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

Prosopagnosia in the context of right handedness, left hemisphere perinatal stroke, epileptogenic cyst, and focal epilepsy: A pre-surgical case report

Prosopagnosia, a neurological condition affecting perception and differentiation of faces, is categorized as either acquired or developmental (present since birth). Acquired cases of prosopagnosia are usually caused by right hemisphere or bilateral damage. We present a right-handed 17-year-old male with a history of focal epilepsy and a new diagnosis of prosopagnosia due to a perinatal stroke affecting the left lingual gyrus, a structure in close proximity to the fusiform face area. In addition to showing that early acquired cases of prosopagnosia may go unrecognized, this case shows that left hemisphere lesions may also affect facial recognition. It is important to screen for prosopagnosia via comprehensive neuropsychological evaluation in patients with lesions proximal to the fusiform face area.

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.

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.

Novel approaches to functional lateralization: Assessing information in activity patterns across hemispheres and more accurately identifying structural homologues

Functional lateralization is typically measured by comparing activation levels across the right and left hemispheres of the brain. Significant additional information, however, exists within distributed multi-voxel patterns of activity - a format not detectable by traditional activation-based analysis of functional magnetic resonance imaging (fMRI) data. We introduce and test two methods -one anatomical, one functional- that allow hemispheric information asymmetries to be detected. We first introduce and apply a novel tool that draws on brain 'surface fingerprints' to pair every location in one hemisphere with its hemispheric homologue. We use anatomical data to show that this approach is more accurate than the common distance-from-midline method for comparing bilateral regions. Next, we introduce a complementary analysis method that quantifies multivariate laterality in functional data. This new 'multivariate Laterality Index' (mLI) reflects both quantitative and qualitative information-differences across homologous activity patterns. We apply the technique here to functional data collected as participants viewed faces and non-faces. Using the previously generated surface fingerprints to pair-up homologous searchlights in each hemisphere, we use the novel multivariate laterality technique to identify face-information asymmetries across right and left counterparts of the fusiform gyrus, inferior temporal gyrus, superior parietal lobule, and early visual areas. The typical location of the fusiform face area has greater information asymmetry for faces than for shapes. More generally, we argue that the field should consider an information-based approach to lateralization.

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.

What is the prevalence of developmental prosopagnosia? An empirical assessment of different diagnostic cutoffs

The prevalence of developmental prosopagnosia (DP), lifelong face recognition deficits, is widely reported to be 2-2.5%. However, DP has been diagnosed in different ways across studies, resulting in differing prevalence rates. In the current investigation, we estimated the range of DP prevalence by administering well-validated objective and subjective face recognition measures to an unselected web-based sample of 3116 18-55 year-olds and applying DP diagnostic cutoffs from the last 14 years. We found estimated prevalence rates ranged from .64-5.42% when using a z-score approach and .13-2.95% when using a percentile approach, with the most commonly used cutoffs by researchers having a prevalence rate of .93% (z-score, .45% when using percentiles). We next used multiple cluster analyses to examine whether there was a natural grouping of poorer face recognizers but failed to find consistent grouping beyond those with generally above versus below average face recognition. Lastly, we investigated whether DP studies with more relaxed diagnostic cutoffs were associated with better performance on the Cambridge Face Perception Test. In a sample of 43 studies, there was a weak nonsignificant association between greater diagnostic strictness and better DP face perception accuracy (Kendall's tau-b correlation, τb =.18 z-score; τb = .11 percentiles). Together, these results suggest that researchers have used more conservative DP diagnostic cutoffs than the widely reported 2-2.5% prevalence. We discuss the strengths and weaknesses of using more inclusive cutoffs, such as identifying mild and major forms of DP based on DSM-5.

Lateralization of word and face processing in developmental dyslexia and developmental prosopagnosia

In right-handed adults, face processing is lateralized to the right hemisphere and visual word processing to the left hemisphere. According to the many-to-many account (MTMA) of functional cerebral organization this lateralization pattern is partly dependent on the acquisition of literacy. Hence, the MTMA predicts that: (i) processing of both words and faces should show no or at least less lateralization in individuals with developmental dyslexia compared with controls, and (ii) lateralization in word processing should be normal in individuals with developmental prosopagnosia whereas lateralization in face processing should be absent. To test these hypotheses, 21 right-handed adults with developmental dyslexia and 21 right-handed adults with developmental prosopagnosia performed a divided visual field paradigm with delayed matching of faces, words and cars. Contrary to the predictions, we find that lateralization effects in face processing are within the normal range for both developmental dyslexics and prosopagnosics. Moreover, the group with developmental dyslexia showed right hemisphere lateralization for word processing. We argue that these findings are incompatible with the specific predictions of the MTMA.

Is It Just Face Blindness? Exploring Developmental Comorbidity in Individuals with Self-Reported Developmental Prosopagnosia

Developmental prosopagnosia (DP)—or ‘face blindness’—refers to life-long problems with facial recognition in the absence of brain injury. We know that neurodevelopmental disorders tend to co-occur, and this study aims to explore if individuals with self-reported DP also report indications of other neurodevelopmental disorders, deficits, or conditions (developmental comorbidity). In total, 115 individuals with self-reported DP participated in this online cross-sectional survey. Face recognition impairment was measured with a validated self-report instrument. Indications of difficulties with navigation, math, reading, or spelling were measured with a tailored questionnaire using items from published sources. Additional diagnoses were measured with direct questions. We also included open-ended questions about cognitive strengths and difficulties. Results: Overall, 57% reported at minimum one developmental comorbidity of interest, with most reflecting specific cognitive impairment (e.g., in memory or object recognition) rather than diagnostic categories (e.g., ADHD, dyslexia). Interestingly, many participants reported cognitive skills or strengths within the same domains that others reported impairment, indicating a diverse pattern of cognitive strengths and difficulties in this sample. The frequency and diversity of self-reported developmental comorbidity suggests that face recognition could be important to consider in future investigations of neurodevelopmental comorbidity patterns.

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.

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 Architect Who Lost the Ability to Imagine: The Cerebral Basis of Visual Imagery

While the loss of mental imagery following brain lesions was first described more than a century ago, the key cerebral areas involved remain elusive. Here we report neuropsychological data from an architect (PL518) who lost his ability for visual imagery following a bilateral posterior cerebral artery (PCA) stroke. We compare his profile to three other patients with bilateral PCA stroke and another architect with a large PCA lesion confined to the right hemisphere. We also compare structural images of their lesions, aiming to delineate cerebral areas selectively lesioned in acquired aphantasia. When comparing the neuropsychological profile and structural magnetic resonance imaging (MRI) for the aphantasic architect PL518 to patients with either a comparable background (an architect) or bilateral PCA lesions, we find: (1) there is a large overlap of cognitive deficits between patients, with the very notable exception of aphantasia which only occurs in PL518, and (2) there is large overlap of the patients' lesions. The only areas of selective lesion in PL518 is a small patch in the left fusiform gyrus as well as part of the right lingual gyrus. We suggest that these areas, and perhaps in particular the region in the left fusiform gyrus, play an important role in the cerebral network involved in visual imagery.