Associative visual agnosia: a case study

Experiments with a Hollow Mask and a Reverspective: Top-down Influences in the Inversion Effect for 3-D Stimuli

Earlier psychophysical and physiological studies, obtained mostly with two-dimensional (2-D) stimuli, provided evidence for the hypothesis that the processing of faces differs from that of scenes. We report on our experiments, employing realistic three-dimensional (3-D) stimuli of a hollow mask and a scene, that offer further evidence for this hypothesis. The stimuli used for both faces and scenes were bistable, namely they could elicit either the veridical or an illusory volumetric percept. Our results indicate that the illusion is weakened when the stimuli are inverted, suggesting the involvement of top-down processes. This inversion effect is statistically significant for the facial stimulus, but the trend did not reach statistical significance for the scene stimulus. These results support the hypothesis that configural processing is stronger for the 3-D perception of faces than it is for scenes, and extend the conclusions of earlier studies on 2-D stimuli.

Monkey and human face perception: inversion effects for human faces but not for monkey faces or scenes

Three rhesus monkeys and two groups of 10 human subjects judged upright or inverted pictures as same or different. The pictures were black and white pairs of human faces, monkey faces, or scenes. The monkeys were trained with sets of 50 pictures and were tested with other sets of 36 pictures from each category. The groups of 10 human subjects were tested with the same pictures used to test monkeys. Both monkeys and humans showed large performance decrements to inverted human faces relative to upright human faces but neither species showed inversion effects for monkey faces or scenes. A second test with both monkeys and humans showed the same pattern of results with a different set of human-face pictures that varied more in sex (female as well as male), facial hair, eyeglasses, haircut, view angle, and background than those of the first test. The results indicate similar face-processing mechanisms in monkeys and humans despite experiential and evolutionary differences.

Differential contribution of right and left temporo-occipital and anterior temporal lesions to face recognition disorders

In the study of prosopagnosia, several issues (such as the specific or non-specific manifestations of prosopagnosia, the unitary or non-unitary nature of this syndrome and the mechanisms underlying face recognition disorders) are still controversial. Two main sources of variance partially accounting for these controversies could be the qualitative differences between the face recognition disorders observed in patients with prevalent lesions of the right or left hemisphere and in those with lesions encroaching upon the temporo-occipital (TO) or the (right) anterior temporal cortex. Results of our review seem to confirm these suggestions. Indeed, they show that (a) the most specific forms of prosopagnosia are due to lesions of a right posterior network including the occipital face area and the fusiform face area, whereas (b) the face identification defects observed in patients with left TO lesions seem due to a semantic defect impeding access to person-specific semantic information from the visual modality. Furthermore, face recognition defects resulting from right anterior temporal lesions can usually be considered as part of a multimodal people recognition disorder. The implications of our review are, therefore, the following: (1) to consider the components of visual agnosia often observed in prosopagnosic patients with bilateral TO lesions as part of a semantic defect, resulting from left-sided lesions (and not from prosopagnosia proper); (2) to systematically investigate voice recognition disorders in patients with right anterior temporal lesions to determine whether the face recognition defect should be considered a form of "associative prosopagnosia" or a form of the "multimodal people recognition disorder."

Searching for the elusive neural substrates of body part terms: a neuropsychological study

Previous neuropsychological studies suggest that, compared to other categories of concrete entities, lexical and conceptual aspects of body part knowledge are frequently spared in brain-damaged patients. To further investigate this issue, we administered a battery of 12 tests assessing lexical and conceptual aspects of body part knowledge to 104 brain-damaged patients with lesions distributed throughout the telencephalon. There were two main outcomes. First, impaired oral naming of body parts, attributable to a disturbance of the mapping between lexical-semantic and lexical-phonological structures, was most reliably and specifically associated with lesions in the left frontal opercular and anterior/inferior parietal opercular cortices and in the white matter underlying these regions (8 patients). Also, 1 patient with body part anomia had a left occipital lesion that included the "extrastriate body area" (EBA). Second, knowledge of the meanings of body part terms was remarkably resistant to impairment, regardless of lesion site; in fact, we did not uncover a single patient who exhibited significantly impaired understanding of the meanings of these terms. In the 9 patients with body part anomia, oral naming of concrete entities was evaluated, and this revealed that 4 patients had disproportionately worse naming of body parts relative to other types of concrete entities. Taken together, these findings extend previous neuropsychological and functional neuroimaging studies of body part knowledge and add to our growing understanding of the nuances of how different linguistic and conceptual categories are operated by left frontal and parietal structures.

