Are faces special? A case of pure prosopagnosia

Visual self-face and self-body recognition in a left-brain-damaged prosopagnosic patient

The present case study describes the patient N.G., who reported prosopagnosia along with difficulty in recognising herself in the mirror following a left-sided temporo-occipital hemispheric stroke. The neuropsychological and experimental investigation revealed only a mild form of apperceptive prosopagnosia, without visual agnosia, primarily caused by an impaired visual processing of face-parts and body parts but not of full faces. Emotional expressions did not modulate her face processing. On the other hand, N.G. showed a marked impairment of visual self-recognition, as assessed with visual matching-to-sample tasks, both at the level of body-part and face-part processing and at a full-face level, featured by a deficit in the perceptual discrimination of her own face and body, as compared to the others' face and body. N.G.'s lesion mapping showed damage to the left inferior occipito-temporal cortex, affecting the inferior occipital gyrus and compromising long-range connections between the occipital/temporo-occipital areas and the anterior fronto-temporal areas. Overall, the present case report documents that visual processing of the person's own face may be selectively compromised by a left-sided hemispheric lesion disconnecting extra-striate body- and face-selective visual areas to self-representation regions. Moreover, others' (full) face processing may be preserved, as compared with the impaired ability to discriminate others' body and face parts.

The neuropsychological evaluation of face identity recognition

Facial identity recognition (FIR) is arguably the ultimate form of recognition for the adult human brain. Even if the term prosopagnosia is reserved for exceptionally rare brain-damaged cases with a category-specific abrupt loss of FIR at adulthood, subjective and objective impairments or difficulties of FIR are common in the neuropsychological population. Here we provide a critical overview of the evaluation of FIR both for clinicians and researchers in neuropsychology. FIR impairments occur following many causes that should be identified objectively by both general and specific, behavioral and neural examinations. We refute the commonly used dissociation between perceptual and memory deficits/tests for FIR, since even a task involving the discrimination of unfamiliar face images presented side-by-side relies on cortical memories of faces in the right-lateralized ventral occipito-temporal cortex. Another frequently encountered confusion is between specific deficits of the FIR function and a more general impairment of semantic memory (of people), the latter being most often encountered following anterior temporal lobe damage. Many computerized tests aimed at evaluating FIR have appeared over the last two decades, as reviewed here. However, despite undeniable strengths, they often suffer from ecological limitations, difficulties of instruction, as well as a lack of consideration for processing speed and qualitative information. Taking into account these issues, a recently developed behavioral test with natural images manipulating face familiarity, stimulus inversion, and correct response times as a key variable appears promising. The measurement of electroencephalographic (EEG) activity in the frequency domain from fast periodic visual stimulation also appears as a particularly promising tool to complete and enhance the neuropsychological assessment of FIR.

Can face recognition be selectively preserved in some cases of amnesia? A cautionary tale

Evidence suggests that some patients with isolated hippocampal damage appear to present with selective preservation of unfamiliar face recognition relative to other kinds of visual test stimuli (e.g., words). Bird and Burgess (2008) formulated a review and secondary analysis of a group of 10 cases all tested on a clinical assessment of word and face recognition memory (RMT, Warrington, 1984), which confirmed the key memory dissociation at the group level. The current work provides an updated secondary analysis of such cases with a larger published sample (N = 52). In addition to group-level analyses, we also re-evaluate evidence using a single case statistical approach (Crawford & Garthwaite, 2005), enabling us to determine how many would make criteria for a 'classical dissociation' (Crawford, Garthwaite, & Gray, 2003). Overall, group-level analyses indicated the key pattern of significant differences confined to words was limited to small control sample comparisons. When using the large control sample provided by Bird and Burgess (2008), hippocampal cases as a group were significantly poorer for both classes of items. Furthermore, our single-case approach indicated few had a performance pattern of a relative difference across face > word categories that would meet statistical significance; namely within individual differences across categories that would warrant a significant 'classical dissociation'. Moreover, these analyses also found several cases with a 'classical dissociation' in the reverse direction: namely preserved recognition of words. Such analyses serve to demonstrate the need for a more conservative statistical approach to be undertaken when reporting selective 'preservation' of a category in recognition memory. Whilst material specificity has important implications for understanding the role of the hippocampus in memory, our results highlight the need for statistical methods to be unquestionably rigorous before any claims are made. Lastly, we highlight other methodological issues critical to group analyses and make suggestions for future work.

