Prosopagnosia as an impairment to face-specific mechanisms: Elimination of the alternative hypotheses in a developmental case

Navigating Memorability Landscapes: Hyperbolic Geometry Reveals Hierarchical Structures in Object Concept Memory

Why are some object concepts (e.g., birds, cars, vegetables, etc.) more memorable than others? Prior studies have suggested that features (e.g., color, animacy, etc.) and typicality (e.g., robin vs. penguin) of object images influences the likelihood of being remembered. However, a complete understanding of object memorability remains elusive. In this study, we examine whether the geometric relationship between object concepts explains differences in their memorability. Specifically, we hypothesize that image concepts will be geometrically arranged in hierarchical structures and that memorability will be explained by a concept's depth in these hierarchical trees. To test this hypothesis, we construct a Hyperbolic representation space of object concepts (N=1,854) from the THINGS database (Hebart et al., 2019), which consists of naturalistic images of concrete objects, and a space of 49 feature dimensions derived from data-driven models. Using ALBATROSS (Stier, A. J., Giusti, C., & Berman, M. G., In prep), a stochastic topological data analysis technique that detects underlying structures of data, we demonstrate that Hyperbolic geometry efficiently captures the hierarchical organization of object concepts above and beyond a traditional Euclidean geometry and that hierarchical organization is related to memorability. We find that concepts closer to the center of the representational space are more prototypical and also more memorable. Importantly, Hyperbolic distances are more predictive of memorability and prototypicality than Euclidean distances, suggesting that concept memorability and typicality are organized hierarchically. Taken together, our work presents a novel hierarchical representational structure of object concepts that explains memorability and typicality.

Normative data of the Italian Famous Face Test

The faces we see in daily life exist on a continuum of familiarity, ranging from personally familiar to famous to unfamiliar faces. Thus, when assessing face recognition abilities, adequate evaluation measures should be employed to discriminate between each of these processes and their relative impairments. We here developed the Italian Famous Face Test (IT-FFT), a novel assessment tool for famous face recognition in typical and clinical populations. Normative data on a large sample (N = 436) of Italian individuals were collected, assessing both familiarity (d') and recognition accuracy. Furthermore, this study explored whether individuals possess insights into their overall face recognition skills by correlating the Prosopagnosia Index-20 (PI-20) with the IT-FFT; a negative correlation between these measures suggests that people have a moderate insight into their face recognition skills. Overall, our study provides the first online-based Italian test for famous faces (IT-FFT), a test that could be used alongside other standard tests of face recognition because it complements them by evaluating real-world face familiarity, providing a more comprehensive assessment of face recognition abilities. Testing different aspects of face recognition is crucial for understanding both typical and atypical face recognition.

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.

Both identity and non-identity face perception tasks predict developmental prosopagnosia and face recognition ability

Developmental prosopagnosia (DP) is characterised by deficits in face identification. However, there is debate about whether these deficits are primarily perceptual, and whether they extend to other face processing tasks (e.g., identifying emotion, age, and gender; detecting faces in scenes). In this study, 30 participants with DP and 75 controls completed a battery of eight tasks assessing four domains of face perception (identity; emotion; age and gender; face detection). The DP group performed worse than the control group on both identity perception tasks, and one task from each other domain. Both identity perception tests uniquely predicted DP/control group membership, and performance on two measures of face memory. These findings suggest that deficits in DP may arise from issues with face perception. Some non-identity tasks also predicted DP/control group membership and face memory, even when face identity perception was accounted for. Gender perception and speed of face detection consistently predicted unique variance in group membership and face memory; several other tasks were only associated with some measures of face recognition ability. These findings indicate that face perception deficits in DP may extend beyond identity perception. However, the associations between tasks may also reflect subtle aspects of task demands or stimuli.

Decoding face recognition abilities in the human brain

Why are some individuals better at recognizing faces? Uncovering the neural mechanisms supporting face recognition ability has proven elusive. To tackle this challenge, we used a multimodal data-driven approach combining neuroimaging, computational modeling, and behavioral tests. We recorded the high-density electroencephalographic brain activity of individuals with extraordinary face recognition abilities-super-recognizers-and typical recognizers in response to diverse visual stimuli. Using multivariate pattern analyses, we decoded face recognition abilities from 1 s of brain activity with up to 80% accuracy. To better understand the mechanisms subtending this decoding, we compared representations in the brains of our participants with those in artificial neural network models of vision and semantics, as well as with those involved in human judgments of shape and meaning similarity. Compared to typical recognizers, we found stronger associations between early brain representations of super-recognizers and midlevel representations of vision models as well as shape similarity judgments. Moreover, we found stronger associations between late brain representations of super-recognizers and representations of the artificial semantic model as well as meaning similarity judgments. Overall, these results indicate that important individual variations in brain processing, including neural computations extending beyond purely visual processes, support differences in face recognition abilities. They provide the first empirical evidence for an association between semantic computations and face recognition abilities. We believe that such multimodal data-driven approaches will likely play a critical role in further revealing the complex nature of idiosyncratic face recognition in the human brain.

