Congenital prosopagnosia without object agnosia? A literature review

Imagery and perception in acquired prosopagnosia: Functional variants and their relation to structure

Current models of face perception and the face-processing network suggest that acquired prosopagnosia may not be a single disorder but rather a family of variants differing in mechanism. It has been proposed that tests of face perception and face imagery can probe component processes to support apperceptive, associative, and amnestic distinctions. However, validating this proposal is hampered by the rarity of this condition. Here we report observations gathered over two-and-a-half decades on the perception of facial shape and the imagery for famous faces of twenty-three patients. Patients with lesions limited to the occipitotemporal lobes had an apperceptive profile, with impaired perception of facial shape but no or mild deficits for face imagery. The apperceptive defect affected not just configuration but also feature size and external contour, especially in the upper face, and was more severe when subjects attended to multiple aspects of the face. An amnestic profile, with severely impaired imagery and minimally affected perception, was seen in two patients, one with right and one with bilateral anterior temporal damage. Four patients had an apperceptive/amnestic combination, all with bilateral occipitotemporal and right anterior temporal damage. Right anterior temporal damage alone often caused only mild imagery deficits: along with their relatively intact face perception, these subjects came closest to meeting proposed exclusionary criteria for an associative variant, i.e., relative preservation of both imagery and perception. These results confirm a link between apperceptive prosopagnosia and occipitotemporal lesions. Damage to the right anterior temporal lobe was common to all with a severe amnestic deficit, but often requiring additional damage.

Rehabilitation and intervention of developmental and acquired prosopagnosia: A systematic review

Prosopagnosia is a neurological disorder; characterized by an impairment in facial recognition. It can occur from acquired prosopagnosia (occurring in approximately 5.6% of the population), or from developmental prosopagnosia (occurring in approximately 2% of the population). Despite the relatively high prevalence of prosopagnosia, there has been limited research into intervention for this condition. The current systematic review aimed to review the evidence base to aid the development of practice guidelines for clinicians working with impacted individuals. A systemic search identified 14 studies, 10 of which involved participants with developmental prosopagnosia, while the remaining studies involved participants with acquired prosopagnosia. Overall, the findings identified two strategies which produced significant improvement in face recognition in prosopagnosics. The first strategy involved a perceptual learning strategy (a restorative approach). While this strategy improved face processing abilities, the intervention was time-consuming and relied on specific software. The second strategy involved learned association of distinguishable facial features (a compensatory approach). This intervention produced improvements in face recognition and was quick to administer, however, the gains made were not generalisable to untrained faces. The current review identified a number of limitations in the existing literature, such as the lack of single-case experimental designs and randomized controlled trials, limited control for practice effects, and no consensus with regard to the assessment and diagnosis of prosopagnosia. This review highlighted the need for further research to inform practice guidelines.

Assessment of Developmental Prosopagnosia in an Individual with Tourette Syndrome and Attention Deficit Hyperactivity Disorder: A Case Report

BACKGROUND/OBJECTIVES

Prosopagnosia is the inability to recognize people by their faces. Developmental prosopagnosia is the hereditary or congenital variant of the condition. The aim of this study was to demonstrate the assessment of developmental prosopagnosia in a clinical context, using a combination of commercially available clinical assessment tools and experimental tools described in the research literature.

METHODS

We conducted a comprehensive neuropsychological assessment of a man with Tourette syndrome and attention deficit hyperactivity disorder (ADHD). The patient (ON) had experienced difficulties with face identity recognition throughout his life but believed they were caused by a lack of interest in others.

RESULTS

The neuropsychological assessment revealed varying degrees of difficulties primarily related to executive functions, attention, reaction time, and memory processes, as expected in a person with Tourette's syndrome and ADHD. In addition, ON reported severe problems with face recognition on a prosopagnosia questionnaire and demonstrated severely impaired performance on tests of face memory and face perception commonly used to diagnose prosopagnosia. Interestingly, he reported familial face recognition problems on the maternal side of the family, while tics and ADHD symptoms occurred on the paternal side. This suggests that, in this case, the conditions were likely inherited through different genetic pathways.

CONCLUSIONS

Proper assessment of face recognition problems, which includes a broad spectrum of clinical assessment tools, could help patients develop awareness and acceptance of themselves and their difficulties, and could serve as a basis for the development of clinical interventions. While ON's DP, Tourette syndrome, and ADHD may have distinct genetic origins, impairment in face identity recognition has been observed across several neurodevelopmental conditions and is likely more common than currently thought.