Twenty years of investigation with the case of prosopagnosia PS to understand human face identity recognition. Part II: Neural basis

Patient PS sustained her dramatic brain injury in 1992, the same year as the first report of a neuroimaging study of human face recognition. The present paper complements the review on the functional nature of PS's prosopagnosia (part I), illustrating how her case study directly, i.e., through neuroimaging investigations of her brain structure and activity, but also indirectly, through neural studies performed on other clinical cases and neurotypical individuals, inspired and constrained neural models of human face recognition. In the dominant right hemisphere for face recognition in humans, PS's main lesion concerns (inputs to) the inferior occipital gyrus (IOG), in a region where face-selective activity is typically found in normal individuals ('Occipital Face Area', OFA). Her case study initially supported the criticality of this region for face identity recognition (FIR) and provided the impetus for transcranial magnetic stimulation (TMS), intracerebral electrical stimulation, and cortical surgery studies that have generally supported this view. Despite PS's right IOG lesion, typical face-selectivity is found anteriorly in the middle portion of the fusiform gyrus, a hominoid structure (termed the right 'Fusiform Face Area', FFA) that is widely considered to be the most important region for human face recognition. This finding led to the original proposal of direct anatomico-functional connections from early visual cortices to the FFA, bypassing the IOG/OFA (lulu), a hypothesis supported by further neuroimaging studies of PS, other neurological cases and neuro-typical individuals with original visual stimulation paradigms, data recordings and analyses. The proposal of a lack of sensitivity to face identity in PS's right FFA due to defective reentrant inputs from the IOG/FFA has also been supported by other cases, functional connectivity and cortical surgery studies. Overall, neural studies of, and based on, the case of prosopagnosia PS strongly question the hierarchical organization of the human neural face recognition system, supporting a more flexible and dynamic view of this key social brain function.

Inversion Reduces Sensitivity to Complex Emotions in Eye Regions

Inferring humans’ complex emotions is challenging but can be done with surprisingly limited emotion signals, including merely the eyes alone. Here, we test for a role of lower-level perceptual processes involved in such sensitivity using the well-validated Reading the Mind in the Eyes task. Over three experiments, we manipulated configural processing to show that it contributes to sensitivity to complex emotion from human eye regions. Specifically, inversion, a well-established manipulation affecting configural processing, undermined sensitivity to complex emotions in eye regions (Experiments 1-3). Inversion extended to undermine sensitivity to nonmentalistic information from human eye regions (gender; Experiment 2) but did not extend to affect sensitivity to attributes of nonhuman animals (Experiment 3). Taken together, the current findings provide evidence for the novel hypothesis that configural processing facilitates sensitivity to complex emotions conveyed by the eyes via the broader extraction of socially relevant information.

Acquired Prosopagnosia with Structurally Intact and Functional Fusiform Face Area and with Face Identity-Specific Configuration Processing Deficits

Prosopagnosia or loss of face perception and recognition is still poorly understood and rare single cases of acquired prosopagnosia can provide a unique window on the behavioural and brain basis of normal face perception. The present study of a new case of acquired prosopagnosia with bilateral occipito-temporal lesions but a structurally intact FFA and OFA investigated whether the lesion overlapped with the face network and whether the structurally intact FFA showed a face selective response. We also investigated the behavioral correlates of the neural findings and assessed configural processing in the context of facial and non-facial identity recognition, expression recognition and memory, also focusing on the face-selectivity of each specific deficit. The findings reveal a face-selective response in the FFA, despite lesions in the face perception network. At the behavioural level, the results showed impaired configural processing for facial identity, but not for other stimulus categories and not for facial expression recognition. These findings challenge a critical role of the FFA for face identity processing and support a domain-specific account of configural processing.

