patients had lesions limited to the right hemisphere while one had bilateral lesions with more pronounced lesions in the right hemisphere. The patients completed a total of seven word recognition tasks: two lexical decision tasks and five reading aloud tasks totalling more than 1200 trials. The performances of the four older patients (3 female, age range 50-64 years) were compared to those of 12 older controls (8 female, age range 56-66 years), while the performances of the younger prosopagnosic (male, 31 years) were compared to those of 14 younger controls (9 female, age range 20-33 years). We analysed all results at the single-patient level using Crawford's t-test. Across seven tasks, four prosopagnosics performed as quickly and accurately as controls. Our results demonstrate that acquired prosopagnosia can exist without word recognition deficits. These findings are inconsistent with a key prediction of MTMT. They instead support the hypothesis that face recognition is carried out by specialized mechanisms that do not contribute to recognition of written words.

What is special about expertise? Visual expertise reveals the interactive nature of real-world object recognition

Ever since Diamond and Carey (1986. J. Exp. Psychol.: Gen., vol. 115, pp. 107-117) seminal work, the main model for studying expertise in visual object recognition ("visual expertise") has been face perception. The underlying assumption was that since faces may be considered the ultimate domain of visual expertise, any face-processing signature might actually be a general characteristic of visual expertise. However, while humans are clearly experts in face recognition, visual expertise is not restricted to faces and can be observed in a variety of domains. This raises the question of whether face recognition is in fact the right model to study visual expertise, and if not, what are the common cognitive and neural characteristics of visual expertise. The current perspective article addresses this question by revisiting past and recent neuroimaging and behavioural works on visual expertise. The view of visual expertise that emerges from these works is that expertise is a unique phenomenon, with distinctive neural and cognitive characteristics. Specifically, visual expertise is a controlled, interactive process that develops from the reciprocal interactions between the visual system and multiple top-down factors, including semantic knowledge, top-down attentional control, and task relevance. These interactions enable the ability to flexibly access domain-specific information at multiple scales and levels guided by multiple recognition goals. Extensive visual experience with a given object category culminates in the recruitment of these multiple systems, and is reflected in widespread neural activity, extending well beyond visual cortex, to include higher-level cortical areas.