Colour knowledge in semantic dementia: It is not all black and white

In three experiments we assessed the colour knowledge of patients with semantic dementia, a neuro-degenerative condition that gradually erodes conceptual knowledge. In Experiment 1, the patients' colour naming performance correlated strongly with their object naming for frequency-matched items, with no patient showing better-than-expected naming of colours relative to objects. In Experiment 2, where patients were asked to colour black-and-white line drawings of common objects, all patients were impaired relative to controls, and performance correlated strongly with degree of semantic deficit. The fact that patients often erroneously selected green for fruits or vegetables, and brown for animals, suggests some preservation of general knowledge about the colours that typify a given domain. In Experiment 3, patients were given pairs of identical line drawings of familiar animals, fruits and vegetables--one of each pair coloured correctly, and one incorrectly--and were asked to choose the correct one. When the target's colour was characteristic of the domain, patients scored well; but when the distractor had a typical hue and the target's colour was unusual (e.g. a green versus an orange carrot), performance was far poorer. The results are discussed with reference to alternative theories about the neural basis of conceptual knowledge.

Electrophysiological correlates of associative visual agnosia lesioned in the ventral pathway

Visual agnosia has been well studied by anatomical, neuropsychological and neuroimaging studies. However, functional changes in the brain have been rarely assessed by electrophysiological methods. We carried out electrophysiological examinations on a 23-year-old man with associative visual agnosia, prosopagnosia and cerebral achromatopsia to evaluate the higher brain dysfunctions of visual recognition. Electrophysiological methods consisted of achromatic, chromatic and category-specific visual evoked potentials (CS-VEPs), and event-related potentials (ERPs) with color and motion discrimination tasks. Brain magnetic resonance imaging revealed large white matter lesions in the bilateral temporo-occipital lobes involving the lingual and fusiform gyri (V4) and inferior longitudinal fasciculi due to multiple sclerosis. Examinations including CS-VEPs demonstrated dysfunctions of face and object perception while sparing semantic word perception after primary visual cortex (V1) in the ventral pathway. ERPs showed abnormal color perception in the ventral pathway with normal motion perception in the dorsal pathway. These electrophysiological findings were consistent with lesions in the ventral pathway that were detected by clinical and neuroimaging findings. Therefore, CS-VEPs and ERPs with color and motion discrimination tasks are useful methods for assessing the functional changes of visual recognition such as visual agnosia.

A metanalysis of impaired and spared naming for different categories of knowledge in patients with a visuo-verbal disconnection

The study of the neuroanatomical correlates of category-specific semantic disorders has strongly supported the 'sensory/motor model of semantic knowledge,' which assumes that the cortical areas that have critically contributed to the development of various categories are also implicated in their semantic representation. However, if the anatomo-clinical correlates are consistent with the model, less clearcut results have been obtained by functional neuroimaging experiments. In the present metanalysis, I addressed the question from a different viewpoint, shifting attention from the anatomical lesion in patients with category-specific semantic disorders to the pattern of naming impairment shown by patients suffering from a disconnection between visual areas and lexical output mechanisms. According to the model, living entities should be particularly impaired, since their semantic representations are mainly based upon visual perceptual attributes. On the contrary, actions and body parts (and to a lesser extent artefacts) should be relatively spared, as their semantic representations are mainly based upon motor, somato-sensory or functional attributes. These predictions were checked by reviewing the categorical pattern of naming impairment shown by patients with a visuo-verbal disconnection and a category-specific naming impairment published in the last 20 years. The pattern of impaired and spared categories observed in these patients was consistent with the hypothesis, since: (1) 'actions' and 'body parts' were systematically spared in comparison to all the other categories; (2) 'artefacts' were relatively spared with respect to the 'living categories'; and (3) within the biological categories, 'plants' were usually more impaired than animals.