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.

Intermediate, Wholistic Shape Representation in Object Recognition: A Pre-Attentive Stage of Processing?

Evidence is presented for intermediate, wholistic visual representations of objects and non-objects that are computed online and independent of visual attention. Short-term visual priming was examined between visually similar shapes, with targets either falling at the (valid) location cued by primes or at another (invalid) location. Object decision latencies were facilitated when the overall shapes of the stimuli were similar irrespective of whether the location of the prime was valid or invalid, with the effects being equally large for object and non-object targets. In addition, the effects were based on the overall outlines of the stimuli and low spatial frequency components, not on local parts. In conclusion, wholistic shape representations based on outline form, are rapidly computed online during object recognition. Moreover, activation of common wholistic shape representations prime the processing of subsequent objects and non-objects irrespective of whether they appear at attended or unattended locations. Rapid derivation of wholistic form provides a key intermediate stage of object recognition.

Complementary deficits in perceptual classification in pure alexia and acquired prosopagnosia - New insights from two classic cases

Pure alexia and prosopagnosia traditionally have been seen as prime examples of dissociated, category-specific agnosias affecting reading and face recognition, respectively. More recent accounts have moved towards domain-independent explanations that postulate potential cross-links between different types of visual agnosia. According to one proposal, abnormal crowding, i.e. the impairment of recognition when features of adjacent objects are positioned too closely to each other, might provide a unified account for the perceptual deficits experienced by an agnosic patient. An alternative approach is based on the notion of complementary visual subsystems favouring the processing of abstract categories and specific exemplars, respectively. To test predictions of these two approaches with regard to pure alexia and prosopagnosia, we present previously unpublished data on digit recognition and visual crowding from two in the neuropsychological literature extensively studied patients, KD and MT (e.g., Campbell et al., 1986; Landis and Regard, 1988; Rentschler et al., 1994). Patient MT, diagnosed with pure alexia, showed pronounced abnormal foveal crowding, whereas KD, diagnosed with prosopagnosia, did not. These results form a distinct double dissociation with the performance of the two patients in other perceptual classification tasks involving Gabor micropatterns and textures, as well as Glass patterns, which revealed a significantly greater impairment in KD relative to MT. Based on an analysis of the specific task demands we argue that prosopagnosia and pure alexia may involve complementary deficits in instantiation and abstraction, respectively, during perceptual classification, beyond any category specificity. Such an explanation appears in line with previous distinctions between a predominantly left-hemispheric, abstract-category and a predominantly right-hemispheric, specific-exemplar subsystem underlying object recognition.

Prosopagnosia and disorders of face processing

Face recognition is a form of expert visual processing. Acquired prosopagnosia is the loss of familiarity for facial identity and has several functional variants, namely apperceptive, amnestic, and associative forms. Acquired forms are usually caused by either occipitotemporal or anterior temporal lesions, right or bilateral in most cases. In addition, there is a developmental form, whose functional and structural origins are still being elucidated. Despite their difficulties with recognizing faces, some of these subjects still show signs of covert recognition, which may have a number of explanations. Other aspects of face perception can be spared in prosopagnosic subjects. Patients with other types of face processing difficulties have been described, including impaired expression processing, impaired lip-reading, false familiarity for faces, and a people-specific amnesia. Recent rehabilitative studies have shown some modest ability to improve face perception in prosopagnosic subjects through perceptual training protocols.

The Effect of Perceptual Learning on Face Recognition in Individuals with Central Vision Loss

Purpose

To examine whether perceptual learning can improve face discrimination and recognition in older adults with central vision loss.

