Prosopagnosia: current perspectives

Face pareidolia minimally engages macaque face selective neurons

The macaque cerebral cortex contains concentrations of neurons that prefer faces over inanimate objects. Although these so-called face patches are thought to be specialized for the analysis of facial signals, their exact tuning properties remain unclear. For example, what happens when an object by chance resembles a face? Everyday objects can sometimes, through the accidental positioning of their internal components, appear as faces. This phenomenon is known as face pareidolia. Behavioral experiments have suggested that macaques, like humans, perceive illusory faces in such objects. However, it is an open question whether such stimuli would naturally stimulate neurons residing in cortical face patches. To address this question, we recorded single unit activity from four fMRI-defined face-selective regions: the anterior medial (AM), anterior fundus (AF), prefrontal orbital (PO), and perirhinal cortex (PRh) face patches. We compared neural responses elicited by images of real macaque faces, pareidolia-evoking objects, and matched control objects. Contrary to expectations, we found no evidence of a general preference for pareidolia-evoking objects over control objects. Although a subset of neurons exhibited stronger responses to pareidolia-evoking objects, the population responses to both categories of objects were similar, and collectively much less than to real macaque faces. These results suggest that neural responses in the four regions we tested are principally concerned with the analysis of realistic facial characteristics, whereas the special attention afforded to face-like pareidolia stimuli is supported by activity elsewhere in the brain.

A novel, rapid, quantitative method for face discrimination

Face discrimination ability has been widely studied in psychology, however a self-administered, adaptive method has not yet been developed. In this series of studies, we utilize Foraging Interactive D-prime (FInD) in conjunction with the Basel Face Model to quantify thresholds of face discrimination ability both in-lab and remotely. In Experiment 1, we measured sensitivity to changes for all 199 structural Principal Components of the Basel Face Model and found observers were most sensitive to the first 10 components, so we focused on these for the remaining studies. In Experiment 2, we remotely investigated how thresholds varied when one component changed, compared to when two components changed in combination. Thresholds measured remotely were not significantly different from those measured in-lab (t(14) = 0.23, p = .821), and thresholds were significantly lower for components in combination than alone (t(7) = 2.90, p = .023), consistent with probability summation and Euclidean distance between faces, but not superadditivity. In Experiment 3, we replicated Experiment 2 with slight rotation to the faces to prevent pointwise comparisons. Thresholds were higher with rotation (t(30) = 4.32, p < .001) and for single than combined components, but did not reach significance (t(7) = 2.24, p = .061). Charts were measured in approximately 25.90 ± 8.10 seconds.

Distributed network flows generate localized category selectivity in human visual cortex

A central goal of neuroscience is to understand how function-relevant brain activations are generated. Here we test the hypothesis that function-relevant brain activations are generated primarily by distributed network flows. We focused on visual processing in human cortex, given the long-standing literature supporting the functional relevance of brain activations in visual cortex regions exhibiting visual category selectivity. We began by using fMRI data from N = 352 human participants to identify category-specific responses in visual cortex for images of faces, places, body parts, and tools. We then systematically tested the hypothesis that distributed network flows can generate these localized visual category selective responses. This was accomplished using a recently developed approach for simulating - in a highly empirically constrained manner - the generation of task-evoked brain activations by modeling activity flowing over intrinsic brain connections. We next tested refinements to our hypothesis, focusing on how stimulus-driven network interactions initialized in V1 generate downstream visual category selectivity. We found evidence that network flows directly from V1 were sufficient for generating visual category selectivity, but that additional, globally distributed (whole-cortex) network flows increased category selectivity further. Using null network architectures we also found that each region's unique intrinsic "connectivity fingerprint" was key to the generation of category selectivity. These results generalized across regions associated with all four visual categories tested (bodies, faces, places, and tools), and provide evidence that the human brain's intrinsic network organization plays a prominent role in the generation of functionally relevant, localized responses.

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.

Asymmetries in event-related potentials part 1: A systematic review of face processing studies

The human brain shows distinct lateralized activation patterns for a range of cognitive processes. One such function, which is thought to be lateralized to the right hemisphere (RH), is human face processing. Its importance for social communication and interaction has led to a plethora of studies investigating face processing in health and disease. Temporally highly resolved methods, like event-related potentials (ERPs), allow for a detailed characterization of different processing stages and their specific lateralization patterns. This systematic review aimed at disentangling some of the contradictory findings regarding the RH specialization in face processing focusing on ERP research in healthy participants. Two databases were searched for studies that investigated left and right electrodes while participants viewed (mostly neutral) facial stimuli. The included studies used a variety of different tasks, which ranged from passive viewing to memorizing faces. The final data selection highlights, that strongest lateralization to the RH was found for the N170, especially for right-handed young male participants. Left-handed, female, and older participants showed less consistent lateralization patterns. Other ERP components like the P1, P2, N2, P3, and the N400 were overall less clearly lateralized. The current review highlights that many of the assumed lateralization patterns are less clear than previously thought and that the variety of stimuli, tasks, and EEG setups used, might contribute to the ambiguous findings.

The heterogeneity of holistic processing profiles in developmental prosopagnosia: holistic processing is impaired but not absent

Although it is generally assumed that face recognition relies on holistic processing, whether face recognition deficits observed in Developmental Prosopagnosics (DPs) can be explained by impaired holistic processing is currently under debate. The mixed findings from past studies could be the consequence of DP's heterogeneous deficit nature and the use of different measures of holistic processing-the inversion, part-whole, and composite tasks-which showed a poor association among each other. The present study aimed to gain further insight into the role of holistic processing in DPs. Groups of DPs and neurotypicals completed three tests measuring holistic face processing and non-face objects (i.e., Navon task). At a group level, DPs showed (1) diminished, but not absent, inversion and part-whole effects, (2) comparable magnitudes of the composite face effect and (3) global precedence effect in the Navon task. However, single-case analyses showed that these holistic processing deficits in DPs are heterogeneous.