Hemispheric asymmetries in face recognition in health and dysfunction

A defining characteristic of the human brain is that, notwithstanding the clear anatomic similarities, the two cerebral hemispheres have several different functional superiorities. The focus of this chapter is on the hemispheric asymmetry associated with the function of face identity processing, a finely tuned and expert behavior for almost all humans that is acquired incidentally from birth and continues to be refined through early adulthood. The first section lays out the well-accepted doctrine that face perception is a product of the right hemisphere, a finding based on longstanding behavioral data from healthy adult human observers. Data are then presented from neuropsychologic studies conducted with individuals with prosopagnosia, which is either acquired after a lesion to the right hemisphere or is developmental in nature with no obvious lesion. The second section reviews data on the neural correlates of face perception, gathered using a host of imaging methodologies all the way from electroencephalography (EEG) through functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) studies to transcranial magnetic stimulation and intracranial depth recording. The penultimate section reviews empirical findings that track the emergence of the hemispheric asymmetry for faces, and offers a theoretical proposal that lays out possible origins of the adult asymmetry profile. Lastly, the hemispheric asymmetry associated with the perception of emotional face expression is considered. While considerable progress has been made in understanding the functional organization of the human cerebral cortex and its biases and asymmetries, much remains to be determined and the many inconsistencies remain to be reconciled in future research.

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.

Global changes in the pattern of connectivity in developmental prosopagnosia

Developmental prosopagnosia is a neurodevelopmental condition characterized by difficulties in recognizing the identity of a person from their face. While current theories of the neural basis of developmental prosopagnosia focus on the face processing network, successful recognition of face identities requires broader integration of neural signals across the whole brain. Here, we asked whether disruptions in global functional and structural connectivity contribute to the face recognition difficulties observed in developmental prosopagnosia. We found that the left temporal pole was less functionally connected to the rest of the brain in developmental prosopagnosia. This was driven by weaker contralateral connections to the middle and inferior temporal gyri, as well as to the medial prefrontal cortex. The pattern of global connectivity in the left temporal pole was also disrupted in developmental prosopagnosia. Critically, these changes in global functional connectivity were only evident when participants viewed faces. Structural connectivity analysis revealed localized reductions in connectivity between the left temporal pole and a number of regions, including the fusiform gyrus, inferior temporal gyrus, and orbitofrontal cortex. Our findings underscore the importance of whole-brain integration in supporting typical face recognition and provide evidence that disruptions in connectivity involving the left temporal pole may underlie the characteristic difficulties of developmental prosopagnosia.

The 2024 Richardson Lecture: Prosopagnosia - A Classic Neurologic Deficit Meets the Modern Era

Acquired prosopagnosia is a rare disorder, but it serves as a model for impairments in expert-level visual processing. This review discusses five key observations made over the past 30 years. First, there are variants, an apperceptive type linked to damage to the inferior occipitotemporal cortex and an amnestic type associated with anterior temporal lesions, both either right or bilateral. Second, these variants are clustered in syndromes with other perceptual deficits, the apperceptive type with field defects, dyschromatopsia and topographagnosia, and the amnestic type with topographagnosia and the auditory disorders of phonagnosia and acquired amusia. Third, extensive testing often shows additional problems with recognizing exemplars of other objects, especially when degrees of expertise are taken into account. Fourth, the prosopagnosic impairment does not affect all facial information. For example, the perception of expression and lip-reading likely depends on other neural substrates than those for processing facial identity. Last, face perception in prosopagnosia is not immutable but can improve with extensive training, though as yet this does not represent a cure for the condition. Continuing work with neural networks and animal models will enhance our understanding of this intriguing condition and what it tells us about how our brains process vision.