Methods

Ten participants with age-related macular degeneration (ARMD) received 5 days of training on a face discrimination task (mean age, 78 ± 10 years). We measured the magnitude of improvements (i.e., a reduction in threshold size at which faces were able to be discriminated) and whether they generalized to an untrained face recognition task. Measurements of visual acuity, fixation stability, and preferred retinal locus were taken before and after training to contextualize learning-related effects. The performance of the ARMD training group was compared to nine untrained age-matched controls (8 = ARMD, 1 = juvenile macular degeneration; mean age, 77 ± 10 years).

Results

Perceptual learning on the face discrimination task reduced the threshold size for face discrimination performance in the trained group, with a mean change (SD) of –32.7% (+15.9%). The threshold for performance on the face recognition task was also reduced, with a mean change (SD) of –22.4% (+2.31%). These changes were independent of changes in visual acuity, fixation stability, or preferred retinal locus. Untrained participants showed no statistically significant reduction in threshold size for face discrimination, with a mean change (SD) of –8.3% (+10.1%), or face recognition, with a mean change (SD) of +2.36% (–5.12%).

Conclusions

This study shows that face discrimination and recognition can be reliably improved in ARMD using perceptual learning. The benefits point to considerable perceptual plasticity in higher-level cortical areas involved in face-processing. This novel finding highlights that a key visual difficulty in those suffering from ARMD is readily amenable to rehabilitation.

Atypical holistic processing of facial identity and expression in a case of acquired prosopagnosia

Typical face perception is mediated by holistic processing (i.e., the simultaneous integration of face parts into a whole representation). People with Acquired Prosopagnosia (AP), who have lost the ability to recognise faces after a brain lesion, should thus show atypical holistic coding. Our aim is to use the composite-face effect (CFE) as a measure of holistic processing in ST, a 48-year-old woman with AP but normal recognition of facial expressions of emotions, and matched healthy control participants. Two experiments examining the CFE for identity (Experiment 1) and for expression of emotions (Experiment 2) were conducted. Contrary to controls, in both experiments, ST showed an atypical (i.e., reversed) CFE, thus suggesting altered holistic mechanisms affecting both components of perceptual judgement. Results also suggest that normal facial expression recognition is achievable even with holistic processing difficulties, possibly through compensatory, part-based, mechanisms.

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.

Over time, the right results will emerge

Scientific research involves going beyond the well-trodden and well-tested ideas and theories that form the core of scientific knowledge. During the time scientists are working things out, some results will be right, and others will be wrong. Over time, the right results will emerge. Lisa Randall (Frank B. Baird, Jr. Professor of Science, Physics Department, Harvard University) We are grateful to all the commentators for the important and thoughtful comments raised in response to the Geskin and Behrmann (G & B) literature survey. The issues raised in the introduction to this Special Issue and in these commentaries not only address and challenge aspects of the G & B literature review, but contribute perspectives and extensions that go well beyond the scope of the review. As is evident from G & B and from the 13 commentaries, many aspects of congenital prosopagnosia (CP) remain controversial. Adopting the language of the quote above, the intention of the G & B survey, along with the commentaries and this response, is to establish a collaborative process from which the right results (and right theory) will emerge in time. We are grateful to the editor of this Special Issue, Dr. Brad Mahon, for his support and for facilitating this collaborative exchange in Cognitive Neuropsychology.

How many faces do people know?

Over our species history, humans have typically lived in small groups of under a hundred individuals. However, our face recognition abilities appear to equip us to recognize very many individuals, perhaps thousands. Modern society provides access to huge numbers of faces, but no one has established how many faces people actually know. Here, we describe a method for estimating this number. By combining separate measures of recall and recognition, we show that people know about 5000 faces on average and that individual differences are large. Our findings offer a possible explanation for large variation in identification performance. They also provide constraints on understanding the qualitative differences between perception of familiar and unfamiliar faces-a distinction that underlies all current theories of face recognition.

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.