A mechanistic alternative to minimal sufficiency as the guiding principle for NCC research

A central project for the neuroscience of consciousness is to reveal the neural basis of consciousness. For the past 20-odd years, this project has been conceptualized in terms of minimal sufficiency. Recently, a number of authors have suggested that the project is better conceived in mechanistic terms as the search for difference-makers. In this paper, I (i) motivate this mechanistic alternative to minimal sufficiency, (ii) develop it further by clarifying debates about the prospects of leveraging mutual manipulability to distinguish constitutive difference-makers from those that are merely causal, and (iii) explore the implications this has for recent debates concerning the status of the prefrontal cortex. I argue that adopting a mechanistic approach to the neuroscience of consciousness suggests that the prefrontal cortex is part of the neural mechanisms underlying consciousness even if it is not strictly speaking a necessary part.

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.

A new way of classifying developmental prosopagnosia: Balanced Integration Score

Despite severe everyday problems recognising faces, some individuals with developmental prosopagnosia (DP) can achieve typical accuracy scores on laboratory face recognition tests. To address this, studies sometimes also examine response times (RTs), which tend to be longer in DPs relative to control participants. In the present study, 24 potential (according to self-report) DPs and 110 age-matched controls completed the Cambridge Face and Bicycle Memory Tests, old new faces task, and a famous faces test. We used accuracy and the Balanced Integration Score (BIS), a measure that adjusts accuracy for RTs, to classify our sample at the group and individual levels. Subjective face recognition ability was assessed using the PI20 questionnaire and semi structured interviews. Fifteen DPs showed a major impairment using BIS compared with only five using accuracy alone. Logistic regression showed that a model incorporating the BIS measures was the most sensitive for classifying DP and showed highest area under the curve (AUC). Furthermore, larger between-group effect sizes were observed for a derived global (averaged) memory measure calculated using BIS versus accuracy alone. BIS is thus an extremely sensitive novel measure for attenuating speed-accuracy trade-offs that can otherwise mask impairment measured only by accuracy in DP.

Prosopagnosia Due to Metastatic Brain Tumor: A Case-Based Review

Prosopagnosia, also referred to as "face blindness," is a type of visual agnosia characterized by a decreased capacity to recognize familiar faces with a preserved ability to identify individuals based on non-facial visual traits or voice. Prosopagnosia can be categorized as developmental (DP) or acquired (AP) owing to a variety of underlying conditions, including trauma, neurodegenerative diseases, stroke, neuroinfections, and, less frequently, malignancies. Facial recognition is a complex process in which different neuronal networks are involved. The infrequent but notable higher visual-processing abnormalities can be caused by lesions of the inferior longitudinal fasciculus (ILF) in the non-dominant temporal lobe. We report a rare case of AP in a 69-year-old patient who is right-hand dominant with rectal carcinoma cerebral metastases. The patient complained of dizziness, vertigo, falls, and trouble recognizing her family members' faces. The CT scan of the head with contrast revealed two metastatic brain lesions with vasogenic edema, as one of them was in the right cerebellar hemisphere, causing dislocation and compression of the ILF. Corticosteroids and osmotherapy were utilized as a conservative treatment approach, which resulted in the prosopagnosia being completely withdrawn. In conclusion, patients with primary brain tumors or metastatic disease rarely present with an isolated cognitive deficit such as prosopagnosia. Based on the anatomical features and the personalized approach, a conservative or surgical approach may be useful to improve higher cortical functioning.

Face memory deficit in visually impaired children who live in a developing country

PURPOSE

The development of face processing abilities is a continuous process reaching maturity in adulthood. To achieve it in plenitude, children must have an adequate visual function. The purpose of this study was to assess how the face memory ability of children with visual impairment living in a developing country compares to those with normal vision in the same setting.

METHODS

This was a case-control study. Children with visual impairment of different causes and age-matched normal controls underwent a complete eye examination and the Cambridge Face Memory Test for Children (CFMT-C). Images were presented on a computer screen and the test results were expressed as a percentage of right answers (%). Children with impaired vision were assorted into binocular and monocular deficiency and the groups were compared with the Kruskal-Wallis test.

RESULTS

The sample comprised 40 children with visual impairment and 31 age-matched controls. The groups did not differ in age and gender distribution. Patients with binocular impairment (18 subjects) had lower mean CFMT-C scores, as compared to monocular patients (22 patients with strabismic amblyopia) and children with normal vision (57.7 ± 18.9, 76.2 ± 15.6, and 71.3 ± 12.7, respectively, p = 0.008).

CONCLUSIONS

Children with binocular visual impairment had diminished face memory ability. Amblyopia due to strabismus did not affect face memory. Attempts should focus on the prevention of visual loss and early rehabilitation so that these children can develop adequate face memory ability.

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.

Holistic and featural processing's link to face recognition varies by individual and task

While it is generally accepted that holistic processing facilitates face recognition, recent studies suggest that poor recognition might also arise from imprecise perception of local features in the face. This study aimed to examine to what extent holistic and featural processing relates to individual differences in face recognition ability (FRA), during face learning (Experiment 1) and face recognition (Experiment 2). Participants performed two tasks: (1) The "Cambridge Face Memory Test-Chinese" which measured participants' FRAs, and (2) an "old/new recognition memory test" encompassing whole faces (preserving holistic and featural processing) and faces revealed through a dynamic aperture (impairing holistic processing but preserving featural processing). Our results showed that participants recognised faces more accurately in conditions when holistic information was preserved, than when it is impaired. We also show that the better use of holistic processing during face learning and face recognition was associated with better FRAs. However, enhanced featural processing during recognition, but not during learning, was related to better FRAs. Together, our findings demonstrate that good face recognition depends on distinct roles played by holistic and featural processing at different stages of face recognition.

