Face identity matching is selectively impaired in developmental prosopagnosia

Impairments for faces but not for abstract shapes in developmental prosopagnosia: Evidence from visual working memory tasks

We investigated visual working memory (VWM) for faces and two novel non-face pattern types (Blobs and Mondrians) in individuals with developmental prosopagnosia (DP) and age-matched controls. Participants completed both simultaneous and sequential encoding tasks, judging whether a probe item matched one shown at encoding. DPs showed a consistent face disadvantage across both encoding types, while controls showed a face advantage, but only during simultaneous encoding. Compared to controls, DPs had impaired face VWM in both tasks but performed equivalently for abstract shapes and patterns. Face VWM impairments in DP were not exacerbated by increased memory load or updating demands, suggesting these deficits stem from face perception difficulties that affect encoding rather than general VWM mechanisms. Our group-based analyses were supplemented by individual case statistics. Overall, our findings indicate that DPs do not exhibit general VWM deficits, but rather specific difficulties with face processing across formats.

Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses

The Diagnostic Statistical Manual of Mental Disorders (DSM-5) recommends diagnosing neurocognitive disorders (i.e., cognitive impairment) when a patient scores beyond - 1 SD below neurotypical norms on two tests. I review how this approach will fail due to cognitive tests' power limitations, validity issues, imperfect reliabilities, and biases, before summarizing their resulting negative consequences. As a proof of concept, I use developmental prosopagnosia, a condition characterized by difficulties recognizing faces, to show the DSM-5 only diagnoses 62-70% (n1 = 61, n2 = 165) versus 100% (n1 = 61) through symptoms alone. Pooling the DSM-5 missed cases confirmed the presence of group-level impairments on objective tests, which were further evidenced through meta-analyses, thus validating their highly atypical symptoms. These findings support a paradigm shift towards bespoke diagnostic approaches for distinct cognitive impairments, including a symptom-based method when validated effective. I reject dogmatic adherence to the DSM-5 approach to neurocognitive disorders, and underscore the importance of a data driven, transdiagnostic approach to understanding patients' subjective cognitive impairments. This will ultimately benefit patients, their families, clinicians, and scientific progress.

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.

Face Feature Change Detection Ability in Developmental Prosopagnosia and Super-Recognisers

In non-clinical populations, facial features (eyes, nose, mouth) may vary in their contribution to face identity perception. Changes to whole faces are easier to detect than changes to individual features, and eye changes are typically easier to detect than mouth changes, which in turn are easier to detect than nose changes. However, how this differs for people with face recognition difficulties (developmental prosopagnosia; DP) and for individuals with superior face recognition abilities (super-recognisers; SR) is not clear; although findings from previous studies have suggested differences, the nature of this difference is not understood. The aim of this study was to examine whether differences in the ability to detect feature changes in DPs and SRs were (a) quantitative, meaning that the pattern across feature changes remained the same but there was an overall upwards or downwards shift in performance, or (b) qualitative, meaning that the pattern across feature changes was different. Using a change detection task in which individual face features (eyes, nose, mouth) changed between sequentially presented faces, we found that while prosopagnosics showed a quantitative difference in performance with a downwards shift across all conditions, super-recognisers only showed qualitative differences: they were better able to detect when the face was the same and were marginally (but not non-significantly) worse at detecting when the eyes changed. Further, the only condition which distinguished between the three groups was the ability to identify when the same face was presented, with SRs being better than controls, and controls being better than DPs. Our findings suggest that, in feature-matching tasks, differences for DPs are due to them being overall worse at the task, while SRs use a qualitatively different strategy.

Binocular rivalry reveals differential face processing in congenital prosopagnosia

Congenital Prosopagnosia (CP) is an innate impairment in face perception with heterogeneous characteristics. It is still unclear if and to what degree holistic processing of faces is disrupted in CP. Such disruption would be expected to lead to a focus on local features of the face. In this study, we used binocular rivalry (BR) to implicitly measure face perception in conditions that favour holistic or local processing. The underlying assumption is that if stimulus saliency affects the perceptual dominance of a given stimulus in BR, one can deduce how salient a stimulus is for a given group (here: participants with and without CP) based on the measured perceptual dominance. A further open question is whether the deficit in face processing in CP extends to the processing of the facial display of emotions. In experiment 1, we compared predominance of upright and inverted faces displaying different emotions (fearful, happy, neutral) vs. houses between participants with CP (N = 21) and with normal face perception (N = 21). The results suggest that CP observers process emotions in faces automatically but rely more on local features than controls. The inversion of faces, which is supposed to disturb holistic processing, affected controls in a more pronounced way than participants with CP. In experiment 2, we introduced the Thatcher effect in BR by inverting the eye and mouth regions of the presented faces in the hope of further increasing the effect of face inversion. However, our expectations were not borne out by the results. Critically, both experiments showed that inversion effects were more pronounced in controls than in CP, suggesting that holistic face processing is less relevant in CP. We find BR to be a useful implicit test for assessing visual processing specificities in neurological participants.

