The power of how-lessons learned from neuropsychology and face processing

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.

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.

Data-driven studies in face identity processing rely on the quality of the tests and data sets

There is growing interest in how data-driven approaches can help understand individual differences in face identity processing (FIP). However, researchers employ various FIP tests interchangeably, and it is unclear whether these tests 1) measure the same underlying ability/ies and processes (e.g., confirmation of identity match or elimination of identity match) 2) are reliable, 3) provide consistent performance for individuals across tests online and in laboratory. Together these factors would influence the outcomes of data-driven analyses. Here, we asked 211 participants to perform eight tests frequently reported in the literature. We used Principal Component Analysis and Agglomerative Clustering to determine factors underpinning performance. Importantly, we examined the reliability of these tests, relationships between them, and quantified participant consistency across tests. Our findings show that participants' performance can be split into two factors (called here confirmation and elimination of an identity match) and that participants cluster according to whether they are strong on one of the factors or equally on both. We found that the reliability of these tests is at best moderate, the correlations between them are weak, and that the consistency in participant performance across tests and is low. Developing reliable and valid measures of FIP and consistently scrutinising existing ones will be key for drawing meaningful conclusions from data-driven studies.

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.

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.

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.

Differences between and within individuals, and subprocesses of face cognition: implications for theory, research and personnel selection

Recent investigations of individual differences have demonstrated striking variability in performance both within the same subprocess in face cognition (e.g. face perception), but also between two different subprocesses (i.e. face perception versus face recognition) that are assessed using different tasks (face matching versus face memory). Such differences between and within individuals between and within laboratory tests raise practical challenges. This applies in particular to the development of screening tests for the selection of personnel in real-world settings where faces are routinely processed, such as at passport control. The aim of this study, therefore, was to examine the performance profiles of individuals within and across two different subprocesses of face cognition: face perception and face recognition. To this end, 146 individuals completed four different tests of face matching-one novel tool for assessing proficiency in face perception, as well as three established measures-and two benchmark tests of face memory probing face recognition. In addition to correlational analyses, we further scrutinized individual performance profiles of the highest and lowest performing observers identified per test, as well as across all tests. Overall, a number of correlations emerged between tests. However, there was limited evidence at the individual level to suggest that high proficiency in one test generalized to other tests measuring the same subprocess, as well as those that measured a different subprocess. Beyond emphasizing the need to honour inter-individual differences through careful multivariate assessment in the laboratory, our findings have real-world implications: combinations of tests that most accurately map the task(s) and processes of interest are required for personnel selection.

Normative data for two challenging tests of face matching under ecological conditions

Background

Unfamiliar face processing is an ability that varies considerably between individuals. Numerous studies have aimed to identify its underlying determinants using controlled experimental procedures. While such tests can isolate variables that influence face processing, they usually involve somewhat unrealistic situations and optimized face images as stimulus material. As a consequence, the extent to which the performance observed under laboratory settings is informative for predicting real-life proficiency remains unclear.

Results

We present normative data for two ecologically valid but underused tests of face matching: the Yearbook Test (YBT) and the Facial Identity Card Sorting Test (FICST). The YBT (n = 252) measures identity matching across substantial age-related changes in facial appearance, while the FICST (n = 218) assesses the ability to process unfamiliar facial identity despite superficial image variations. To determine the predictive value of both tests, a subsample of our cohort (n = 181) also completed a commonly used test of face recognition and two tests of face perception (the long form of the Cambridge Face Memory Test (CFMT+), the Expertise in Facial Comparison Test (EFCT) and the Person Identification Challenge Test (PICT)).

Conclusions

Focusing on the top performers identified independently per test, we made two important observations: 1) YBT and FICST performance can predict CFMT+ scores and vice versa; and 2) EFCT and PICT scores neither reliably predict superior performance in ecologically meaningful and challenging tests of face matching, nor in the most commonly used test of face recognition. These findings emphasize the necessity for using challenging and ecologically relevant, and thus highly sensitive, tasks of unfamiliar face processing to identify high-performing individuals in the normal population.

Progress in perceptual research: the case of prosopagnosia

Prosopagnosia is an impairment in the ability to recognize faces and can be acquired after a brain lesion or occur as a developmental variant. Studies of prosopagnosia make important contributions to our understanding of face processing and object recognition in the human visual system. We review four areas of advances in the study of this condition in recent years. First are issues surrounding the diagnosis of prosopagnosia, including the development and evaluation of newer tests and proposals for diagnostic criteria, especially for the developmental variant. Second are studies of the structural basis of prosopagnosia, including the application of more advanced neuroimaging techniques in studies of the developmental variant. Third are issues concerning the face specificity of the defect in prosopagnosia, namely whether other object processing is affected to some degree and in particular the status of visual word processing in light of recent predictions from the "many-to-many hypothesis". Finally, there have been recent rehabilitative trials of perceptual learning applied to larger groups of prosopagnosic subjects that show that face impairments are not immutable in this condition.