No increased prevalence of prosopagnosia in aphantasia: Visual recognition deficits are small and not restricted to faces

Aphantasia and prosopagnosia are both rare conditions with impairments in visual cognition. While prosopagnosia refers to a face recognition deficit, aphantasics exhibit a lack of mental imagery. Current object recognition theories propose an interplay of perception and mental representations, making an association between recognition performance and visual imagery plausible. While the literature assumes a link between aphantasia and prosopagnosia, other impairments in aphantasia have been shown to be rather global. Therefore, we assumed that aphantasics do not solely exhibit impairments in face recognition but rather in general visual recognition performance, probably moderated by stimulus complexity. To test this hypothesis, 65 aphantasics were compared to 55 controls in a face recognition task, the Cambridge Face Memory Test, and a corresponding object recognition task, the Cambridge Car Memory Test. In both tasks, aphantasics performed worse than controls, indicating mild recognition deficits without face-specificity. Additional correlations between imagery vividness and performance in both tasks were found, suggesting that visual imagery influences visual recognition not only in imagery extremes. Stimulus complexity produced the expected moderation effect but only for the whole imagery-spectrum and only with face stimuli. Overall, the results imply that aphantasia is linked to a general but mild deficit in visual recognition.

Alcohol Use Predicts Face Perception Impairments and Difficulties in Face Recognition

Background: Risky alcohol use is related to a variety of cognitive impairments, including memory and visuo-perceptual difficulties. Remarkably, no prior work has assessed whether usage of alcohol can predict difficulties perceiving facial identity. Objectives: Therefore, this study aimed to investigate whether riskier alcohol consumption predicted impairments in face perception and self-reported difficulties in face recognition. Results: Participants (N = 239, male = 77) were over 18 years old and had normal or corrected-to-normal vision. Alcohol use was assessed using the Alcohol Use Disorder Identification Test (AUDIT), while face recognition difficulties were determined by the 20-item Prosopagnosia Index questionnaire (PI20). A subsample of participants (N = 126, male = 51) completed the Cambridge Face Perception task (CFPT) to assess their face perception ability. Multiple linear regressions showed significant models of prediction on both face perception and face recognition when considering AUDIT score and age as predictors. Conclusion: This study suggested, for the first time, that risky alcohol use predicts both poorer visuo-perceptual processing for faces and self-reported difficulties in face recognition.

Face Blindness in Children and Current Interventions

Children with prosopagnosia, also known as face blindness, struggle to recognize the faces of acquaintances, which can have a negative impact on their social interactions and overall functioning. This paper reviews existing research on interventions for children with prosopagnosia, including compensatory and remedial strategies, and provides a summary and comparison of their effectiveness. However, despite the availability of these interventions, their effectiveness remains limited and constrained by various factors. The lack of a widely accepted treatment for children with prosopagnosia emphasizes the need for further research to improve intervention strategies. Last, three future research directions were proposed to improve interventions for prosopagnosia, including ecological approaches, the social challenges faced by children, and new potential intervention methods.

Why can people with developmental prosopagnosia recognise some familiar faces? Insights from subjective experience

Developmental prosopagnosia is a relatively common visuo-cognitive condition, characterised by impaired facial identity recognition. Impairment severity appears to reside on a continuum, however, it is unknown whether instances of milder deficits reflect the successful use of spontaneous (typical) face recognition strategies, or the application of extraneous compensatory cues to recognition. Here, we explore this issue in two studies. First, 23 adults with developmental prosopagnosia were asked about their use of spontaneous versus compensatory face recognition techniques in everyday life, using a series of closed- and open-ended questions. Second, the same participants performed a computerised famous face recognition task where they were asked to provide reasons why they could make any successful identifications. Findings from both studies suggest that people with developmental prosopagnosia can successfully, and quite frequently, use compensatory strategies to recognition, and that these cues support the majority of instances of preserved familiar face recognition. In contrast, 16 of the 23 participants were able to spontaneously recognise familiar faces on at least some occasions, but there were vast individual differences in frequencies of success. These findings have important implications for our conceptualisation of the condition, as well as for diagnostic practice.

Consensus recommendations for clinical assessment tools for the diagnosis of posterior cortical atrophy syndrome from the Atypical AD PIA of ISTAART

INTRODUCTION

Delay in diagnosis of posterior cortical atrophy (PCA) syndrome is common, and the lack of familiarity with assessment tools for identifying visual cortical dysfunction is a contributing factor. We propose recommendations for the approach to the evaluation of PCA clinical features during the office visit, the neuropsychological evaluation, and the research setting. A recommended screening battery for eye clinics is also proposed.

METHODS

Recommendations were developed using results from a web-based survey of members of Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Atypical Alzheimer's Disease Professional Interest Area (PIA), literature review, and consensus by the PCA assessment working party of the Atypical Alzheimer's Disease PIA.

RESULTS

Survey results revealed robust agreement for assessment tool preferences for PCA features, and many respondents indicated that they reserve assessment tools for use only when PCA is suspected. For some PCA features, curated tools were preferred over validated battery tools, particularly for the office visit. Consensus recommendations superseded survey preferences for two core cognitive features within the 2017 PCA diagnostic criteria.

DISCUSSION

These consensus recommendations provide an evaluation framework for PCA clinical features and can facilitate timely and accurate recognition and diagnosis of PCA. Broader use of these tools should be sought, and development and validation of novel PCA clinical outcome assessments are needed to improve our understanding of atypical AD and other dementias and support the inclusion of those with PCA in treatment trials.