Familial Transmission of Developmental Prosopagnosia: New Case Reports from an Extended Family and Identical Twins

Existing evidence suggests that developmental prosopagnosia (DP) is a surprisingly prevalent condition, with some individuals describing lifelong difficulties with facial identity recognition. Together with case reports of multiple family members with the condition, this evidence suggests that DP is inherited in at least some instances. Here, we offer some novel case series that further support the heritability of the condition. First, we describe five adult siblings who presented to our lab with symptoms of DP. Second, for the first known time in the literature, we describe a pair of adult identical twins who contacted us in the belief that they both experience DP. The condition was confirmed in three of the five siblings (with minor symptoms observed in the remaining two) and in both twins. Supplementary assessments suggested that all individuals also experienced some degree of difficulty with facial identity perception, but that object recognition was preserved. These findings bolster the evidence supporting the heritability of DP and suggest that it can be a specific impairment in some cases.

Investigating the Influence of Autism Spectrum Traits on Face Processing Mechanisms in Developmental Prosopagnosia

Autism traits are common exclusionary criteria in developmental prosopagnosia (DP) studies. We investigated whether autism traits produce qualitatively different face processing in 43 DPs with high vs. low autism quotient (AQ) scores. Compared to controls (n = 27), face memory and perception were similarly deficient in the high- and low-AQ DPs, with the high-AQ DP group additionally showing deficient face emotion recognition. Task-based fMRI revealed reduced occipito-temporal face selectivity in both groups, with high-AQ DPs additionally demonstrating decreased posterior superior temporal sulcus selectivity. Resting-state fMRI showed similar reduced face-selective network connectivity in both DP groups compared with controls. Together, this demonstrates that high- and low-AQ DP groups have very similar face processing deficits, with additional facial emotion deficits in high-AQ DPs.

Null effect of anodal and cathodal transcranial direct current stimulation (tDCS) on own- and other-race face recognition

Successful face recognition is important for social interactions and public security. Although some preliminary evidence suggests that anodal and cathodal transcranial direct current stimulation (tDCS) might modulate own- and other-race face identification, respectively, the findings are largely inconsistent. Hence, we examined the effect of both anodal and cathodal tDCS on the recognition of own- and other-race faces. Ninety participants first completed own- and other-race Cambridge Face Memory Test (CFMT) as baseline measurements. Next, they received either anodal tDCS, cathodal tDCS or sham stimulation and finally they completed alternative versions of the own- and other-race CFMT. No difference in performance, in terms of accuracy and reaction time, for own- and other-race face recognition between anodal tDCS, cathodal tDCS and sham stimulation was found. Our findings cast doubt upon the efficacy of tDCS to modulate performance in face identification tasks.

The Neural Correlates of Developmental Prosopagnosia: Twenty-Five Years on

Faces play a crucial role in social interactions. Developmental prosopagnosia (DP) refers to the lifelong difficulty in recognizing faces despite the absence of obvious signs of brain lesions. In recent decades, the neural substrate of this condition has been extensively investigated. While early neuroimaging studies did not reveal significant functional and structural abnormalities in the brains of individuals with developmental prosopagnosia (DPs), recent evidence identifies abnormalities at multiple levels within DPs' face-processing networks. The current work aims to provide an overview of the convergent and contrasting findings by examining twenty-five years of neuroimaging literature on the anatomo-functional correlates of DP. We included 55 original papers, including 63 studies that compared the brain structure (MRI) and activity (fMRI, EEG, MEG) of healthy control participants and DPs. Despite variations in methods, procedures, outcomes, sample selection, and study design, this scoping review suggests that morphological, functional, and electrophysiological features characterize DPs' brains, primarily within the ventral visual stream. Particularly, the functional and anatomical connectivity between the Fusiform Face Area and the other face-sensitive regions seems strongly impaired. The cognitive and clinical implications as well as the limitations of these findings are discussed in light of the available knowledge and challenges in the context of DP.

Dissociations between face identity and face expression processing in developmental prosopagnosia

Individuals with developmental prosopagnosia (DPs) experience severe and lifelong deficits recognising faces, but whether their deficits are selective to the processing of face identity or extend to the processing of face expression remains unclear. Clarifying this issue is important for understanding DP impairments and advancing theories of face processing. We compared identity and expression processing in a large sample of DPs (N = 124) using three different matching tasks that each assessed identity and expression processing with identical experimental formats. We ran each task in upright and inverted orientations and we measured inversion effects to assess the integrity of upright-specific face processes. We report three main results. First, DPs showed large deficits at discriminating identity but only subtle deficits at discriminating expression. Second, DPs showed a reduced inversion effect for identity but a normal inversion effect for expression. Third, DPs' performance on the expression tasks were linked to autism traits, but their performance on the identity tasks were not. These results constitute several dissociations between identity and expression processing in DP, and they are consistent with the view that the core impairment in DP is highly selective to identity.