Impaired Face Feature-to-Location Statistical Learning and Single-Feature Discrimination in Developmental Prosopagnosia

Individuals with developmental prosopagnosia (DP) experience severe face memory deficits that are often accompanied by impairments in face perception. Images of human facial features are better discriminated between when they are presented in the locations on the visual field that they typically appear in while viewing human faces in daily life, than in locations which they do not typically appear (i.e., better performance for eyes in the upper visual field, and better performance for mouths in the lower visual field). These feature-to-location tuning effects (FLEs) can be explained by a retinotopically organised visual statistical learning mechanism. We had a large group of DP participants (N = 64), a control group (N = 74) and a group of individuals with a mild form of DP (N = 58) complete a single-feature discrimination task to determine whether face perception deficits in DP can be accounted for by an impairment in face feature-to-location tuning. The results showed that individuals with DP did not have significant FLEs, suggesting a marked impairment in the underlying visual statistical learning mechanism. In contrast, the mild DP group showed normal FLE effects which did not differ from the control group. Both DP groups had impaired single-feature processing (SFP) as compared to the control group. We also examined the effects of age on FLEs and SFP.

Familiarity enhances functional connectivity between visual and nonvisual regions of the brain during natural viewing

We explored the neural correlates of familiarity with people and places using a naturalistic viewing paradigm. Neural responses were measured using functional magnetic resonance imaging, while participants viewed a movie taken from Game of Thrones. We compared inter-subject correlations and functional connectivity in participants who were either familiar or unfamiliar with the TV series. Higher inter-subject correlations were found between familiar participants in regions, beyond the visual brain, that are typically associated with the processing of semantic, episodic, and affective information. However, familiarity also increased functional connectivity between face and scene regions in the visual brain and the nonvisual regions of the familiarity network. To determine whether these regions play an important role in face recognition, we measured responses in participants with developmental prosopagnosia (DP). Consistent with a deficit in face recognition, the effect of familiarity was significantly attenuated across the familiarity network in DP. The effect of familiarity on functional connectivity between face regions and the familiarity network was also attenuated in DP. These results show that the neural response to familiarity involves an extended network of brain regions and that functional connectivity between visual and nonvisual regions of the brain plays an important role in the recognition of people and places during natural viewing.

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.

The neuropsychological evaluation of face identity recognition

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

What is developmental about developmental prosopagnosia?

Developmental prosopagnosia (DP) is characterised by difficulties recognising face identities and is associated with diverse co-occurring object recognition difficulties. The high co-occurrence rate and heterogeneity of associated difficulties in DP is an intrinsic feature of developmental conditions, where co-occurrence of difficulties is the rule, rather than the exception. However, despite its name, cognitive and neural theories of DP rarely consider the developmental context in which these difficulties occur. This leaves a large gap in our understanding of how DP emerges in light of the developmental trajectory of face recognition. Here, we argue that progress in the field requires re-considering the developmental origins of differences in face recognition abilities, rather than studying the end-state alone. In practice, considering development in DP necessitates a re-evaluation of current approaches in recruitment, design, and analyses.

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.

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.

Decoding face recognition abilities in the human brain

Why are some individuals better at recognizing faces? Uncovering the neural mechanisms supporting face recognition ability has proven elusive. To tackle this challenge, we used a multimodal data-driven approach combining neuroimaging, computational modeling, and behavioral tests. We recorded the high-density electroencephalographic brain activity of individuals with extraordinary face recognition abilities-super-recognizers-and typical recognizers in response to diverse visual stimuli. Using multivariate pattern analyses, we decoded face recognition abilities from 1 s of brain activity with up to 80% accuracy. To better understand the mechanisms subtending this decoding, we compared representations in the brains of our participants with those in artificial neural network models of vision and semantics, as well as with those involved in human judgments of shape and meaning similarity. Compared to typical recognizers, we found stronger associations between early brain representations of super-recognizers and midlevel representations of vision models as well as shape similarity judgments. Moreover, we found stronger associations between late brain representations of super-recognizers and representations of the artificial semantic model as well as meaning similarity judgments. Overall, these results indicate that important individual variations in brain processing, including neural computations extending beyond purely visual processes, support differences in face recognition abilities. They provide the first empirical evidence for an association between semantic computations and face recognition abilities. We believe that such multimodal data-driven approaches will likely play a critical role in further revealing the complex nature of idiosyncratic face recognition in the human brain.