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.

Two face masks are better than one: congruency effects in face matching

Although the positive effects of congruency between stimuli are well replicated in face memory paradigms, mixed findings have been found in face matching. Due to the current COVID-19 pandemic, face masks are now very common during daily life outdoor activities. Thus, the present study aims to further explore congruency effects in matching faces partially occluded by surgical masks. Observers performed a face matching task consisting of pairs of faces presented in full view (i.e., full-view condition), pairs of faces in which only one of the faces had a mask (i.e., one-mask condition), and pairs of faces in which both faces had a mask (i.e., two-mask condition). Although face masks disrupted performance in identity match and identity mismatch trials, in match trials, we found better performance in the two-mask condition compared to the one-mask condition. This finding highlights the importance of congruency between stimuli on face matching when telling faces together.

Face Processing in Developmental Prosopagnosia: Altered Neural Representations in the Fusiform Face Area

Rationale: Face expertise is a pivotal social skill. Developmental prosopagnosia (DP), i.e., the inability to recognize faces without a history of brain damage, affects about 2% of the general population, and is a renowned model system of the face-processing network. Within this network, the right Fusiform Face Area (FFA), is particularly involved in face identity processing and may therefore be a key element in DP. Neural representations within the FFA have been examined with Representational Similarity Analysis (RSA), a data-analytical framework in which multi-unit measures of brain activity are assessed with correlation analysis. Objectives: Our study intended to scrutinize modifications of FFA-activation during face encoding and maintenance based on RSA. Methods: Thirteen participants with DP (23-70 years) and 12 healthy control subjects (19-62 years) participated in a functional MRI study, including morphological MRI, a functional FFA-localizer and a modified Sternberg paradigm probing face memory encoding and maintenance. Memory maintenance of one, two, or four faces represented low, medium, and high memory load. We examined conventional activation differences in response to working memory load and applied RSA to compute individual correlation-matrices on the voxel level. Group correlation-matrices were compared via Donsker's random walk analysis. Results: On the functional level, increased memory load entailed both a higher absolute FFA-activation level and a higher degree of correlation between activated voxels. Both aspects were deficient in DP. Interestingly, control participants showed a homogeneous degree of correlation for successful trials during the experiment. In DP-participants, correlation levels between FFA-voxels were significantly lower and were less sustained during the experiment. In behavioral terms, DP-participants performed poorer and had longer reaction times in relation to DP-severity. Furthermore, correlation levels were negatively correlated with reaction times for the most demanding high load condition. Conclusion: We suggest that participants with DP fail to generate robust and maintained neural representations in the FFA during face encoding and maintenance, in line with poorer task performance and prolonged reaction times. In DP, alterations of neural coding in the FFA might therefore explain curtailing in working memory and contribute to impaired long-term memory and mental imagery.

Developmental Prosopagnosia and Elastic Versus Static Face Recognition in an Incidental Learning Task

Previous research on the beneficial effect of motion has postulated that learning a face in motion provides additional cues to recognition. Surprisingly, however, few studies have examined the beneficial effect of motion in an incidental learning task and developmental prosopagnosia (DP) even though such studies could provide more valuable information about everyday face recognition compared to the perception of static faces. In the current study, 18 young adults (Experiment 1) and five DPs and 10 age-matched controls (Experiment 2) participated in an incidental learning task during which both static and elastically moving unfamiliar faces were sequentially presented and were to be recognized in a delayed visual search task during which the faces could either keep their original presentation or switch (from static to elastically moving or vice versa). In Experiment 1, performance in the elastic-elastic condition reached a significant improvement relative to the elastic-static and static-elastic condition, however, no significant difference could be detected relative to the static-static condition. Except for higher scores in the elastic-elastic compared to the static-elastic condition in the age-matched group, no other significant differences were detected between conditions for both the DPs and the age-matched controls. The current study could not provide compelling evidence for a general beneficial effect of motion. Age-matched controls performed generally worse than DPs, which may potentially be explained by their higher rates of false alarms. Factors that could have influenced the results are discussed.

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.

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

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