Face distortions in prosopometamorphopsia provide new insights into the organization of face perception

Prosopometamorphopsia (PMO) is a striking condition of visual perception in which facial features appear distorted, for example drooping, swelling, or twisting. Although numerous cases have been reported, few of those investigations have carried out formal testing motivated by theories of face perception. However, because PMO involves conscious visual distortions to faces which participants can report, it can be used to probe fundamental questions about face representations. Here we review cases of PMO that address theoretical questions in visual neuroscience including face specificity, inverted face processing, the importance of the vertical midline, dissociable representations for each half of the face, hemispheric specialization, the relationship between face recognition and conscious face perception, and the reference frames that face representations are embedded within. Finally, we list and touch upon eighteen open questions that make clear how much is left to learn about PMO and the potential it has to provide important advances in face perception.

Persistent prosopagnosia following COVID-19

COVID-19 can cause psychological problems including loss of smell and taste, long-lasting memory, speech, and language impairments, and psychosis. Here, we provide the first report of prosopagnosia following symptoms consistent with COVID-19. Annie is a 28-year-old woman who had normal face recognition prior to contracting COVID-19 in March 2020. Two months later, she noticed face recognition difficulties while experiencing symptom relapses and her deficits with faces have persisted. On two tests of familiar face recognition and two tests of unfamiliar face recognition, Annie showed clear impairments. In contrast, she scored normally on tests assessing face detection, face identity perception, object recognition, scene recognition, and non-visual memory. Navigational deficits frequently co-occur with prosopagnosia, and Annie reports that her navigational abilities are substantially worse than before she became ill. Self-report survey data from 54 respondents with long COVID showed that a majority reported reductions in visual recognition and navigation abilities. In summary, Annie's results indicate that COVID-19 can produce severe and selective neuropsychological impairment similar to deficits seen following brain damage, and it appears that high-level visual impairments are not uncommon in people with long COVID.

Contrasting domain-general and domain-specific accounts in cognitive neuropsychology: An outline of a new approach with developmental prosopagnosia as a case

The backbone of cognitive neuropsychology is the observation of (double) dissociations in performance between patients, suggesting some degree of independence between cognitive processes (domain specificity). In comparison, observations of associations between disorders/deficits have been deemed less evidential in neuropsychological theorizing about cognitive architecture. The reason is that associations can reflect damage to independent cognitive processes that happen to be mediated by structures commonly affected by the same brain disorder rather than damage to a shared (domain-general) mechanism. Here we demonstrate that it is in principle possible to discriminate between these alternatives by means of a procedure involving large unbiased samples. We exemplify the procedure in the context of developmental prosopagnosia (DP), but the procedure is in principle applicable to all neuropsychological deficits/disorders. A simulation of the procedure on a dataset yields estimates of dissociations/associations that are well in line with existing DP-studies, and also suggests that seemingly selective disorders can reflect damage to both domain-general and domain-specific cognitive processes. However, the simulation also highlights some limitations that should be considered if the procedure is to be applied prospectively. The main advantage of the procedure is that allows for examination of both associations and dissociations in the same sample. Hence, it may help even the balance in the use of associations and dissociations as grounds for neuropsychological theorizing.

New evidence of impaired expression recognition in developmental prosopagnosia

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by lifelong face recognition difficulties. To date, it remains unclear whether or not individuals with DP experience impaired recognition of facial expressions. It has been proposed that DPs may have sufficient perceptual ability to correctly interpret facial expressions when tasks are relatively easy (e.g., the stimuli are unambiguous and viewing conditions are optimal), but exhibit subtle impairments when tested under more challenging conditions. In the present study, we sought to take advantage of the COVID-19 pandemic to test this view. It is well-established that the surgical-type masks worn during the pandemic hinder the recognition and interpretation of facial emotion in typical participants. Relative to typical participants, we hypothesized that DPs may be disproportionately impaired when asked to interpret the facial emotion of people wearing face masks. We compared the ability of 34 DPs and 60 age-matched typical controls to recognize facial emotions i) when the whole face is visible, and ii) when the lower portion of the face is covered with a surgical mask. When expression stimuli were viewed without a mask, the DPs and typical controls exhibited similar levels of performance. However, when expression stimuli were shown with a mask, the DPs showed signs of subtle expression recognition deficits. The DPs were particularly prone to mislabeling masked expressions of happiness as emotion neutral. These results add to a growing body of evidence that under some conditions, DPs do exhibit subtle deficits of expression recognition.

Implicit evidence on the dissociation of identity and emotion recognition

Recognition of identity and of emotional facial expressions of individuals are both based on processing of the human face. While most studies show these abilities to be dissociated, some others find evidence of a connection. One possible explanation for these contradictory results comes from neurological evidence, which points to identity recognition being mostly based on holistic processing, while emotion recognition seems to be based on both an explicit, fine-grained process, and an implicit, mostly-holistic one. Our main hypothesis, that would explain the contradictory findings, is that holistic implicit emotion recognition, specifically, would be related to identity recognition, while explicit emotion recognition would be a process separate to identity recognition. To test this hypothesis, we employed an experimental paradigm in which spatial frequencies of visual stimuli are manipulated so that automatic, holistic-based, implicit emotion recognition influences perceived friendliness of unfamiliar faces. We predicted the effect to be related to identity recognition ability, since they both require holistic face processing. After a successful replication study, we employed the paradigm with 140 participants, measuring also identity recognition ability and explicit emotion recognition ability. Results showed that the effect is not moderated by these two variables (p = .807 and .373, respectively), suggesting that the independence of identity and emotion recognition holds even when considering, specifically, implicit emotion recognition.