Is "memory-for-when" universal? Group and individual variability in temporal position memory for words, faces, and classrooms

Many contemporary theories of memory assume that everyone automatically stores temporal contextual information about all types of encountered information, yet most studies on this topic have used words and ignored individual differences. Five experiments accumulated evidence that explicit storage of temporal context information does not appear to occur automatically for all people and types of memoranda. We collected judgments of temporal position (memory-for-when) for words (Experiments 1 & 3), faces (Experiments 2A, 3, 4, and 5), and classrooms (Experiments 2B & 3). At the group level, for each of these memoranda memory-for-when was sensitive to the original input position and showed a temporal primacy effect reflecting better memory for position for items near the beginning of the list, indicating some automatic storage of temporal context information. However, memory-for-when was significantly better for words than classrooms, with faces in the middle. Moreover, individuals varied dramatically in their ability to indicate memory-for-when, especially for classrooms where many people performed at or near chance. Taken together, the data suggest that explicit memory-for-when may be dissociable from the more implicit use of temporal contextual information that is theorised to occur during free recall.

Evidence for a Classical Dissociation between Face and Object Recognition in Developmental Prosopagnosia

It is still a matter of debate whether developmental prosopagnosia is a disorder selective to faces or whether object recognition is also affected. In a previous study, based on a small sample of developmental prosopagnosics (DPs; N = 10), we found impairments in both domains although the difficulties were most pronounced for faces. Importantly, impairments with faces and objects were systematically related. We suggested that that the seemingly disproportional impairment for faces in DP was likely to reflect differences between stimulus categories in visual similarity. Here, we aimed to replicate these findings in a larger, independent sample of DPs (N = 21) using the same experimental paradigms. Contrary to our previous results, we found no disproportional effect of visual similarity on performance with faces or objects in the new DP group when compared to controls (N = 21). The new DP group performed within the control range, and significantly better than the old DP-group, on sensitive and demanding object recognition tasks, and we can demonstrate a classical dissociation between face and object recognition at the group level. These findings are perhaps the strongest evidence yet presented for a face-specific deficit in developmental prosopagnosia.

Familial Transmission of Developmental Prosopagnosia: New Case Reports from an Extended Family and Identical Twins

Existing evidence suggests that developmental prosopagnosia (DP) is a surprisingly prevalent condition, with some individuals describing lifelong difficulties with facial identity recognition. Together with case reports of multiple family members with the condition, this evidence suggests that DP is inherited in at least some instances. Here, we offer some novel case series that further support the heritability of the condition. First, we describe five adult siblings who presented to our lab with symptoms of DP. Second, for the first known time in the literature, we describe a pair of adult identical twins who contacted us in the belief that they both experience DP. The condition was confirmed in three of the five siblings (with minor symptoms observed in the remaining two) and in both twins. Supplementary assessments suggested that all individuals also experienced some degree of difficulty with facial identity perception, but that object recognition was preserved. These findings bolster the evidence supporting the heritability of DP and suggest that it can be a specific impairment in some cases.

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.

A new approach to diagnosing and researching developmental prosopagnosia: Excluded cases are impaired too

Developmental prosopagnosia is characterized by severe, lifelong difficulties when recognizing facial identity. Unfortunately, the most common diagnostic assessment (Cambridge Face Memory Test) misses 50-65% of individuals who believe that they have this condition. This results in such excluded cases' absence from scientific knowledge, effect sizes of impairment potentially overestimated, treatment efficacy underrated, and may elicit in them a negative experience of research. To estimate their symptomology and group-level impairments in face processing, we recruited a large cohort who believes that they have prosopagnosia. Matching prior reports, 56% did not meet criteria on the Cambridge Face Memory Test. However, the severity of their prosopagnosia symptoms and holistic perception deficits were comparable to those who did meet criteria. Excluded cases also exhibited face perception and memory impairments that were roughly one standard deviation below neurotypical norms, indicating the presence of objective problems. As the prosopagnosia index correctly classified virtually every case, we propose it should be the primary method for providing a diagnosis, prior to subtype categorization. We present researchers with a plan on how they can analyze these excluded prosopagnosia cases in their future work without negatively impacting their traditional findings. We anticipate such inclusion will enhance scientific knowledge, more accurately estimate effect sizes of impairments and treatments, and identify commonalities and distinctions between these different forms of prosopagnosia. Owing to their atypicalities in visual perception, we recommend that the prosopagnosia index should be used to screen out potential prosopagnosia cases from broader vision research.

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.

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.