The influence of misnaming on object recognition: a case of multimodal agnosia

We present a case of multimodal agnosia in the visual and tactile modality due to an infarction in the territory of the left posterior cerebral artery. The patient's ability to recognize objects fluctuated depending on his verbal activity. When he misnamed presented objects, he tended to use them and to draw them in keeping with the wrong name. We submit that the mechanism causing associative agnosia is more dynamic than it was hitherto considered. It originates from the rivalry between top-down central regulation and bottom-up peripheral flow.

Left posterior BA37 is involved in object recognition: a TMS study

Functional imaging studies have proposed a role for left BA37 in phonological retrieval, semantic processing, face processing and object recognition. The present study targeted the posterior aspect of BA37 to see whether a deficit, specific to one of the above types of processing could be induced. Four conditions were investigated: word and nonword reading, colour naming and picture naming. Repetitive transcranial magnetic stimulation (rTMS) was delivered over posterior BA37 of the left and right hemispheres (lBA37 and rBA37, respectively) and over the vertex. Subjects were significantly slower to name pictures when TMS was given over lBA37 compared to vertex or rBA37. rTMS over lBA37 had no significant effect on word reading, nonword reading or colour naming. The picture naming deficit is suggested to result from a disruption to object recognition processes. This study corroborates the finding from a recent imaging study, that the most posterior part of left hemispheric BA37 has a necessary role in object recognition.

Common and distinct neural substrates for pragmatic, semantic, and syntactic processing of spoken sentences: an fMRI study

Extracting meaning from speech requires the use of pragmatic, semantic, and syntactic information. A central question is: Does the processing of these different types of linguistic information have common or distinct neuroanatomical substrates? We addressed this issue using functional magnetic resonance imaging (fMRI) to measure neural activity when subjects listened to spoken normal sentences contrasted with sentences that had either (A) pragmatical, (B) semantic (selection restriction), or (C) syntactic (subcategorical) violations sentences. All three contrasts revealed robust activation of the left-inferior-temporal/fusiform gyrus. Activity in this area was also observed in a combined analysis of all three experiments, suggesting that it was modulated by all three types of linguistic violation. Planned statistical comparisons between the three experiments revealed (1) a greater difference between conditions in activation of the left-superior-temporal gyrus for the pragmatic experiment than the semantic/syntactic experiments; (2) a greater difference between conditions in activation of the right-superior and middle-temporal gyrus in the semantic experiment than in the syntactic experiment; and (3) no regions activated to a greater degree in the syntactic experiment than in the semantic experiment. These data show that, while left- and right-superior-temporal regions may be differentially involved in processing pragmatic and lexico-semantic information within sentences, the left-inferior-temporal/fusiform gyrus is involved in processing all three types of linguistic information. We suggest that this region may play a key role in using pragmatic, semantic (selection restriction), and subcategorical information to construct a higher representation of meaning of sentences.

The neural substrate of picture naming

A PET study of 10 normal males was carried out using the bolus H215O intravenous injection technique to examine the effects of picture naming and semantic judgment on blood flow. In a series of conditions, subjects (1) passively viewed flashing plus signs, (2) noted the occurrence of abstract patterns, (3) named animal pictures, or (4) carried out a semantic judgment on animal pictures. Anticipatory scans were carried out after the subjects were presented with the instructions but before they began the cognitive task, as they were passively viewing plus signs. Our results serve to clarify a number of current controversies regarding the neural substrate of picture naming. The results indicate that the fusiform gyrus is unlikely to be the region where low-level perceptual processing such as shape analysis is undertaken. In fact, our evidence suggests that activation of the fusiform gyrus is most likely related to visual perceptual semantic processing. In addition, the inferior/middle frontal lobe activity observed while performing the picture naming and semantic judgment tasks does not appear to be due to the effects of anticipation or preparation. Furthermore, there appears to be a set of regions (a semantic network) that becomes activated regardless of whether the subjects perform a picture naming or semantic judgment task. Finally, picture naming of animals did not activate either parietal regions or anterior inferior left temporal regions, regardless of what subtraction baseline was used.