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.

Psychophysical profiles in super-recognizers

Facial identity matching ability varies widely, ranging from prosopagnosic individuals (who exhibit profound impairments in face cognition/processing) to so-called super-recognizers (SRs), possessing exceptional capacities. Yet, despite the often consequential nature of face matching decisions—such as identity verification in security critical settings—ability assessments tendentially rely on simple performance metrics on a handful of heterogeneously related subprocesses, or in some cases only a single measured subprocess. Unfortunately, methodologies of this ilk leave contributions of stimulus information to observed variations in ability largely un(der)specified. Moreover, they are inadequate for addressing the qualitative or quantitative nature of differences between SRs’ abilities and those of the general population. Here, therefore, we sought to investigate individual differences—among SRs identified using a novel conservative diagnostic framework, and neurotypical controls—by systematically varying retinal availability, bandwidth, and orientation of faces’ spatial frequency content in two face matching experiments. Psychophysical evaluations of these parameters’ contributions to ability reveal that SRs more consistently exploit the same spatial frequency information, rather than suggesting qualitatively different profiles between control observers and SRs. These findings stress the importance of optimizing procedures for SR identification, for example by including measures quantifying the consistency of individuals’ behavior.

Patterns of perceptual performance in developmental prosopagnosia: An in-depth case series

Developmental prosopagnosia (DP) is a syndrome characterized by lifelong impairment in face recognition in the absence of brain damage. A key question regarding DP concerns which process(es) might be affected to selectively/disproportionally impair face recognition. We present evidence from a group of DPs, combining an overview of previous results with additional analyses important for understanding their pattern of preserved and impaired perceptual abilities. We argue that for most of these individuals, the common denominator is a deficit in (rapid) processing of global shape information. We conclude that the deficit in this group of DPs is not face-selective, but that it may appear so because faces are more visually similar-and recognized at a more fine-grained level-than objects. Indeed, when the demand on perceptual differentiation and visual similarity are held constant for faces and objects, we find no evidence for a disproportionate deficit for faces in this group of DPs.

Different and common brain signals of altered neurocognitive mechanisms for unfamiliar face processing in acquired and developmental prosopagnosia

Neuropsychological studies have shown that prosopagnosic individuals perceive face structure in an atypical way. This might preclude the formation of appropriate face representations and, consequently, hamper effective recognition. The present ERP study, in combination with Bayesian source reconstruction, investigates how information related to both external (E) and internal (I) features was processed by E.C. and I.P., suffering from acquired and developmental prosopagnosia, respectively. They carried out a face-feature matching task with new faces. E.C. showed poor performance and remarkable lack of early face-sensitive P1, N170 and P2 responses on right (damaged) posterior cortex. Although she presented the expected mismatch effect to target faces in the E-I sequence, it was of shorter duration than in Controls, and involved left parietal, right frontocentral and dorsofrontal regions, suggestive of reduced neural circuitry to process face configurations. In turn, I.P. performed efficiently but with a remarkable bias to give "match" responses. His face-sensitive potentials P1-N170 were comparable to those from Controls, however, he showed no subsequent P2 response and a mismatch effect only in the I-E sequence, reflecting activation confined to those regions that sustain typically the initial stages of face processing. Relevantly, neither of the prosopagnosics exhibited conspicuous P3 responses to features acting as primes, indicating that diagnostic information for constructing face representations could not be sufficiently attended nor deeply encoded. Our findings suggest a different locus for altered neurocognitive mechanisms in the face network in participants with different types of prosopagnosia, but common indicators of a deficient allocation of attentional resources for further recognition.

Evidence for normal novel object recognition abilities in developmental prosopagnosia

The issue of the face specificity of recognition deficits in developmental prosopagnosia (DP) is fundamental to the organization of high-level visual memory and has been increasingly debated in recent years. Previous DP investigations have found some evidence of object recognition impairments, but have almost exclusively used familiar objects (e.g. cars), where performance may depend on acquired object-specific experience and related visual expertise. An object recognition test not influenced by experience could provide a better, less contaminated measure of DPs' object recognition abilities. To investigate this, in the current study we tested 30 DPs and 30 matched controls on a novel object memory test (NOMT Ziggerins) and the Cambridge Face Memory Test (CFMT). DPs with severe impairment on the CFMT showed no differences in accuracy or reaction times compared with controls on the NOMT. We found similar results when comparing DPs with a larger sample of 274 web-based controls. Additional individual analyses demonstrated that the rate of object recognition impairment in DPs did not differ from the rate of impairment in either control group. Together, these results demonstrate unimpaired object recognition in DPs for a class of novel objects that serves as a powerful index for broader novel object recognition capacity.