Using representational similarity analysis to reveal category and process specificity in visual object recognition

Cross-condition comparisons on neurodevelopmental conditions are central in neurodiversity research. In the realm of visual perception, the performance of participants with different category-specific disorders such as developmental prosopagnosia (problems with faces) and dyslexia (problems with words) have contributed to understanding of perceptual processes involved in word and face recognition. Alterations in face and word recognition are present in several neurodiverse populations, and improved knowledge about their relationship may increase our understanding of this variability of impairment. The present study investigates organizing principles of visual object processing and their implications for developmental disorders of recognition. Some accounts suggest that distinct mechanisms are responsible for recognizing objects of different categories, while others propose that categories share or even compete for cortical resources. We took an individual differences approach to estimate the relationship between abilities in recognition. Neurotypical participants (N = 97 after outlier exclusion) performed a match-to-sample task with faces, houses, and pseudowords. Either individual features or feature configurations were manipulated. To estimate the separability of visual recognition mechanisms, we used representational similarity analysis (RSA) where correlational matrices for accuracy were compared to predicted data patterns. Recognition abilities separated into face recognition on one hand and house/pseudoword recognition on the other, indicating that face recognition may rely on relatively selective mechanisms in neurotypicals. We also found evidence for a general visual object recognition mechanism, while some combinations of category (faces, houses, words) and processing type (featural, configural) likely rely on additional mechanisms. Developmental conditions may therefore reflect combinations of impaired and intact aspects of specific and general visual object recognition mechanisms, where featural and configural processes for one object category separate from the featural or configural processing of another. More generally, RSA is a promising approach for advancing understanding of neurodiversity, including shared aspects and distinctions between neurodevelopmental conditions of visual recognition.

Dissociations between face identity and face expression processing in developmental prosopagnosia

Individuals with developmental prosopagnosia (DPs) experience severe and lifelong deficits recognising faces, but whether their deficits are selective to the processing of face identity or extend to the processing of face expression remains unclear. Clarifying this issue is important for understanding DP impairments and advancing theories of face processing. We compared identity and expression processing in a large sample of DPs (N = 124) using three different matching tasks that each assessed identity and expression processing with identical experimental formats. We ran each task in upright and inverted orientations and we measured inversion effects to assess the integrity of upright-specific face processes. We report three main results. First, DPs showed large deficits at discriminating identity but only subtle deficits at discriminating expression. Second, DPs showed a reduced inversion effect for identity but a normal inversion effect for expression. Third, DPs' performance on the expression tasks were linked to autism traits, but their performance on the identity tasks were not. These results constitute several dissociations between identity and expression processing in DP, and they are consistent with the view that the core impairment in DP is highly selective to identity.

Recognition of animal faces is impaired in developmental prosopagnosia

An on-going debate in psychology and neuroscience concerns the way faces and objects are represented. Domain-specific theories suggest that faces are processed via a specialised mechanism, separate from objects. Developmental prosopagnosia (DP) is a neurodevelopmental disorder in which there is a deficit in the ability to recognize conspecific (human) faces. It is unclear, however, whether prosopagnosia also affects recognition of heterospecific (animal) faces. To address this question, we compared recognition performance with human and animal faces in neurotypical controls and participants with DP. We found that DPs showed deficits in the recognition of both human and animal faces compared to neurotypical controls. In contrast to, we found no group-level deficit in the recognition of animate or inanimate non-face objects in DPs. Using an individual-level approach, we demonstrate that in 60% of cases in which face recognition is impaired, there is a concurrent deficit with animal faces. Together, these results show that DPs have a general deficit in the recognition of faces that encompass a range of configural and morphological structures.

The neural correlates of domain-general visual ability

People vary in their general ability to compare, identify, and remember objects. Research using latent variable modeling identifies a domain-general visual recognition ability (called o) that reflects correlations among different visual tasks and categories. We measure associations between a psychometrically-sensitive measure of o and a neurometrically-sensitive measure of visual sensitivity to shape. We report evidence for distributed neural correlates of o using functional and anatomical regions-of-interest (ROIs) as well as whole brain analyses. Neural selectivity to shape is associated with o in several regions of the ventral pathway, as well as additional foci in parietal and premotor cortex. Multivariate analyses suggest the distributed effects in ventral cortex reflect a common mechanism. The network of brain areas where neural selectivity predicts o is similar to that evoked by the most informative features for object recognition in prior work, showing convergence of 2 different approaches on identifying areas that support the best object recognition performance. Because o predicts performance across many visual tasks for both novel and familiar objects, we propose that o could predict the magnitude of neural changes in task-relevant areas following experience with specific task and object category.

The face inversion effect or the face upright effect?