The more you know the less you can tell: inhibitory effects of visuo-semantic activation on modality specific visual misnaming

WH, a 77-years old right-handed psychoanalyst, displayed modality specific visual misnaming as a sequel of an embolic stroke in the left posterior cerebral artery. WH's errors in visual object naming consisted mainly of semantic paraphasias and perseverations. His verbalizations during testing sometimes manifested a conflict between correct responses and perseverations. Analysis of the stream of information from visual perception via semantics to phonology suggested incomplete access from vision to semantics as the source of errors. The disconnection did not affect verbo-visual matching, though he was unable to reject names that did not correspond to visual stimuli. Action naming was relatively spared, but naming of pictures of actions with objects was worse than naming of pictures of intransitive actions. Tactile naming worsened with simultaneous vision of objects. In visual object naming the error rate increased with increasing familiarity of objects. We propose that an interaction of excitation and inhibition within a single semantic system can explain the clinical phenomena of modality specific visual misnaming.

Associative visual agnosia resulting from a disconnection between intact visual memory and semantic systems

We report the case of a patient (RC) who developed a severe visual agnosia, associated to alexia without agraphia, color anomia and amnesia, following an ischemic stroke in the territory supplied by the left posterior cerebral artery. Based on his proficient performance on tests evaluating analysis of elementary visual features, formation of viewer-centered and object-centered representations of visual stimuli and discrimination between drawings representing real and unreal objects, we concluded that the critical locus of deficit was a disconnection between the normally functioning visual memory store and the semantic system. RC's disturbance in visual processing of human faces paralleled his recognition disorder of other classes of objects. The possible contribution of neurobiological factors in determining RC's agnosic deficit is discussed.

Associative agnosia and optic aphasia: qualitative or quantitative difference?

We report a patient who, following the partial removal of a tentorial meningioma, suffered a hematoma in the left occipital lobe, which was resected. He showed severe anomia for visually presented stimuli, while naming was normal when they were presented in the tactile, auditory and verbal modality. His performance on visuo-perceptual tests, not requiring meaning identification, provided evidence that he was able to access the stored representations of stimuli. When recognition was assessed with non-verbal tasks, a mixed pattern of findings emerged and the patient showed features of both associative agnosia and optic aphasia. He was severely impaired in producing pantomimes in response to pictures, but only marginally impaired in sorting figures from the same superordinate category into fine-grained subcategories. He performed within the normal range on an associative task, in which the distractors bore no semantic relation to the target, but made many errors when the distractors and the target were semantically related. We propose that the interpretation advanced by Coslett and Saffran (Brain, 1989) for optic aphasia also holds for associative agnosia and argue that both syndromes reflect the impaired access of structured representations to left hemisphere semantics, but differ in terms of the degree of compensation provided by the semantic resources of the right hemisphere. Since the anatomical basis of the two syndromes may be very similar, we submit that what makes the difference is the semantic potential of the patient's right hemisphere.

Modality specific naming and gesture disturbances: a case with optic aphasia, bilateral tactile aphasia, optic apraxia and tactile apraxia

This study reports a patient who manifested optic aphasia, tactile aphasia, optic apraxia, and tactile apraxia following an operation for epidural left parietal haematoma. He could neither name nor pantomime the use of objects presented visually or tactually, but correctly performed semantic association tasks, thus demonstrating preserved recognition. He could name and pantomime the use of auditorily presented objects. Experimental results disproved that pantomime disorders were secondary to naming disorders, and suggested that modality specific aphasia and modality specific apraxia are independent clinical syndromes. CT scans showed injury to the posterior callosal radiations, the white matter of the angular gyrus, and the medial portion of the occipital lobe in the left hemisphere. We suggest that modality specific aphasia and modality specific apraxia can be explained by assuming a common semantic memory store.