Left hemisphere abnormalities in developmental prosopagnosia when looking at faces but not words

Developmental prosopagnosia is a disorder characterized by profound and lifelong difficulties with face recognition in the absence of sensory or intellectual deficits or known brain injury. While there has been a surge in research on developmental prosopagnosia over the last decade and a half, the cognitive mechanisms behind the disorder and its neural underpinnings remain elusive. Most recently it has been proposed that developmental prosopagnosia may be a manifestation of widespread disturbance in neural migration which affects both face responsive brain regions as well as other category-sensitive visual areas. We present a combined behavioural and functional MRI study of face, object and word processing in a group of developmental prosopagnosics (N = 15). We show that developmental prosopagnosia is associated with reduced activation of core ventral face areas during perception of faces. The reductions were bilateral but tended to be more pronounced in the left hemisphere. As the first study to address category selectivity for word processing in developmental prosopagnosia, we do not, however, find evidence for reduced activation of the visual word form area during perception of orthographic material. We also find no evidence for reduced activation of the lateral occipital complex during perception of objects. These imaging findings correspond well with the behavioural performance of the developmental prosopagnosics, who show severe impairment for faces but normal reading and recognition of line drawings. Our findings suggest that a general deficit in neural migration across ventral occipito-temporal cortex is not a viable explanation for developmental prosopagnosia. The finding of left hemisphere involvement in our group of developmental prosopagnosics was at first surprising. However, a closer look at existing studies shows similar, but hitherto undiscussed, findings. These left hemisphere abnormalities seen in developmental prosopagnosia contrasts with lesion and imaging studies suggesting primarily right hemisphere involvement in acquired prosopagnosia, and this may reflect that the left hemisphere is important for the development of a normal face recognition network.

The discrimination of facial sex in developmental prosopagnosia

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterised by difficulties recognising and discriminating faces. It is currently unclear whether the perceptual impairments seen in DP are restricted to identity information, or also affect the perception of other facial characteristics. To address this question, we compared the performance of 17 DPs and matched controls on two sensitive sex categorisation tasks. First, in a morph categorisation task, participants made binary decisions about faces drawn from a morph continuum that blended incrementally an average male face and an average female face. We found that judgement precision was significantly lower in the DPs than in the typical controls. Second, we used a sex discrimination task, where female or male facial identities were blended with an androgynous average face. We manipulated the relative weighting of each facial identity and the androgynous average to create four levels of signal strength. We found that DPs were significantly less sensitive than controls at each level of difficulty. Together, these results suggest that the visual processing difficulties in DP extend beyond the extraction of facial identity and affects the extraction of other facial characteristics. Deficits of facial sex categorisation accord with an apperceptive characterisation of DP.

Self-reported face recognition is highly valid, but alone is not highly discriminative of prosopagnosia-level performance on objective assessments

Severe developmental deficits in face recognition ability (developmental prosopagnosia, or DP) have been vigorously studied over the past decade, yet many questions remain unanswered about their origins, nature, and social consequences. A rate-limiting factor in answering such questions is the challenge of recruiting rare DP participants. Although self-reported experiences have long played a role in efforts to identify DPs, much remains unknown about how such self-reports can or should contribute to screening or diagnosis. Here, in a large, population-based web sample, we investigated the effectiveness of self-report, used on its own, as a screen to identify individuals who will ultimately fail, at a conventional cutoff, the two types of objective tests that are most commonly used to confirm DP diagnoses: the Cambridge Face Memory Test (CFMT) and the famous faces memory test (FFMT). We used a highly reliable questionnaire (alpha = .91), the Cambridge Face Memory Questionnaire (CFMQ), and revealed strong validity via high correlations of .44 with the CFMT and .52 with the FFMT. However, cutoff analyses revealed that no CFMQ score yielded a clinical-grade combination of sensitivity and positive predictive value in enough individuals to support using it alone as a DP diagnostic or screening tool. This result was replicated in an analysis of data from the widely used PI20 questionnaire, a 20-question self-assessment of facial recognition similar in form to the CFMQ. We therefore recommend that screens for DP should, wherever possible, include objective as well as subjective assessment tools.

Evaluating object recognition ability in developmental prosopagnosia using the Cambridge Car Memory Test

Individuals with developmental prosopagnosia (DP) sometimes experience object identification difficulties in addition to problems recognizing faces. To better understand the distribution of non-face object recognition ability in this population, we administered the Cambridge Car Memory Test (CCMT) - a leading, standardized measure of object recognition ability - to a large sample of DPs (N = 46). When considered as a single group, the DPs scored lower than matched controls. This finding provides further evidence that developmental object agnosia (DOA) may be more common in DP than in the general population. Relative to the DPs' face recognition deficits, however, car matching deficits were small and inconsistent. In fact, we observed a striking range of CCMT performance in our DP sample. While some DPs performed extremely poorly, many more achieved scores within one standard deviation of the typical mean, and several DP participants achieved excellent CCMT scores comparable with the best controls.

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.

The hidden identity of faces: a case of lifelong prosopagnosia

BACKGROUND

Not being able to recognize a person's face is a highly debilitating condition from which people with developmental prosopagnosia (DP) suffer their entire life. Here we describe the case of J, a 30 year old woman who reports being unable to recognize her parents, her husband, or herself in the mirror.