Faces, people and the brain: The 45th Sir Frederic Bartlett Lecture

The fact that the face is a source of diverse social signals allows us to use face and person perception as a model system for asking important psychological questions about how our brains are organised. A key issue concerns whether we rely primarily on some form of generic representation of the common physical source of these social signals (the face) to interpret them, or instead create multiple representations by assigning different aspects of the task to different specialist components. Variants of the specialist components hypothesis have formed the dominant theoretical perspective on face perception for more than three decades, but despite this dominance of formally and informally expressed theories, the underlying principles and extent of any division of labour remain uncertain. Here, I discuss three important sources of constraint: first, the evolved structure of the brain; second, the need to optimise responses to different everyday tasks; and third, the statistical structure of faces in the perceiver's environment. I show how these constraints interact to determine the underlying functional organisation of face and person perception.

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.

Face and Word Recognition Can Be Selectively Affected by Brain Injury or Developmental Disorders

Face and word recognition have traditionally been thought to rely on highly specialised and relatively independent cognitive processes. Some of the strongest evidence for this has come from patients with seemingly category-specific visual perceptual deficits such as pure prosopagnosia, a selective face recognition deficit, and pure alexia, a selective word recognition deficit. Together, the patterns of impaired reading with preserved face recognition and impaired face recognition with preserved reading constitute a double dissociation. The existence of these selective deficits has been questioned over the past decade. It has been suggested that studies describing patients with these pure deficits have failed to measure the supposedly preserved functions using sensitive enough measures, and that if tested using sensitive measurements, all patients with deficits in one visual category would also have deficits in the other. The implications of this would be immense, with most textbooks in cognitive neuropsychology requiring drastic revisions. In order to evaluate the evidence for dissociations, we review studies that specifically investigate whether face or word recognition can be selectively affected by acquired brain injury or developmental disorders. We only include studies published since 2004, as comprehensive reviews of earlier studies are available. Most of the studies assess the supposedly preserved functions using sensitive measurements. We found convincing evidence that reading can be preserved in acquired and developmental prosopagnosia and also evidence (though weaker) that face recognition can be preserved in acquired or developmental dyslexia, suggesting that face and word recognition are at least in part supported by independent processes.

Face Context Influences Local Part Processing: An ERP Study

Perception of face parts on the basis of features is thought to be different from perception of whole faces, which is more based on configural information. Face context is also suggested to play an important role in face processing. To investigate how face context influences the early-stage perception of facial local parts, we used an oddball paradigm that tested perceptual stages of face processing rather than recognition. We recorded the event-related potentials (ERPs) elicited by whole faces and face parts presented in four conditions (upright-normal, upright-thatcherised, inverted-normal and inverted-thatcherised), as well as the ERPs elicited by non-face objects (whole houses and house parts) with corresponding conditions. The results showed that face context significantly affected the N170 with increased amplitudes and earlier peak latency for upright normal faces. Removing face context delayed the P1 latency but did not affect the P1 amplitude prominently for both upright and inverted normal faces. Across all conditions, neither the N170 nor the P1 was modulated by house context. The significant changes on the N170 and P1 components revealed that face context influences local part processing at the early stage of face processing and this context effect might be specific for face perception. We further suggested that perceptions of whole faces and face parts are functionally distinguished.

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.

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.

The man who mistook his neuropsychologist for a popstar: when configural processing fails in acquired prosopagnosia

We report the case of an individual with acquired prosopagnosia who experiences extreme difficulties in recognizing familiar faces in everyday life despite excellent object recognition skills. Formal testing indicates that he is also severely impaired at remembering pre-experimentally unfamiliar faces and that he takes an extremely long time to identify famous faces and to match unfamiliar faces. Nevertheless, he performs as accurately and quickly as controls at identifying inverted familiar and unfamiliar faces and can recognize famous faces from their external features. He also performs as accurately as controls at recognizing famous faces when fracturing conceals the configural information in the face. He shows evidence of impaired global processing but normal local processing of Navon figures. This case appears to reflect the clearest example yet of an acquired prosopagnosic patient whose familiar face recognition deficit is caused by a severe configural processing deficit in the absence of any problems in featural processing. These preserved featural skills together with apparently intact visual imagery for faces allow him to identify a surprisingly large number of famous faces when unlimited time is available. The theoretical implications of this pattern of performance for understanding the nature of acquired prosopagnosia are discussed.