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

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

Music perception in acquired prosopagnosia

BACKGROUND

Acquired prosopagnosia is often associated with other deficits such as dyschromatopsia and topographagnosia, from damage to adjacent perceptual networks. A recent study showed that some subjects with developmental prosopagnosia also have congenital amusia, but problems with music perception have not been described with the acquired variant.

OBJECTIVE

Our goal was to determine if music perception was also impaired in subjects with acquired prosopagnosia, and if so, its anatomic correlate.

METHOD

We studied eight subjects with acquired prosopagnosia, all of whom had extensive neuropsychological and neuroimaging testing. They performed a battery of tests evaluating pitch and rhythm processing, including the Montréal Battery for the Evaluation of Amusia.

RESULTS

At the group level, subjects with anterior temporal lesions were impaired in pitch perception relative to the control group, but not those with occipitotemporal lesions. Three of eight subjects with acquired prosopagnosia had impaired musical pitch perception while rhythm perception was spared. Two of the three also showed reduced musical memory. These three reported alterations in their emotional experience of music: one reported music anhedonia and aversion, while the remaining two had changes consistent with musicophilia. The lesions of these three subjects affected the right or bilateral temporal poles as well as the right amygdala and insula. None of the three prosopagnosic subjects with lesions limited to the inferior occipitotemporal cortex exhibited impaired pitch perception or musical memory, or reported changes in music appreciation.

CONCLUSION

Together with the results of our previous studies of voice recognition, these findings indicate an anterior ventral syndrome that can include the amnestic variant of prosopagnosia, phonagnosia, and various alterations in music perception, including acquired amusia, reduced musical memory, and subjective reports of altered emotional experience of music.

The Danish Version of the 20-Item Prosopagnosia Index (PI20): Translation, Validation and a Link to Face Perception

Developmental prosopagnosia (DP) is a neurodevelopmental condition characterized by face recognition problems. Psychometrically sound self-report measures of face recognition problems are important tools in classification of DP. A widely used measure of such problems is the 20-item prosopagnosia index (PI20). Here, we present a Danish translation of the PI20 (PI20_DK). We administered the PI20_DK alongside three objective measures of face and object processing performance to 119 participants to validate the PI20_DK. Further, we assess the underlying factor structure of the PI20_DK. Finally, as the first study in the field, we investigate the association between self-reported face recognition ability and face perception performance. The project was preregistered prior to data collection. The results suggest excellent convergent validity, discriminant validity and internal consistency for the PI20_DK. A confirmatory factor analysis, however, indicates a suboptimal fit of the PI20_DK to a one factor solution. An investigation of the association between the PI20_DK and face perception suggests that the poor fit may reflect that the PI20_DK measures problems with face recognition in general and not specifically face memory problems.

Face identity and facial expression representations with adaptation paradigms: New directions for potential applications

Adaptation and aftereffect are well-known procedures for exploring our neural representation of visual stimuli. It has been reported that they occur in face identity, facial expressions, and low-level visual features. This method has two primary advantages. One is to reveal the common or shared process of faces, that is, the overlapped or discrete representation of face identities or facial expressions. The other is to investigate the coding system or theory of face processing that underlies the ability to recognize faces. This study aims to organize recent research to guide the reader into the field of face adaptation and its aftereffect and to suggest possible future expansions in the use of this paradigm. To achieve this, we reviewed the behavioral short-term aftereffect studies on face identity (i.e., who it is) and facial expressions (i.e., what expressions such as happiness and anger are expressed), and summarized their findings about the neural representation of faces. First, we summarize the basic characteristics of face aftereffects compared to simple visual features to clarify that facial aftereffects occur at a different stage and are not inherited or combinations of low-level visual features. Next, we introduce the norm-based coding hypothesis, which is one of the theories used to represent face identity and facial expressions, and adaptation is a commonly used procedure to examine this. Subsequently, we reviewed studies that applied this paradigm to immature or impaired face recognition (i.e., children and individuals with autism spectrum disorder or prosopagnosia) and examined the relationships between their poor recognition performance and representations. Moreover, we reviewed studies dealing with the representation of non-presented faces and social signals conveyed via faces and discussed that the face adaptation paradigm is also appropriate for these types of examinations. Finally, we summarize the research conducted to date and propose a new direction for the face adaptation paradigm.

Individuals with developmental prosopagnosia show independent impairments in face perception, face memory and face matching

Individuals with developmental prosopagnosia (DP) all exhibit impairments in face memory, but the specificity of these face memory impairments is debated. One problem is that standard behavioural tasks are not able to provide independent measurement of face perception, face memory, and face matching (the decision process required to judge whether two instances of a face are of the same individual or different individuals). The present study utilised a new test of face matching, the Oxford Face Matching Test (OFMT), and a novel analysis strategy to derive these independent indices. Twenty-nine individuals with DP and the same number of matched neurotypical controls completed the OFMT, the Glasgow Face Matching Test, and the Cambridge Face Memory Test. Results revealed individuals with DP exhibit impairments in face perception, face memory and face matching. Collectively, these results suggest that face processing impairments in DP are more comprehensive than has previously been suggested.