Object recognition in acquired and developmental prosopagnosia

Whether face and object recognition are dissociated in prosopagnosia continues to be debated: a recent review highlighted deficiencies in prior studies regarding the evidence for such a dissociation. Our goal was to study cohorts with acquired and developmental prosopagnosia with a complementary battery of tests of object recognition that address prior limitations, as well as evaluating for residual effects of object expertise. We studied 15 subjects with acquired and 12 subjects with developmental prosopagnosia on three tests: the Old/New Tests, the Cambridge Bicycle Memory Test, and the Expertise-adjusted Test of Car Recognition. Most subjects with developmental prosopagnosia were normal on the Old/New Tests: for acquired prosopagnosia, subjects with occipitotemporal lesions often showed impairments while those with anterior temporal lesions did not. Ten subjects showed a putative classical dissociation between the Cambridge Face and Bicycle Memory Tests, seven of whom had normal reaction times. Both developmental and acquired groups showed reduced car recognition on the expertise-adjusted test, though residual effects of expertise were still evident. Two subjects with developmental prosopagnosia met criteria for normal object recognition across all tests. We conclude that strong evidence for intact object recognition can be found in a few subjects but the majority show deficits, particularly those with the acquired form. Both acquired and developmental forms show residual but reduced object expertise effects.

Super-recognizers: From the lab to the world and back again

The recent discovery of individuals with superior face processing ability has sparked considerable interest amongst cognitive scientists and practitioners alike. These ‘Super‐recognizers’ (SRs) offer clues to the underlying processes responsible for high levels of face processing ability. It has been claimed that they can help make societies safer and fairer by improving accuracy of facial identity processing in real‐world tasks, for example when identifying suspects from Closed Circuit Television or performing security‐critical identity verification tasks. Here, we argue that the current understanding of superior face processing does not justify widespread interest in SR deployment: There are relatively few studies of SRs and no evidence that high accuracy on laboratory‐based tests translates directly to operational deployment. Using simulated data, we show that modest accuracy benefits can be expected from deploying SRs on the basis of ideally calibrated laboratory tests. Attaining more substantial benefits will require greater levels of communication and collaboration between psychologists and practitioners. We propose that translational and reverse‐translational approaches to knowledge development are critical to advance current understanding and to enable optimal deployment of SRs in society. Finally, we outline knowledge gaps that this approach can help address.

Decisional space modulates visual categorization - Evidence from saccadic reaction times

Manual and saccadic reaction times (SRTs) have been used to determine the minimum time required for different types of visual categorizations. Such studies have demonstrated extremely rapid detection of faces within natural scenes, whereas increasingly complex decisions (i.e. levels of processing) require longer processing times. We reasoned that visual categorization speed is not only dependent on the processing level, but is further affected by decisional space constraints. In the context of two different tasks, observers performed choice saccades towards female (gender categorization) or personally familiar (familiarity categorization) faces. Additionally, familiarity categorizations were completed with stimulus sets that differed in the number of individuals presented (3 vs. 7 identities) to investigate the effect of decisional space constraints. We observe an inverse relationship between visual categorization proficiency and decisional space. Observers were most accurate for categorization of gender, which could be achieved in as little as 140 ms. Categorization of highly predictable targets was more error-prone and required an additional ∼100 ms processing time. Our findings add to an increasing body of evidence demonstraing that pre-activation of identity-information can modulate early visual processing in a top-down manner. They also emphasize the importance of considering procedural aspects, as well as terminology when aiming to characterize cognitive processes.

Over time, the right results will emerge

Scientific research involves going beyond the well-trodden and well-tested ideas and theories that form the core of scientific knowledge. During the time scientists are working things out, some results will be right, and others will be wrong. Over time, the right results will emerge. Lisa Randall (Frank B. Baird, Jr. Professor of Science, Physics Department, Harvard University) We are grateful to all the commentators for the important and thoughtful comments raised in response to the Geskin and Behrmann (G & B) literature survey. The issues raised in the introduction to this Special Issue and in these commentaries not only address and challenge aspects of the G & B literature review, but contribute perspectives and extensions that go well beyond the scope of the review. As is evident from G & B and from the 13 commentaries, many aspects of congenital prosopagnosia (CP) remain controversial. Adopting the language of the quote above, the intention of the G & B survey, along with the commentaries and this response, is to establish a collaborative process from which the right results (and right theory) will emerge in time. We are grateful to the editor of this Special Issue, Dr. Brad Mahon, for his support and for facilitating this collaborative exchange in Cognitive Neuropsychology.

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

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

Decisional space determines saccadic reaction times in healthy observers and acquired prosopagnosia

Determining the familiarity and identity of a face have been considered as independent processes. Covert face recognition in cases of acquired prosopagnosia, as well as rapid detection of familiarity have been taken to support this view. We tested P.S. a well-described case of acquired prosopagnosia, and two healthy controls (her sister and daughter) in two saccadic reaction time (SRT) experiments. Stimuli depicted their family members and well-matched unfamiliar distractors in the context of binary gender, or familiarity decisions. Observers' minimum SRTs were estimated with Bayesian approaches. For gender decisions, P.S. and her daughter achieved sufficient performance, but displayed different SRT distributions. For familiarity decisions, her daughter exhibited above chance level performance and minimum SRTs corresponding to those reported previously in healthy observers, while P.S. performed at chance. These findings extend previous observations, indicating that decisional space determines performance in both the intact and impaired face processing system.