On the modularity of face recognition: the riddle of domain specificity

The present paper focuses on the modular attributes of face recognition, defined in terms of domain specificity. Domain specificity is examined by looking into the innate nature of face recognition, the special effects related to the recognition of inverted faces, the specificity of electrophysiological responsivity to facial stimuli, and the specific impairment in face recognition associated with localized brain damage. Converging evidence from these sources seems to consistently show that face recognition is not qualitatively unique, as it proceeds in a manner similar to the recognition of other visuospatial objects. However, it seems to be special in that it may involve specific mechanisms dedicated to face recognition. Among infants, differential responsivity to faces and to other objects in terms of age of onset, attraction and course of development, seems to indicate the operation of a special process. Unusual inversion effects in face recognition might be due to the special expertise that humans develop for recognizing upright faces. Face-selective single unit responses in the monkey's brain implies the existence in the visual system of cells which are exclusively dedicated to the processing of facial stimuli. Finally, in prosopagnosia localized brain damage is linked to a specific inability to recognize familiar faces. Taken together, the data seem to show that some elements in the process of face recognition are domain specific, and in that sense, modular.

Visual agnosia and optic aphasia: are they anatomically distinct?

A patient with left infero-medial occipital-temporal infarct suffered a visual agnosia that, by a minor change of the task, could be manipulated to optic aphasia. Tools in actual use and pantomimes of tool use were better named than stationary tools, a dissociation that suggests differences in the ability of stimuli to evoke associations over multiple modalities. Based on this case and analysis of previous reports we suggest that optic aphasia differs from visual agnosia primarily in the degree of callosal disconnection and that the preserved demonstration of tools use and semantic classification of optic aphasia reflect right hemisphere contribution to visual processing.

Loss of visual imagery and loss of visual knowledge--a case study

As a sequel of a left posterior cerebral artery infarction a patient had severely defective mental imagery of shapes and colours of objects. Imagery of faces, letters, and topological relationships was preserved. The impairment of imagery of object colours was associated with colour agnosia and colour anomia. For colours, there was no difference between performance on tasks calling for imagery of object colours and tasks affording a distinction between correctly and incorrectly coloured objects. For shapes of objects, imagery appeared to be below the level of the patient's knowledge about the visual appearance of objects as manifested by the ability to identify objects and to distinguish correctly from incorrectly drawn pictures. The apparently selective image generation deficit for shapes of objects could be a sequel of loss of knowledge about visual attributes of objects, if superior performance on shape recognition tasks was afforded by perceptual entry level representation which enable a rapid identification of objects but are inaccessible to introspective consciousness.

Visual associative agnosia and optic aphasia. A single case study and a review of the syndromes

The case is presented of a patient who showed visual naming disturbances caused by a left occipital infarction. His performance on tests of visual naming, of recognition not requiring a verbal response, and of verbal-visual matching demonstrated a wide range of qualitatively different errors, including complete inability to recognize the object, access to partial semantic knowledge, and mere name finding difficulty. On the basis of the present case and of a review of the recent literature, the clinical distinction between visual associative agnosia and optic aphasia and the relation of these disorders with the anatomical site of lesion are discussed.

Personal relevance and the human right hemisphere

Brain damage can selectively disrupt or distort information and ability across the range of human behaviors. One domain that has not been considered as an independent attribute consists of acquisition and maintenance of personal relevant entities such as "familiar" faces, persons, voices, names, linguistic expressions, handwriting, topography, and so on. In experimental studies of normal mentation, personal relevance is revealed in studies of emotion, arousal, affect, preference and familiarity judgments, and memory. Following focal brain damage, deficits and distortions in the experience of personal relevance, as well as in recognizing formerly personally relevant phenomena, are well known to occur. A review and interpretation of these data lead to a proposal that the right hemisphere has a special role in establishing, maintaining, and processing personally relevant aspects of the individual's world.