Common neural substrates of diverse neurodevelopmental disorders

Neurodevelopmental disorders are categorized and studied according to their manifestations as distinct syndromes. For instance, congenital prosopagnosia and dyslexia have largely non-overlapping research literatures and clinical pathways for diagnosis and intervention. On the other hand, the high incidence of neurodevelopmental comorbidities or co-existing extreme strengths and weaknesses suggest that transdiagnostic commonalities may be greater than currently appreciated. The core-periphery model holds that brain regions within the stable core perceptual and motor regions are more densely connected to one another compared to regions in the flexible periphery comprising multimodal association regions. This model provides a framework for the interpretation of neural data in normal development and clinical disorders. Considering network-level commonalities reported in studies of neurodevelopmental disorders, variability in multimodal association cortex connectivity may reflect a shared origin of seemingly distinct neurodevelopmental disorders. This framework helps to explain both comorbidities in neurodevelopmental disorders and profiles of strengths and weaknesses attributable to competitive processing between cognitive systems within an individual.

Multiple-stage impairments of unfamiliar face learning in developmental prosopagnosia: Evidence from fMRI repetition suppression and multi-voxel pattern stability

Individuals with developmental prosopagnosia (DP) are characterized by severe face recognition deficits, yet it remains unknown how they are hindered in the process of unfamiliar face learning. Here we tracked the changes of neural activation during unfamiliar face repetition in DP with fMRI to reveal their neural deficits in learning unfamiliar faces. At the perceptual level, we found that the bilateral fusiform face area (FFA) in individuals with DP showed attenuated repetition suppression for faces, suggesting an inefficient perceptual analysis for learned faces. At the mnemonic level, individuals with DP showed decreased multi-voxel pattern stability for repeated faces in bilateral medial temporal lobe (MTL), suggesting an unstable mnemonic representation for learned faces. In addition, resting-state functional connectivity between the FFA and MTL was also disrupted in individuals with DP. Finally, the MTL's unstable mnemonic representation was associated with the impaired face recognition performance in DP. In sum, our study provides evidence that individuals with DP showed multi-stage neural deficits in unfamiliar face learning and sheds new light on how unfamiliar faces are learned in normal population.

Face specific inversion effects provide evidence for two subtypes of developmental prosopagnosia

Many studies have attempted to identify the perceptual underpinnings of developmental prosopagnosia (DP). The majority have focused on whether holistic and configural processing mechanisms are impaired in DP. However, previous work suggests that there is substantial heterogeneity in holistic and configural processing within the DP population; further, there is disagreement as to whether any deficits are face-specific or reflect a broader perceptual deficit. This study used a data-driven approach to examine whether there are systematic patterns of variability in DP that reflect different underpinning perceptual deficits. A group of individuals with DP (N = 37) completed a cognitive battery measuring holistic/configural and featural processing in faces and non-face objects. A two-stage cluster analysis on data from the Cambridge Face Perception Test identified two subgroups of DPs. Across several tasks, the first subgroup (N = 21) showed typical patterns of holistic/configural processing (measured via inversion effects); the second (N = 16) was characterised by reduced or abolished inversion effects compared to age-matched control participants (N = 91). The subgroups did not differ on tasks measuring upright face matching, object matching, non-face holistic processing, or composite effects. These findings indicate two separable pathways to face recognition impairment, one characterised by impaired configural processing and the other potentially by impaired featural processing. Comparisons to control participants provide some preliminary evidence that the deficit in featural processing may extend to some non-face stimuli. Our results demonstrate the utility of examining both the variability between and consistency across individuals with DP as a means of illuminating our understanding of face recognition in typical and atypical populations.

Treatment of transient prosopagnosia with a tyrosine kinase inhibitor in a case of brain metastasis from EGFR-mutated lung adenocarcinoma

Background:

Prosopagnosia is a rare form of apraxia, in which a person has normal memory and vision, but has impaired cognition of human faces that are manifested through symptoms such as not being able to recognize the face of a familiar person, one has known or not being able to remember the face of a person. Here, we report the case of a patient with transient prosopagnosia associated with brain metastasis from epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma who was treated with tyrosine kinase inhibitors (TKIs).

Case Description:

A 52-year-old right-handed man with lung adenocarcinoma was introduced to our department because brain metastasis. On admission, he complained that he could not recognize his wife’s face, but he could recall her face based on her voice. MRI revealed a right temporo-occipital enhancing lesion with perifocal edema and dissemination that were indicative of brain metastasis from lung adenocarcinoma. Two weeks after open biopsy, he was started on TKI therapy with osimertinib at a dosage of 80 mg/day. An MRI scan taken 1 month later revealed shrinkage of the metastasis. In addition, he had recovered from transient prosopagnosia and returned to normal life.

Conclusion:

In this study, the TKI osimertinib was administered to a patient with brain metastasis of EGFR-mutated lung adenocarcinoma who presented with prosopagnosia, and the patient’s lesion shrunk and his symptoms were reversed with this treatment.

Evaluating the Reliability and Validity of the Famous Faces Doppelgangers Test, a Novel Measure of Familiar Face Recognition

Face recognition assessments that use images of celebrities require not only face recognition ability but also pop-culture knowledge and successful recall of identifying information. Here, we introduce a task designed to measure face recognition more specifically: the Famous Faces Doppelgangers Test (FFDT). Participants (N = 57,407) identified 40 celebrities paired with lookalike doppelgangers, allowing face recognition ability to be assessed without requiring information recall. In addition, participants reported whether they were familiar with each celebrity, allowing poor face recognition ability to be differentiated from low pop-culture knowledge. FFDT performance was reliable (r_xx = .80), similar across participants of different racial and ethnic groups, and more highly correlated with memory for faces (r = .50) and self-reported face recognition ability (r = .48) than processing speed ability (r = .10). Thus, the FFDT is a reliable, valid, and specific measure of the ability to identify familiar faces, making it a promising new tool for assessing face recognition ability.