The face inversion effect (FIE) refers to the observation that presenting stimuli upside-down impairs the processing of faces disproportionally more than other mono-oriented objects. This has been taken as evidence that processing of faces and objects differ qualitatively. However, nearly all FIE studies are based on comparing individuation of upright faces, which most people are rather good at, with individuation of objects most people are much less familiar with individuating (e.g., radios and airplanes). Consequently, the FIE may mainly reflect differences between categories in how they are processed prior to inversion, with within-category discrimination of upright faces being a much more familiar task than within-category discrimination among members belonging to other object classes. We tested this hypothesis by comparing inversion effects for faces and objects using object recognition tasks that do not require within-category discrimination (object decision and old/new recognition memory tasks). In all tasks (seven with objects and two with faces) we find credible inversion effects, but in no instance were these effects significantly larger for faces than for objects. This suggests that the FIE can be a product of familiarity with the type of identification process required in the upright conditions rather than some process that is selectively affected for faces when stimuli are inverted.

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.

Contrasting domain-general and domain-specific accounts in cognitive neuropsychology: An outline of a new approach with developmental prosopagnosia as a case

The backbone of cognitive neuropsychology is the observation of (double) dissociations in performance between patients, suggesting some degree of independence between cognitive processes (domain specificity). In comparison, observations of associations between disorders/deficits have been deemed less evidential in neuropsychological theorizing about cognitive architecture. The reason is that associations can reflect damage to independent cognitive processes that happen to be mediated by structures commonly affected by the same brain disorder rather than damage to a shared (domain-general) mechanism. Here we demonstrate that it is in principle possible to discriminate between these alternatives by means of a procedure involving large unbiased samples. We exemplify the procedure in the context of developmental prosopagnosia (DP), but the procedure is in principle applicable to all neuropsychological deficits/disorders. A simulation of the procedure on a dataset yields estimates of dissociations/associations that are well in line with existing DP-studies, and also suggests that seemingly selective disorders can reflect damage to both domain-general and domain-specific cognitive processes. However, the simulation also highlights some limitations that should be considered if the procedure is to be applied prospectively. The main advantage of the procedure is that allows for examination of both associations and dissociations in the same sample. Hence, it may help even the balance in the use of associations and dissociations as grounds for neuropsychological theorizing.

Face-Information Sampling in Super-Recognizers

Perceptual processes underlying individual differences in face-recognition ability remain poorly understood. We compared visual sampling of 37 adult super-recognizers-individuals with superior face-recognition ability-with that of 68 typical adult viewers by measuring gaze position as they learned and recognized unfamiliar faces. In both phases, participants viewed faces through "spotlight" apertures that varied in size, with face information restricted in real time around their point of fixation. We found higher accuracy in super-recognizers at all aperture sizes-showing that their superiority does not rely on global sampling of face information but is also evident when they are forced to adopt piecemeal sampling. Additionally, super-recognizers made more fixations, focused less on eye region, and distributed their gaze more than typical viewers. These differences were most apparent when learning faces and were consistent with trends we observed across the broader ability spectrum, suggesting that they are reflective of factors that vary dimensionally in the broader 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.

Characteristic fixation biases in Super-Recognizers

Neurotypical observers show large and reliable individual differences in gaze behavior along several semantic object dimensions. Individual gaze behavior toward faces has been linked to face identity processing, including that of neurotypical observers. Here, we investigated potential gaze biases in Super-Recognizers (SRs), individuals with exceptional face identity processing skills. Ten SRs, identified with a novel conservative diagnostic framework, and 43 controls freely viewed 700 complex scenes depicting more than 5000 objects. First, we tested whether SRs and controls differ in fixation biases along four semantic dimensions: faces, text, objects being touched, and bodies. Second, we tested potential group differences in fixation biases toward eyes and mouths. Finally, we tested whether SRs fixate closer to the theoretical optimal fixation point for face identification. SRs showed a stronger gaze bias toward faces and away from text and touched objects, starting from the first fixation onward. Further, SRs spent a significantly smaller proportion of first fixations and dwell time toward faces on mouths but did not differ in dwell time or first fixations devoted to eyes. Face fixation of SRs also fell significantly closer to the theoretical optimal fixation point for identification, just below the eyes. Our findings suggest that reliable superiority for face identity processing is accompanied by early fixation biases toward faces and preferred saccadic landing positions close to the theoretical optimum for face identification. We discuss future directions to investigate the functional basis of individual fixation behavior and face identity processing ability.