Can We Lose Memories of Faces? Content Specificity and Awareness in a Prosopagnosic

Prosopagnosia is a neurological syndrome in which patients cannot recognize faces. Kecently it has been shown that some prosopagnosics give evidence of "covert" recognition: they show greater autonomic responses to familiar faces than to unfamiliar ones, and respond differently to familiar faces in learning and interference tasks. Although some patients do not show covert recognition, this has usually been attributed to an "apperceptive" deficit that impairs perceptual analysis of the input. The implication is that prosopagnosia is a deficit in access to, or awareness of, memories of faces: the inducing brain injury does not destroy the memories themselves. We present a case study that challenges this view. LH suffers from prosopagnosia as the result of a closed head injury. He cannot recognize familiar faces or report that they are familiar, nor answer questions about the faces from memory, though he can (1) recognize common objects and subtly varying shapes, (2) match faces while ignoring irrelevant information such as emotional expression or angle of view, (3) recognize sex, age, and like-ability from faces, and (4) recognize people by a number of nonfacial channels. The only other categories of shapes that he has marked trouble recognizing are animals and emotional expressions, though even these impairments were not as severe as the one for faces. Three measures (sympathetic skin response, pupil dilation, and learning correct and incorrect names of faces) failed to show any signs of covert face recognition in LH, though the measures were sensitive enough to reflect autonomic reactions in LH to stimuli other than faces, and face familiarity in normal controls. Thus prosopagnosia cannot always be attributed to a mere absence of awareness (i.e., preserved information about faces whose output is disconnected from conscious cognitive processing), to an apperceptive deficit (i.e., preserved information about faces that cannot be accessed due to improperly analyzed perceptual input), or to an inability to recognize complex or subtly varying shapes (i.e., loss or degradation of shape memory in general). We conclude that it is possible for brain injury to eliminate the storage of information about familiar faces and certain related shapes.

A case of associative visual agnosia: neuropsychological findings and theoretical considerations

A 61-year-old right-handed man fell downstairs and was found unconscious. There was no abnormality in the general physical examinations. Neurological examinations revealed a quadrantanopia. Neuropsychological examination revealed an impairment in recent verbal memory, alexia, agraphia, object agnosia, color naming difficulty, prosopagnosia, and visuospatial constructional disability. CT scan demonstrated subcortical hematomas in the temporo-occipital regions of both hemispheres. MRI demonstrated extensive low-intensity lesions in the lingual, fusiform and posterior inferior temporal gyri on both hemispheres. Both inferior longitudinal fasciculi were also affected. His neuropsychological deficits seem best described as a typical form of associative visual agnosia. From the results of neuroradiological findings, the authors emphasize that associative visual agnosia might be produced by an intrahemispheric disconnection between the visual cortices and the temporal lobes which are supposed to be the storage site of the engrams of visual memories. Moreover, the neuropsychological findings suggest that the visuo-constructional ability to convert the two-dimensional input to the three-dimensional construction and the capacity of three-dimensional imagination were severely impaired in our patient. It was considered that these neuropsychological features play an important role in the recognition difficulties of associative visual agnosia.

Category-specific versus modality-specific aphasia for colours: a review of the pioneer case studies

This paper addresses the long-standing dichotomy between category-specific (colour-name aphasia) and modality-specific impaired colour-naming (optic aphasia for colours) in posteriorly brain injured patients with preserved colour vision and language abilities. The data gathered for this paper were obtained from a critical review of the pioneer case studies and the analysis of the author's research findings. A number of easily applicable colour tasks, especially the so-called "verbal-verbal" ones are recommended and are believed to be equipped to refine the clinical assessment of impaired visual and verbal knowledge of colours in the brain damaged as well as to pinpoint the functional defects underlying the varieties of colour-naming impairments.

Interhemispheric communication in a case of total visuo-verbal disconnection

Interhemispheric communication strategies as noted in split-brain subjects may serve a compensatory function in patients with total visuo-verbal disconnection. The results of a case support this expectation. Identification of visual material reflected the perceptual and linguistic limitations of the right hemisphere, and naming was sometimes mediated by the rehearsal of alternatives. Implications for disconnection theory are discussed.