Face masks versus sunglasses: limited effects of time and individual differences in the ability to judge facial identity and social traits

Some research indicates that face masks impair identification and other judgements such as trustworthiness. However, it is unclear whether those effects have abated over time as individuals adjust to widespread use of masks, or whether performance is related to individual differences in face recognition ability. This study examined the effect of masks and sunglasses on face matching and social judgements (trustworthiness, competence, attractiveness). In Experiment 1, 135 participants across three different time points (June 2020-July 2021) viewed unedited faces and faces with masks, sunglasses, or both. Both masks and sunglasses similarly decreased matching performance. The effect of masks on social judgements varied depending on the judgement and whether the face was depicted with sunglasses. There was no effect of timepoint on any measure, suggesting that the effects of masks have not diminished. In Experiment 2, 12 individuals with developmental prosopagnosia (DP) and 10 super-recognisers (SRs) completed the same tasks. The effect of masks on identity matching was reduced in SRs, whereas the effects of masks and sunglasses for the DP group did not differ from controls. These findings indicate that face masks significantly affect face perception, depending on the availability of other facial information, and are not modified by exposure.

Minding my brain: Fourteen neuroscience-based principles to enhance psychotherapy responsiveness

Intersections between psychotherapy and neurosciences are at its dawn. The quest to understand the neural underpinnings of psychological processes has led several generations of scientists to explore neural correlates between mind, brain, and behavior. Neuroscience methods and research has given psychology new perspectives and insights about the structure and function of complex neural pathways, that underly human functioning (cognition, emotion, motivation, and interpersonal behavior). By translating neuroscientific findings into psychotherapeutic principles of change, it is possible to promote responsiveness towards brain dysfunction that underlies patients' psychological malfunctioning. In psychotherapy, responsiveness is a core aspect of the therapeutic change process, especially to adapt psychological interventions to patients' motivational stages and preferences, coping styles, neurobehavioral modes, and emotional needs. Within a transtheoretical and translational approach, contemporary neuroscientific findings are revised, discussed, and used to attempt to build-on fourteen theoretical brain-based principles that may be applied to psychotherapy. Translating these empirical findings into practical principles, clinical strategies and tasks is expected to enhance psychotherapy responsiveness grounded on a science-based knowledge of brain functioning.

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.

EXPRESS: Distinct abilities associated with matching same identity faces vs. discriminating different faces: Evidence from individual differences in prosopagnosics and controls

Previous face matching studies provide evidence that matching same identity faces (match trials) and discriminating different face identities (non-match trials) rely on distinct processes. For example, instructional studies geared towards improving face matching in applied settings have often found selective improvements in match or non-match trials only. Additionally, a small study found that developmental prosopagnosics (DPs) have specific deficits in making match but not non-match judgments. In the current study, we sought to replicate this finding in DPs and examine how individual differences across DPs and controls in match vs. non-match performance relate to featural vs. holistic processing abilities. 43 DPs and 27 controls matched face images shown from similar front views or with varied lighting or viewpoint. Participants also performed tasks measuring featural (eyes/mouth) and holistic processing (part-whole task). We found that DPs showed worse overall matching performance than controls and that their relative match vs. non-match deficit depended on image variation condition, indicating that DPs do not consistently show match- or non-match-specific deficits. When examining the association between holistic and featural processing abilities and match vs. non-match trials in the entire group of DPs and controls, we found a very clear dissociation: Match trials significantly correlated with eye processing ability (r=.48) but not holistic processing (r=.11), whereas non-match trials significantly correlated with holistic processing (r=.32) but not eye processing (r=.03). This suggests that matching same identity faces relies more on eye processing while discriminating different faces relies more on holistic processing.

Not so fast! Response times in the computerized Benton Face Recognition Test may not reflect face recognition ability

Response times (RTs) are commonly used to assess cognitive abilities, though it is unclear whether face processing RTs predict recognition ability beyond accuracy. In the current study, we examined accuracy and RT on a widely used face matching assessment modified to collect meaningful RT data, the computerized Benton Facial Recognition Test (BFRT-c), and measured whether RTs predicted face recognition ability and developmental prosopagnosia (DP) vs. control group membership. 62 controls and 36 DPs performed the BFRT-c as well as validated measures of face recognition ability: the Cambridge Face Memory Test (CFMT) and a Famous Faces Memory Test (FFMT). In controls, BFRT-c accuracy robustly predicted CFMT (r = .49, p < .001), FFMT (r = .43, p < .001), and a CFMT-FFMT composite (r = .54, p < .001), whereas BFRT-c RT was not significantly associated with these measures (all r's  .21). We also found that BFRT-c accuracy significantly differed between DPs and controls, but RT failed to differentiate the groups.

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.

OUP accepted manuscript

While there have been decades of clinical and theoretical interest in developmental and acquired face recognition difficulties, very little work has examined their remediation. Here, we report two studies that examined the efficacy of an existing face training programme in improving face-processing skills in adults and children with developmental face recognition impairments. The programme has only been trialled in typical children to date, where 2 weeks of perceptual training (modelled on an adapted version of the popular family game Guess Who?) resulted in face-specific improvements for memory but not perception after 2 weeks of training. In Study 1, we performed a randomized, parallel groups, placebo-controlled trial of the same programme in 20 adults with a pre-existing diagnosis of developmental prosopagnosia. Assessment tasks were administered immediately before and after training, and 2 weeks later. Face-specific gains in memory (but not perception) were observed in the experimental group and were greatest in those with the poorest face recognition skills at entry. These gains persisted 2 weeks after training ceased. In Study 2, a case-series approach was used to administer the experimental version of the training programme to four children who presented with difficulties in face recognition. Improvements in face memory were observed in three of the participants; while one also improved at face perception, there was mixed evidence for the face specificity of these gains. Together, these findings suggest plasticity in the human face recognition system through to at least mid-adulthood and also pave the way for longer-term implementations of the face training programme that will likely elicit greater gains in both adults and children.