CASE PRESENTATION

We set out to assess the severity of J's prosopagnosia using tests with unfamiliar as well as familiar faces and investigated whether impaired configural processing explains her deficit. To assess the specificity of the impairment, we tested J's performance when evaluating emotions, intentions, and the attractiveness and likability of faces. Detailed testing revealed typical brain activity patterns for faces and normal object recognition skills, and no evidence of any brain injury. However, compared to a group of matched controls, J showed severe deficits in learning new faces, and in recognizing familiar faces when only inner features were available. Her recognition of uncropped faces with blurred features was within the normal range, indicating preserved configural processing when peripheral features are available. J was also unimpaired when evaluating intentions and emotions in faces. In line with healthy controls, J rated more average faces as more attractive. However, she was the only one to rate them as less likable, indicating a preference for more distinctive and easier to recognize faces.

CONCLUSIONS

Taken together, the results illustrate both the severity and the specificity of DP in a single case. While DP is a heterogeneous disorder, an inability to integrate the inner features of the face into a whole might be the best explanation for the difficulties many individuals with prosopagnosia experience.

Perception of musical pitch in developmental prosopagnosia

Studies of developmental prosopagnosia have often shown that developmental prosopagnosia differentially affects human face processing over non-face object processing. However, little consideration has been given to whether this condition is associated with perceptual or sensorimotor impairments in other modalities. Comorbidities have played a role in theories of other developmental disorders such as dyslexia, but studies of developmental prosopagnosia have often focused on the nature of the visual recognition impairment despite evidence for widespread neural anomalies that might affect other sensorimotor systems. We studied 12 subjects with developmental prosopagnosia with a battery of auditory tests evaluating pitch and rhythm processing as well as voice perception and recognition. Overall, three subjects were impaired in fine pitch discrimination, a prevalence of 25% that is higher than the estimated 4% prevalence of congenital amusia in the general population. This was a selective deficit, as rhythm perception was unaffected in all 12 subjects. Furthermore, two of the three prosopagnosic subjects who were impaired in pitch discrimination had intact voice perception and recognition, while two of the remaining nine subjects had impaired voice recognition but intact pitch perception. These results indicate that, in some subjects with developmental prosopagnosia, the face recognition deficit is not an isolated impairment but is associated with deficits in other domains, such as auditory perception. These deficits may form part of a broader syndrome which could be due to distributed microstructural anomalies in various brain networks, possibly with a common theme of right hemispheric predominance.

Self-face and self-body advantages in congenital prosopagnosia: evidence for a common mechanism

Prosopagnosia is a disorder leading to difficulties in recognizing faces. However, recent evidence suggests that individuals with congenital prosopagnosia can achieve considerable accuracy when they have to recognize their own faces (self-face advantage). Yet, whether this advantage is face-specific or not is still unclear. Here, we aimed to investigate whether individuals with congenial prosopagnosia show a self-advantage also in recognizing other self body-parts and, if so, whether the advantage for the body parts differs from the one characterizing the self-face. Eight individuals with congenital prosopagnosia and 22 controls underwent a delayed matching task in which they were required to recognize faces, hands and feet belonging to the self or to others. Controls showed a similar self-advantage for all the stimuli tested; by contrast, individuals with congenital prosopagnosia showed a larger self-advantage with faces compared to hands and feet, mainly driven by their deficit with others' faces. In both groups the self-advantages for the different body parts were strongly and significantly correlated. Our data suggest that the self-face advantage showed by individuals with congenital prosopagnosia is not face-specific and that the same mechanism could be responsible for both the self-face and self body-part advantages.

Assessing susceptibility to distraction along the vocal processing hierarchy

Recent models of voice perception propose a hierarchy of steps leading from a more general, “low-level” acoustic analysis of the voice signal to a voice-specific, “higher-level” analysis. We aimed to engage two of these stages: first, a more general detection task in which voices had to be identified amid environmental sounds, and, second, a more voice-specific task requiring a same/different decision about unfamiliar speaker pairs (Bangor Voice Matching Test [BVMT]). We explored how vulnerable voice recognition is to interfering distractor voices, and whether performance on the aforementioned tasks could predict resistance against such interference. In addition, we manipulated the similarity of distractor voices to explore the impact of distractor similarity on recognition accuracy. We found moderate correlations between voice detection ability and resistance to distraction ( r = .44), and BVMT and resistance to distraction ( r = .57). A hierarchical regression revealed both tasks as significant predictors of the ability to tolerate distractors ( R2 = .36). The first stage of the regression (BVMT as sole predictor) already explained 32% of the variance. Descriptively, the “higher-level” BVMT was a better predictor (β = .47) than the more general detection task (β = .25), although further analysis revealed no significant difference between both beta weights. Furthermore, distractor similarity did not affect performance on the distractor task. Overall, our findings suggest the possibility to target specific stages of the voice perception process. This could help explore different stages of voice perception and their contributions to specific auditory abilities, possibly also in forensic and clinical settings.

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.