The independence of expression and identity in face-processing: evidence from neuropsychological case studies

The processing of facial identity and facial expression have traditionally been seen as independent—a hypothesis that has largely been informed by a key double dissociation between neurological patients with a deficit in facial identity recognition but not facial expression recognition, and those with the reverse pattern of impairment. The independence hypothesis is also reflected in more recent anatomical models of face-processing, although these theories permit some interaction between the two processes. Given that much of the traditional patient-based evidence has been criticized, a review of more recent case reports that are accompanied by neuroimaging data is timely. Further, the performance of individuals with developmental face-processing deficits has recently been considered with regard to the independence debate. This paper reviews evidence from both acquired and developmental disorders, identifying methodological and theoretical strengths and caveats in these reports, and highlighting pertinent avenues for future research.

Neural decoding reveals impaired face configural processing in the right fusiform face area of individuals with developmental prosopagnosia

Most of human daily social interactions rely on the ability to successfully recognize faces. Yet ∼2% of the human population suffers from face blindness without any acquired brain damage [this is also known as developmental prosopagnosia (DP) or congenital prosopagnosia]). Despite the presence of severe behavioral face recognition deficits, surprisingly, a majority of DP individuals exhibit normal face selectivity in the right fusiform face area (FFA), a key brain region involved in face configural processing. This finding, together with evidence showing impairments downstream from the right FFA in DP individuals, has led some to argue that perhaps the right FFA is largely intact in DP individuals. Using fMRI multivoxel pattern analysis, here we report the discovery of a neural impairment in the right FFA of DP individuals that may play a critical role in mediating their face-processing deficits. In seven individuals with DP, we discovered that, despite the right FFA's preference for faces and it showing decoding for the different face parts, it exhibited impaired face configural decoding and did not contain distinct neural response patterns for the intact and the scrambled face configurations. This abnormality was not present throughout the ventral visual cortex, as normal neural decoding was found in an adjacent object-processing region. To our knowledge, this is the first direct neural evidence showing impaired face configural processing in the right FFA in individuals with DP. The discovery of this neural impairment provides a new clue to our understanding of the neural basis of DP.

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

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

The processing of facial identity and expression is interactive, but dependent on task and experience

Facial identity and emotional expression are two important sources of information for daily social interaction. However the link between these two aspects of face processing has been the focus of an unresolved debate for the past three decades. Three views have been advocated: (1) separate and parallel processing of identity and emotional expression signals derived from faces; (2) asymmetric processing with the computation of emotion in faces depending on facial identity coding but not vice versa; and (3) integrated processing of facial identity and emotion. We present studies with healthy participants that primarily apply methods from mathematical psychology, formally testing the relations between the processing of facial identity and emotion. Specifically, we focused on the "Garner" paradigm, the composite face effect and the divided attention tasks. We further ask whether the architecture of face-related processes is fixed or flexible and whether (and how) it can be shaped by experience. We conclude that formal methods of testing the relations between processes show that the processing of facial identity and expressions interact, and hence are not fully independent. We further demonstrate that the architecture of the relations depends on experience; where experience leads to higher degree of inter-dependence in the processing of identity and expressions. We propose that this change occurs as integrative processes are more efficient than parallel. Finally, we argue that the dynamic aspects of face processing need to be incorporated into theories in this field.