The Twenty Item Prosopagnosia Index (PI20) provides meaningful evidence of face recognition impairment

The Twenty Item Prosopagnosia Index (PI20) is a self-report questionnaire used for quantifying prosopagnosic traits. This scale is intended to help researchers identify cases of developmental prosopagnosia by providing standardized self-report evidence to complement diagnostic evidence obtained from objective computer-based tasks. In order to respond appropriately to items, prosopagnosics must have some insight that their face recognition is well below average, while non-prosopagnosics need to understand that their relative face recognition ability falls within the typical range. There has been considerable debate about whether participants have the necessary insight into their face recognition abilities to respond appropriately. In the present study, we sought to determine whether the PI20 provides meaningful evidence of face recognition impairment. In keeping with the intended use of the instrument, we used PI20 scores to identify two groups: high-PI20 scorers (those with self-reported face recognition difficulties) and low-PI20 scorers (those with no self-reported face recognition difficulties). We found that participant groups distinguished on the basis of PI20 scores clearly differed in terms of their mean performance on objective measures of face recognition ability. We also found that high-PI20 scorers were more likely to achieve levels of face recognition accuracy associated with developmental prosopagnosia.

Different measures of holistic face processing tap into distinct but partially overlapping mechanisms

Holistic processing, which includes the integration of facial features and analysis of their relations to one another, is a hallmark of what makes faces 'special'. Various experimental paradigms purport to measure holistic processing but these have often produced inconsistent results. This has led researchers to question the nature and structure of the mechanism(s) underlying holistic processing. Using an individual differences approach, researchers have examined relations between various measures of holistic processing in an attempt to resolve these questions. In keeping with this, we examined relationships between four commonly used measures of holistic face processing in a large group of participants (N = 223): (1) The Face Inversion Effect, (2) the Part Whole Effect (PWE), (3) the Composite Face Effect, and (4) the Configural Featural Detection Task (CFDT). Several novel methodological and analytical elements were introduced, including the use of factor analysis and the inclusion of control conditions to confirm the face specificity of all of the effects measured. The four indexes of holistic processing derived from each measure loaded onto two factors, one encompassing the PWE and the CFDT, and one encompassing the CE. The 16 conditions tested across the four tasks loaded onto four factors, each factor corresponding to a different measure. These results, together with those of other studies, suggest that holistic processing is a multifaceted construct and that different measures tap into distinct but partially overlapping elements of it.

Separate and Shared Neural Basis of Face Memory and Face Perception in Developmental Prosopagnosia

Developmental prosopagnosia (DP), also known as face blindness, is a cognitive disorder with a severe deficit in recognizing faces. However, the heterogeneous nature of DP leads to a longstanding debate on which stages the deficit occurs, face perception (e.g., matching two consecutively presented faces) or face memory (e.g., matching a face to memorized faces). Here, we used the individual difference approach with functional magnetic resonance imaging to explore the neural substrates of DPs' face perception and face memory that may illuminate DPs' heterogeneity. Specifically, we measured the behavioral performance of face perception and face memory in a large sample of individuals suffering DP (N = 64) and then associated the behavioral performance with their face-selective neural responses in the core face network (CFN) and the extended face network (EFN), respectively. Behaviorally, we found that DP individuals were impaired in both face perception and face memory; however, there was only a weak correlation between the performances of two tasks. Consistent with this observation, the neural correlate of DPs' performance in face memory task was localized in the bilateral fusiform face area, whereas DPs' performance in face perception task was correlated with the face selectivity in the right posterior superior temporal sulcus, suggesting that the neural substrates in the CFN for face memory and face perception were separate in DP. In contrast, shared neural substrates of deficits in face perception and face memory tasks were identified in the EFN, including the right precuneus and the right orbitofrontal cortex. In summary, our study provides one of the first empirical evidence that the separate and shared neural substrates of face perception and face memory were identified in the CFN and EFN, respectively, which may help illuminating DP's heterogeneous nature.

The Oxford Face Matching Test: A non-biased test of the full range of individual differences in face perception

Tests of face processing are typically designed to identify individuals performing outside of the typical range; either prosopagnosic individuals who exhibit poor face processing ability, or super recognisers, who have superior face processing abilities. Here we describe the development of the Oxford Face Matching Test (OFMT), designed to identify individual differences in face processing across the full range of performance, from prosopagnosia, through the range of typical performance, to super recognisers. Such a test requires items of varying difficulty, but establishing difficulty is problematic when particular populations (e.g., prosopagnosics, individuals with autism spectrum disorder) may use atypical strategies to process faces. If item difficulty is calibrated on neurotypical individuals, then the test may be poorly calibrated for atypical groups, and vice versa. To obtain items of varying difficulty, we used facial recognition algorithms to obtain face pair similarity ratings that are not biased towards specific populations. These face pairs were used as stimuli in the OFMT, and participants were required to judge whether the face images depicted the same individual or different individuals. Across five studies the OFMT was shown to be sensitive to individual differences in the typical population, and in groups of both prosopagnosic individuals and super recognisers. The test-retest reliability of the task was at least equivalent to the Cambridge Face Memory Test and the Glasgow Face Matching Test. Furthermore, results reveal, at least at the group level, that both face perception and face memory are poor in those with prosopagnosia, and are good in super recognisers.

Children with Disabilities/Special Health Needs and Ocular Refractive Disorders

Children with special needs face many eye problems that should be promptly addressed. Many eye diseases can be treatable if discovered in infancy. There is data showing these children have a higher prevalence of refractive errors than their non-disabled peers. If diagnosed and treated promptly, refractive errors can provide a good quality of life for special needs children.