The Fusiform and Occipital Face Areas Can Process a Nonface Category Equivalently to Faces

The fusiform and occipital face areas (FFA and OFA) are functionally defined brain regions in human ventral occipitotemporal cortex associated with face perception. There is an ongoing debate, however, whether these regions are face-specific or whether they also facilitate the perception of nonface object categories. Here, we present evidence that, under certain conditions, bilateral FFA and OFA respond to a nonface category equivalently to faces. In two fMRI sessions, participants performed same–different judgments on two object categories (faces and chairs). In one session, participants differentiated between distinct exemplars of each category, and in the other session, participants differentiated between exemplars that differed only in the shape or spatial configuration of their features (featural/configural differences). During the latter session, the within-category similarity was comparable for both object categories. When differentiating between distinct exemplars of each category, bilateral FFA and OFA responded more strongly to faces than to chairs. In contrast, during featural/configural difference judgments, bilateral FFA and OFA responded equivalently to both object categories. Importantly, during featural/configural difference judgments, the magnitude of activity within FFA and OFA evoked by the chair task predicted the participants' behavioral performance. In contrast, when participants differentiated between distinct chair exemplars, activity within these face regions did not predict the behavioral performance of the chair task. We conclude that, when the within-category similarity of a face and a nonface category is comparable and when the same cognitive strategies used to process a face are applied to a nonface category, the FFA and OFA respond equivalently to that nonface category and faces.

Developmental prosopagnosics have widespread selectivity reductions across category-selective visual cortex

Developmental prosopagnosia (DP) is a neurodevelopmental disorder characterized by severe deficits with facial identity recognition. It is unclear which cortical areas contribute to face processing deficits in DP, and no previous studies have investigated whether other category-selective areas function normally in DP. To address these issues, we scanned 22 DPs and 27 controls using a dynamic localizer consisting of video clips of faces, scenes, bodies, objects, and scrambled objects. We then analyzed category selectivity, a measure of the tuning of a cortical area to a particular visual category. DPs exhibited reduced face selectivity in all 12 face areas, and the reductions were significant in three posterior and two anterior areas. DPs and controls showed similar responses to faces in other category-selective areas, which suggests the DPs' behavioral deficits with faces result from problems restricted to the face network. DPs also had pronounced scene-selectivity reductions in four of six scene-selective areas and marginal body-selectivity reductions in two of four body-selective areas. Our results demonstrate that DPs have widespread deficits throughout the face network, and they are inconsistent with a leading account of DP which proposes that posterior face-selective areas are normal in DP. The selectivity reductions in other category-selective areas indicate many DPs have deficits spread across high-level visual cortex.

Spatial Mechanisms within the Dorsal Visual Pathway Contribute to the Configural Processing of Faces

Human face recognition is often attributed to configural processing; namely, processing the spatial relationships among the features of a face. If configural processing depends on fine-grained spatial information, do visuospatial mechanisms within the dorsal visual pathway contribute to this process? We explored this question in human adults using functional magnetic resonance imaging and transcranial magnetic stimulation (TMS) in a same-different face detection task. Within localized, spatial-processing regions of the posterior parietal cortex, configural face differences led to significantly stronger activation compared to featural face differences, and the magnitude of this activation correlated with behavioral performance. In addition, detection of configural relative to featural face differences led to significantly stronger functional connectivity between the right FFA and the spatial processing regions of the dorsal stream, whereas detection of featural relative to configural face differences led to stronger functional connectivity between the right FFA and left FFA. Critically, TMS centered on these parietal regions impaired performance on configural but not featural face difference detections. We conclude that spatial mechanisms within the dorsal visual pathway contribute to the configural processing of facial features and, more broadly, that the dorsal stream may contribute to the veridical perception of faces.

Cross-race correlations in the abilities to match unfamiliar faces

The other-race effect in face identification has been documented widely in memory tasks, but it persists also in identity-matching tasks, in which memory contributions are minimized. Whereas this points to a perceptual locus for this effect, it remains unresolved whether matching performance with same- and other-race faces is driven by shared cognitive mechanisms. To examine this question, this study compared Arab and Caucasian observers' ability to match faces of their own race with their ability to match faces of another race using one-to-one (Experiment 1) and one-to-many (Experiment 2) identification tasks. Across both experiments, Arab and Caucasian observers demonstrated reliable other-race effects at a group level. At an individual level, substantial variation in accuracy was found, but performance with same-race and other-race faces correlated consistently and strongly. This indicates that the abilities to match same- and other-race faces share a common cognitive mechanism.

Ensemble coding of face identity is present but weaker in congenital prosopagnosia

Individuals with congenital prosopagnosia (CP) are impaired at identifying individual faces but do not appear to show impairments in extracting the average identity from a group of faces (known as ensemble coding). However, possible deficits in ensemble coding in a previous study (CPs n = 4) may have been masked because CPs relied on pictorial (image) cues rather than identity cues. Here we asked whether a larger sample of CPs (n = 11) would show intact ensemble coding of identity when availability of image cues was minimised. Participants viewed a "set" of four faces and then judged whether a subsequent individual test face, either an exemplar or a "set average", was in the preceding set. Ensemble coding occurred when matching (vs. mismatching) averages were mistakenly endorsed as set members. We assessed both image- and identity-based ensemble coding, by varying whether test faces were either the same or different images of the identities in the set. CPs showed significant ensemble coding in both tasks, indicating that their performance was independent of image cues. As a group, CPs' ensemble coding was weaker than controls in both tasks, consistent with evidence that perceptual processing of face identity is disrupted in CP. This effect was driven by CPs (n= 3) who, in addition to having impaired face memory, also performed particularly poorly on a measure of face perception (CFPT). Future research, using larger samples, should examine whether deficits in ensemble coding may be restricted to CPs who also have substantial face perception deficits.