Normal gaze processing in developmental prosopagnosia

Two key functions in human face perception are gaze discrimination and identity recognition. Here we examine whether gaze discrimination can be intact when identity recognition is impaired in developmental prosopagnosia (DP). We ran a large sample of developmental prosopagnosics (DPs) with a series of gaze discrimination tasks that assess various mechanisms in gaze processing. Experiment 1 (N = 101 DP participants) investigates spatial processing using an abnormal eye gaze detection task and a Wollaston illusion task that measures perceptual integration of eye and head direction. Experiment 2 (N = 45 DP participants) investigates temporal processing using an adaptation task and a serial dependence task. Despite their deficits with identity recognition, DPs performed in the normal range across both experiments. These results demonstrate that gaze discrimination can be normal in DP, and that various mechanisms of gaze processing can be spared when identity recognition is impaired. Our findings clarify the highly selective nature of impairments in DP and provide support for neurocognitive models of face perception with distinct mechanisms for gaze and identity processing.

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

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

A connectivity-constrained computational account of topographic organization in primate high-level visual cortex

Inferotemporal (IT) cortex in humans and other primates is topographically organized, containing multiple hierarchically organized areas selective for particular domains, such as faces and scenes. This organization is commonly viewed in terms of evolved domain-specific visual mechanisms. Here, we develop an alternative, domain-general and developmental account of IT cortical organization. The account is instantiated in interactive topographic networks (ITNs), a class of computational models in which a hierarchy of model IT areas, subject to biologically plausible connectivity-based constraints, learns high-level visual representations optimized for multiple domains. We find that minimizing a wiring cost on spatially organized feedforward and lateral connections, alongside realistic constraints on the sign of neuronal connectivity within model IT, results in a hierarchical, topographic organization. This organization replicates a number of key properties of primate IT cortex, including the presence of domain-selective spatial clusters preferentially involved in the representation of faces, objects, and scenes; columnar responses across separate excitatory and inhibitory units; and generic spatial organization whereby the response correlation of pairs of units falls off with their distance. We thus argue that topographic domain selectivity is an emergent property of a visual system optimized to maximize behavioral performance under generic connectivity-based constraints.

Match me if you can: Evidence for a domain-general visual comparison ability

Visual comparison-comparing visual stimuli (e.g., fingerprints) side by side and determining whether they originate from the same or different source (i.e., "match")-is a complex discrimination task involving many cognitive and perceptual processes. Despite the real-world consequences of this task, which is often conducted by forensic scientists, little is understood about the psychological processes underpinning this ability. There are substantial individual differences in visual comparison accuracy amongst both professionals and novices. The source of this variation is unknown, but may reflect a domain-general and naturally varying perceptual ability. Here, we investigate this by comparing individual differences (N = 248 across two studies) in four visual comparison domains: faces, fingerprints, firearms, and artificial prints. Accuracy on all comparison tasks was significantly correlated and accounted for a substantial portion of variance (e.g., 42% in Exp. 1) in performance across all tasks. Importantly, this relationship cannot be attributed to participants' intrinsic motivation or skill in other visual-perceptual tasks (visual search and visual statistical learning). This paper provides novel evidence of a reliable, domain-general visual comparison ability.

Domain-specific connectivity drives the organization of object knowledge in the brain

The goal of this chapter is to review neuropsychological and functional MRI findings that inform a theory of the causes of functional specialization for semantic categories within occipito-temporal cortex-the ventral visual processing pathway. The occipito-temporal pathway supports visual object processing and recognition. The theoretical framework that drives this review considers visual object recognition through the lens of how "downstream" systems interact with the outputs of visual recognition processes. Those downstream processes include conceptual interpretation, grasping and object use, navigating and orienting in an environment, physical reasoning about the world, and inferring future actions and the inner mental states of agents. The core argument of this chapter is that innately constrained connectivity between occipito-temporal areas and other regions of the brain is the basis for the emergence of neural specificity for a limited number of semantic domains in the brain.

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.