An unusual case of post traumatic visual agnosia posing challenges to rehabilitation

ABSTRACT

Acquired focal visuo-perceptual deficits are rarely reported and rehabilitation strategies are not well established. This is a report on visuo-perceptual deficit following traumatic brain injury that initially went unnoticed. Missing visual agnosia is not unusual especially when perceptual deficits present with visual field defects, impaired insight, and inattention. This case is made more interesting due the rarity of visual agnosia with predominant ventral pathway involvement, affecting object and face recognition. This report provides a brief discussion on visual agnosia spectrum deficits and rehabilitation measures.

Apperceptive Prosopagnosia Secondary to an Ischemic Infarct of the Lingual Gyrus: A Case Report and an Update on the Neuroanatomy, Neurophysiology, and Phenomenology of Prosopagnosia

Phenomenology is the philosophical study of experience and its core feature of sentience, the very ability to be conscious of a sensation and how we perceive it. Nowhere is this idea more vivid, as in the phenomenon of vision and the ability to form and sense a visual percept. The clinical entity of prosopagnosia, the ability to sense but not recognize a face, strikes at the heart of this phenomenon. We describe a classic case of selective apperceptive prosopagnosia due to an ischemic infarct of the left occipital lobe with extension to the lingual gyrus. It is well-established that acquired prosopagnosia usually involves the right more than the left occipital cortex, with localization of lesions bilaterally more than unilaterally. The ischemic infarcts strategically involve the fusiform gyrus, inferior occipital gyrus, the fundus of the posterior temporal sulcus, parahippocampal gyrus, and, rarely, lingual gyrus, which is almost always not a solitary finding. We seize upon this opportunity to explore the concept of visual prosopagnosia and outline the latest ideas on the neuroanatomical localization, neurophysiology, and classification of this intriguing phenomenon.

Birthweight predicts individual differences in adult face recognition ability

It has long been known that premature birth and/or low birthweight can lead to general difficulties in cognitive and emotional functioning throughout childhood. However, the influence of these factors on more specific processes has seldom been addressed, despite their potential to account for wide individual differences in performance that often appear innate. Here, we examined the influence of gestation and birthweight on adults' face perception and face memory skills. Performance on both sub-processes was predicted by birthweight and birthweight-for-gestation, but not gestation alone. Evidence was also found for the domain-specificity of these effects: No perinatal measure correlated with performance on object perception or memory tasks, but they were related to the size of the face inversion effect on the perceptual test. This evidence indicates a novel, very early influence on individual differences in face recognition ability, which persists into adulthood, influences face-processing strategy itself, and may be domain-specific.

The Face of Image Reconstruction: Progress, Pitfalls, Prospects

Recent research has demonstrated that neural and behavioral data acquired in response to viewing face images can be used to reconstruct the images themselves. However, the theoretical implications, promises, and challenges of this direction of research remain unclear. We evaluate the potential of this research for elucidating the visual representations underlying face recognition. Specifically, we outline complementary and converging accounts of the visual content, the representational structure, and the neural dynamics of face processing. We illustrate how this research addresses fundamental questions in the study of normal and impaired face recognition, and how image reconstruction provides a powerful framework for uncovering face representations, for unifying multiple types of empirical data, and for facilitating both theoretical and methodological progress.

Selective defects of face familiarity associated to a left temporo-occipital lesion

Acquired prosopagnosia is usually a consequence of bilateral or right hemisphere lesions and is often associated with topographical disorientation and dyschromatopsia. Left temporo-occipital lesions sometimes result in a face recognition disorder but in a context of visual object agnosia with spared familiarity feelings for faces, usually in left-handers. We describe a patient with a left temporo-occipital hemorrhagic lesion unexpectedly resulting in a deficit of face familiarity, which could represent a mild form of associative prosopagnosia. Our patient failed to feel familiarity feelings even with very well-known famous faces but had neither visual object agnosia nor defects with semantics or naming of celebrities. This was confirmed even when the patient was re-tested a year later. We speculate that a graded lateralization of face processing could be at the basis of occasional cases of prosopagnosia.

Interrogating an ICD-coded electronic health records database to characterize the epidemiology of prosopagnosia

INTRODUCTION

Recognition of faces of family members, friends, and colleagues is an important skill essential for everyday life. Individuals affected by prosopagnosia (face blindness) have difficulty recognizing familiar individuals. The prevalence of prosopagnosia has been estimated to be as high as 3%. Prosopagnosia can severely impact the quality of life of those affected, and it has been suggested to co-occur with conditions such as depression and anxiety.

METHODS

To determine real-world diagnostic frequency of prosopagnosia and the spectrum of its comorbidities, we utilized a large database of more than 7.5 million de-identified electronic health records (EHRs) from patients who received care at major academic health centers and Federally Qualified Health Centers in New York City. We designed a computable phenotype to search the database for diagnosed cases of prosopagnosia, revealing a total of n = 902 cases. In addition, data from a randomly sampled matched control population (n = 100,973) were drawn from the database for comparative analyses to study the condition's comorbidity landscape. Diagnostic frequency of prosopagnosia, epidemiological characteristics, and comorbidity landscape were assessed.

RESULTS

We observed prosopagnosia diagnoses at a rate of 0.012% (12 per 100,000 individuals). We discovered elevated frequency of prosopagnosia diagnosis for individuals who carried certain comorbid conditions, such as personality disorder, depression, epilepsy, and anxiety. Moreover, prosopagnosia diagnoses increased with the number of comorbid conditions.

CONCLUSIONS

Results from this study show a wide range of comorbidities and suggest that prosopagnosia is vastly underdiagnosed. Findings imply important clinical consequences for the diagnosis and management of prosopagnosia as well as its comorbid conditions.