Delayed processing of global shape information in developmental prosopagnosia

There is accumulating evidence suggesting that a central deficit in developmental prosopagnosia (DP), a disorder characterized by profound and lifelong difficulties with face recognition, concerns impaired holistic processing. Some of this evidence comes from studies using Navon’s paradigm where individuals with DP show a greater local or reduced global bias compared with controls. However, it has not been established what gives rise to this altered processing bias. Is it a reduced global precedence effect, changes in susceptibility to interference effects or both? By analyzing the performance of 10 individuals with DP in Navon’s paradigm we find evidence of a reduced global precedence effect: The DPs are slower than controls to process global but not local shape information. Importantly, and in contrast to previous studies, we demonstrate that the DPs perform normally in a comprehensive test of visual attention, showing normal: visual short-term memory capacity, speed of visual processing, efficiency of top-down selectivity, and allocation of attentional resources. Hence, we conclude that the reduced global precedence effect reflects a perceptual rather than an attentional deficit. We further show that this reduced global precedence effect correlates both with the DPs’ face recognition abilities, as well as their ability to recognize degraded (non-face) objects. We suggest that the DPs’ impaired performance in all three domains (Navon, face and object recognition) may be related to the same dysfunction; delayed derivation of global relative to local shape information.

Congenital prosopagnosia without object agnosia? A literature review

A longstanding controversy concerns the functional organization of high-level vision, and the extent to which the recognition of different classes of visual stimuli engages a single system or multiple independent systems. We examine this in the context of congenital prosopagnosia (CP), a neurodevelopmental disorder in which individuals, without a history of brain damage, are impaired at face recognition. This paper reviews all CP cases from 1976 to 2016, and explores the evidence for the association or dissociation of face and object recognition. Of the 238 CP cases with data permitting a satisfactory evaluation, 80.3% evinced an association between impaired face and object recognition whereas 19.7% evinced a dissociation. We evaluate the strength of the evidence and correlate the face and object recognition behaviour. We consider the implications for theories of functional organization of the visual system, and offer suggestions for further adjudication of the relationship between face and object recognition.

Super-recognition in development: A case study of an adolescent with extraordinary face recognition skills

Face recognition abilities vary widely. While face recognition deficits have been reported in children, it is unclear whether superior face recognition skills can be encountered during development. This paper presents O.B., a 14-year-old female with extraordinary face recognition skills: a "super-recognizer" (SR). O.B. demonstrated exceptional face-processing skills across multiple tasks, with a level of performance that is comparable to adult SRs. Her superior abilities appear to be specific to face identity: She showed an exaggerated face inversion effect and her superior abilities did not extend to object processing or non-identity aspects of face recognition. Finally, an eye-movement task demonstrated that O.B. spent more time than controls examining the nose - a pattern previously reported in adult SRs. O.B. is therefore particularly skilled at extracting and using identity-specific facial cues, indicating that face and object recognition are dissociable during development, and that super recognition can be detected in adolescence.

The value of cognitive neuropsychology: The case of vision research

Cognitive neuropsychological evidence is widely viewed as inherently flawed or weak, despite well-reasoned arguments to the contrary by many theorists. Rather than attempting yet another defence of cognitive neuropsychology on logical grounds, we point out through examples that in practice, cognitive neuropsychological evidence is widely accepted as valid and important, and has had a major impact on cognitive theory and research. Objections offered in the abstract rarely arise in the context of actual studies. We develop these points through examples from the domain of vision, discussing cerebral achromatopsia and akinetopsia, selective impairment and sparing of face recognition, perception-action dissociations, and blindsight.

Robust associations between the 20-item prosopagnosia index and the Cambridge Face Memory Test in the general population

Developmental prosopagnosia (DP) is a neurodevelopmental condition, characterized by lifelong face recognition deficits. Leading research groups diagnose the condition using complementary computer-based tasks and self-report measures. In an attempt to standardize the reporting of self-report evidence, we recently developed the 20-item prosopagnosia index (PI20), a short questionnaire measure of prosopagnosic traits suitable for screening adult samples for DP. Strong correlations between scores on the PI20 and performance on the Cambridge Face Memory Test (CFMT) appeared to confirm that individuals possess sufficient insight into their face recognition ability to complete a self-report measure of prosopagnosic traits. However, the extent to which people have insight into their face recognition abilities remains contentious. A lingering concern is that feedback from formal testing, received prior to administration of the PI20, may have augmented the self-insight of some respondents in the original validation study. To determine whether the significant correlation with the CFMT was an artefact of previously delivered feedback, we sought to replicate the validation study in individuals with no history of formal testing. We report highly significant correlations in two independent samples drawn from the general population, confirming: (i) that a significant relationship exists between PI20 scores and performance on the CFMT, and (ii) that this is not dependent on the inclusion of individuals who have previously received feedback. These findings support the view that people have sufficient insight into their face recognition abilities to complete a self-report measure of prosopagnosic traits.