Face processing in the temporal lobe

Face perception is a socially important but complex process with many stages and many facets. There is substantial evidence from many sources that it involves a large extent of the temporal lobe, from the ventral occipitotemporal cortex and superior temporal sulci to anterior temporal regions. While early human neuroimaging work suggested a core face network consisting of the occipital face area, fusiform face area, and posterior superior temporal sulcus, studies in both humans and monkeys show a system of face patches stretching from posterior to anterior in both the superior temporal sulcus and inferotemporal cortex. Sophisticated techniques such as fMRI adaptation have shown that these face-activated regions show responses that have many of the attributes of human face processing. Lesions of some of these regions in humans lead to variants of prosopagnosia, the inability to recognize the identity of a face. Lesion, imaging, and electrophysiologic data all suggest that there is a segregation between identity and expression processing, though some suggest this may be better characterized as a distinction between static and dynamic facial information.

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.

An update of the Benton Facial Recognition Test

The Benton Facial Recognition Test (BFRT) is a paper-and-pen task that is traditionally used to assess face perception skills in neurological, clinical and psychiatric conditions. Despite criticisms of its stimuli, the task enjoys a simple procedure and is rapid to administer. Further, it has recently been computerised (BFRT-c), allowing reliable measurement of completion times and the need for online testing. Here, in response to calls for repeat screening for the accurate detection of face processing deficits, we present the BFRT-Revised (BFRT-r): a new version of the BFRT-c that maintains the task's basic paradigm, but employs new, higher-quality stimuli that reflect recent theoretical advances in the field. An initial validation study with typical participants indicated that the BFRT-r has good internal reliability and content validity. A second investigation indicated that while younger and older participants had comparable accuracy, completion times were longer in the latter, highlighting the need for age-matched norms. Administration of the BFRT-r and BFRT-c to 32 individuals with developmental prosopagnosia resulted in improved sensitivity in diagnostic screening for the BFRT-r compared to the BFRT-c. These findings are discussed in relation to current diagnostic screening protocols for face perception deficits. The BFRT-r is stored in an open repository and is freely available to other researchers.

Accurate but inefficient: Standard face identity matching tests fail to identify prosopagnosia

In recent years, the number of face identity matching tests in circulation has grown considerably and these are being increasingly utilized to study individual differences in face cognition. Although many of these tests were designed for testing typical observers, recent studies have begun to utilize general-purpose tests for studying specific, atypical populations (e.g., super-recognizers and individuals with prosopagnosia). In this study, we examined the capacity of four tests requiring binary face-matching decisions to study individual differences between healthy observers. Uniquely, we used performance of the patient PS (Rossion, 2018), a well-documented case of acquired prosopagnosia (AP), as a benchmark. Two main findings emerged: (i) PS could exhibit typical rates of accuracy in all tests; (ii) compared to age-matched controls and when considering both accuracy and speed to account for potential trade-offs, only the KFMT - but not the EFCT, PICT or GFMT - was able to detect PS's severe impairment. These findings reflect the importance of considering both accuracy and response times to measure individual differences in face matching, and the need for comparing tests in terms of their sensitivity, when used as a measure of human cognition and brain functioning.

Comparing the sensitivity of face matching assessments to detect face perception impairments

Numerous neurological, developmental, and psychiatric conditions demonstrate impaired face recognition, which can be socially debilitating. These impairments can be caused by either deficient face perception or face memory mechanisms. Though there are well-validated, sensitive measures of face memory impairments, it currently remains unclear which assessments best measure face perception impairments. A sensitive, validated face perception measure could help with diagnosing causes of face recognition deficits and be useful in characterizing individual differences in unimpaired populations. Here, we compared the computerized Benton Face Recognition Test (BFRT-c) and Cambridge Face Perception Test (CFPT) in their ability to differentiate developmental prosopagnosics (DPs, N = 30) and age-matched controls (N = 30). Participants completed the BFRT-c, CFPT, and two additional face perception assessments: the University of Southern California Face Perception Test (USCFPT) and a novel same/different face matching test (SDFMT). Participants were also evaluated on objective and subjective face recognition tasks including the Cambridge Face Memory Test, famous faces test, and Prosopagnosia Index-20. We performed a logistic regression with the perception tests predicting DP vs. control group membership and used multiple linear regressions to predict continuous objective and subjective face recognition memory. Our results show that the BFRT-c performed as well as, if not better than, the CFPT, and that both tests clearly outperformed the USCFPT and SDFMT. Further, exploratory analyses revealed that face lighting-change conditions better predicted DP group membership and face recognition abilities than viewpoint-change conditions. Together, these results support the combined use of the BFRT-c and CFPT to best assess face perception impairments.