Prosopagnosia after stroke: potentials for impairment and treatment

The ability to recognize and identify people and determine how they may be feeling from looking at their faces is an important skill that people normally achieve effortlessly in infancy. Effective face recognition skills remain essential for social competence throughout the life course. A major cause of impairment in face processing, conventionally known as prosopagnosia, is stroke. In this article, the potentials for acquired prosopagnosia after stroke are examined. The incidence of prosopagnosia after stroke is difficult to establish, but in one clinical sample about half of those who survived a right hemisphere stroke had prosopagnosia. The recently published National Clinical Guideline for Stroke 2012 omits reference to assessment for prosopagnosia, which suggests that the personal distress and negative impact on social life that can accompany prosopagnosia is not fully appreciated or at least not considered a priority after stroke. The few published cases where there has been a focused attempt to provide rehabilitation for chronic prosopagnosia suggest that lesions in face-processing areas are resistant to treatment but that some recovery can accompany extended practice. It is concluded that where there is evidence of prosopagnosia following stroke, treatment should be offered, although rehabilitation may be better focused on supporting and extending existing compensatory strategies, such as the use of voice, body shape, and gait to assist in person recognition and, as an important consequence, social functioning.

Are patients with schizophrenia impaired in processing non-emotional features of human faces?

It is known that individuals with schizophrenia exhibit signs of impaired face processing, however, the exact perceptual and cognitive mechanisms underlying these deficits are yet to be elucidated. One possible source of confusion in the current literature is the methodological and conceptual inconsistencies that can arise from the varied treatment of different aspects of face processing relating to emotional and non-emotional aspects of face perception. This review aims to disentangle the literature by focusing on the performance of patients with schizophrenia in a range of tasks that required processing of non-emotional features of face stimuli (e.g., identity or gender). We also consider the performance of patients on non-face stimuli that share common elements such as familiarity (e.g., cars) and social relevance (e.g., gait). We conclude by exploring whether observed deficits are best considered as “face-specific” and note that further investigation is required to properly assess the potential contribution of more generalized attentional or perceptual impairments.

Face perception is category-specific: evidence from normal body perception in acquired prosopagnosia

Does the human visual system contain perceptual mechanisms specialized for particular object categories such as faces? This question lies at the heart of a long-running debate in face perception. The face-specific hypothesis posits that face perception relies on mechanisms dedicated to faces, while the expertise hypothesis proposes that faces are processed by more generic mechanisms that operate on objects we have extended experience with. Previous studies that have addressed this question using acquired prosopagnosia are inconclusive because the non-face categories tested (e.g., cars) were not well-matched to faces in terms of visual exposure and perceptual experience. Here we compare perception of faces and bodies in four acquired prosopagnosics. Critically, we used face and body tasks that generate comparable inversion effects in controls, which indicates that our tasks engage orientation-specific perceptual mechanisms for faces and bodies to a similar extent. Three prosopagnosics were able to discriminate bodies normally despite their impairment in face perception. Moreover, they exhibited normal inversion effects for bodies, suggesting their body perception was carried out by the same mechanisms used by controls. Our findings indicate that the human visual system contains processes specialized for faces.

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

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

Investigating the features of the m170 in congenital prosopagnosia

Face perception generates specific neural activity as early as 170 ms post-stimulus onset, termed the M170 when measured with Magnetoencephalography (MEG). We examined the M170 in six people with congenital prosopagnosia (CP) and 11 typical controls. Previous research indicates that there are two neural generators for the M170 (one within the right lateral occipital area - rLO and one within the right fusiform gyrus - rFG), and in the current study we explored whether these sources reflect the processing of different types of information. Individuals with CP showed face-selective M170 responses within the rLO and right rFG, which did not differ in magnitude to those of the controls. To examine possible links between neural activity and behavior we correlated the CPs' MEG activity generated within rLO and rFG with their face perception skills. The rLO-M170 correlated with holistic/configural face processing, whereas the rFG-M170 correlated with featural processing. Hence, the results of our study demonstrate that individuals with CP can show an M170 that is within the normal range, and that the M170 in the rLO and rFG are involved in different aspects of face processing.