Perceptual Expertise Effects Are Not All or None: Spatially Limited Perceptual Expertise for Faces in a Case of Prosopagnosia

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

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

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.

Stability of face recognition abilities after left or right anterior temporal lobectomy

Patients with anterior temporal lobe (ATL) resection due to mesial temporal lobe epilepsy (MTLE) have difficulties at identifying familiar faces and explicitly remembering newly learned faces but their ability to individuate unfamiliar faces remains largely unknown. Moreover, the extent to which their difficulties with familiar face identity recognition and learning is truly due to the ATL resection remains unknown. Here, we report a study of 24 MTLE patients and matched healthy controls tested with an extensive set of seven face and visual object recognition tasks (including three tasks evaluating unfamiliar face individuation) before and about 6 months after unilateral (nine left, 15 right) ATL resection. We found that ATL resection has little or no effect on the patients' preserved pre-surgical ability to perform unfamiliar face individuation, both at the group and individual levels. More surprisingly, ATL resection also has little effect on the patients' performance at recognizing and naming famous faces as well as at learning new faces. A substantial proportion of right MTLE patients (33%) even improved their response times on several tasks, which may indicate a functional release of visuo-spatial processing after resection in the right ATL. Altogether this study shows that face recognition abilities are mainly unaffected by ATL resection in MTLE, either because the critical regions for face recognition are spared or because performance at some tasks is already lower than normal preoperatively. Overall, these findings urge caution when interpreting the causal effect of brain lesions on face recognition ability in patients with ATL resection due to MTLE. They also illustrate the complexity of predicting cognitive outcomes after epilepsy surgery because of the influence of many different intertwined factors.

Investigating the role of the fusiform face area and occipital face area using multifocal transcranial direct current stimulation

The functional role of the occipital face area (OFA) and the fusiform face area (FFA) in face recognition is inconclusive to date. While some research has shown that the OFA and FFA are involved in early (i.e., featural processing) and late (i.e., holistic processing) stages of face recognition respectively, other research suggests that both regions are involved in both early and late stages of face recognition. Thus, the current study aims to further examine the role of the OFA and the FFA using multifocal transcranial direct current stimulation (tDCS). In Experiment 1, we used computer-generated faces. Thirty-five participants completed whole face and facial features (i.e., eyes, nose, mouth) recognition tasks after OFA and FFA stimulation in a within-subject design. No difference was found in recognition performance after either OFA or FFA stimulation. In Experiment 2 with 60 participants, we used real faces, provided stimulation following a between-subjects design and included a sham control group. Results showed that FFA stimulation led to enhanced efficiency of facial features recognition. Additionally, no effect of OFA stimulation was found for either facial feature or whole face recognition. These results suggest the involvement of FFA in the recognition of facial features.

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.

Implicit evidence on the dissociation of identity and emotion recognition

Recognition of identity and of emotional facial expressions of individuals are both based on processing of the human face. While most studies show these abilities to be dissociated, some others find evidence of a connection. One possible explanation for these contradictory results comes from neurological evidence, which points to identity recognition being mostly based on holistic processing, while emotion recognition seems to be based on both an explicit, fine-grained process, and an implicit, mostly-holistic one. Our main hypothesis, that would explain the contradictory findings, is that holistic implicit emotion recognition, specifically, would be related to identity recognition, while explicit emotion recognition would be a process separate to identity recognition. To test this hypothesis, we employed an experimental paradigm in which spatial frequencies of visual stimuli are manipulated so that automatic, holistic-based, implicit emotion recognition influences perceived friendliness of unfamiliar faces. We predicted the effect to be related to identity recognition ability, since they both require holistic face processing. After a successful replication study, we employed the paradigm with 140 participants, measuring also identity recognition ability and explicit emotion recognition ability. Results showed that the effect is not moderated by these two variables (p = .807 and .373, respectively), suggesting that the independence of identity and emotion recognition holds even when considering, specifically, implicit emotion recognition.

Multi-modal Mapping of the Face Selective Ventral Temporal Cortex-A Group Study With Clinical Implications for ECS, ECoG, and fMRI

Face recognition is impaired in patients with prosopagnosia, which may occur as a side effect of neurosurgical procedures. Face selective regions on the ventral temporal cortex have been localized with electrical cortical stimulation (ECS), electrocorticography (ECoG), and functional magnetic resonance imagining (fMRI). This is the first group study using within-patient comparisons to validate face selective regions mapping, utilizing the aforementioned modalities. Five patients underwent surgical treatment of intractable epilepsy and joined the study. Subdural grid electrodes were implanted on their ventral temporal cortices to localize seizure foci and face selective regions as part of the functional mapping protocol. Face selective regions were identified in all patients with fMRI, four patients with ECoG, and two patients with ECS. From 177 tested electrode locations in the region of interest (ROI), which is defined by the fusiform gyrus and the inferior temporal gyrus, 54 face locations were identified by at least one modality in all patients. fMRI mapping showed the highest detection rate, revealing 70.4% for face selective locations, whereas ECoG and ECS identified 64.8 and 31.5%, respectively. Thus, 28 face locations were co-localized by at least two modalities, with detection rates of 89.3% for fMRI, 85.7% for ECoG and 53.6 % for ECS. All five patients had no face recognition deficits after surgery, even though five of the face selective locations, one obtained by ECoG and the other four by fMRI, were within 10 mm to the resected volumes. Moreover, fMRI included a quite large volume artifact on the ventral temporal cortex in the ROI from the anatomical structures of the temporal base. In conclusion, ECS was not sensitive in several patients, whereas ECoG and fMRI even showed activation within 10 mm to the resected volumes. Considering the potential signal drop-out in fMRI makes ECoG the most reliable tool to identify face selective locations in this study. A multimodal approach can improve the specificity of ECoG and fMRI, while simultaneously minimizing the number of required ECS sessions. Hence, all modalities should be considered in a clinical mapping protocol entailing combined results of co-localized face selective locations.

Prosopagnosia and disorders of face processing

Face recognition is a form of expert visual processing. Acquired prosopagnosia is the loss of familiarity for facial identity and has several functional variants, namely apperceptive, amnestic, and associative forms. Acquired forms are usually caused by either occipitotemporal or anterior temporal lesions, right or bilateral in most cases. In addition, there is a developmental form, whose functional and structural origins are still being elucidated. Despite their difficulties with recognizing faces, some of these subjects still show signs of covert recognition, which may have a number of explanations. Other aspects of face perception can be spared in prosopagnosic subjects. Patients with other types of face processing difficulties have been described, including impaired expression processing, impaired lip-reading, false familiarity for faces, and a people-specific amnesia. Recent rehabilitative studies have shown some modest ability to improve face perception in prosopagnosic subjects through perceptual training protocols.

Damasio's error - Prosopagnosia with intact within-category object recognition

The sudden inability to recognize individual faces following brain damage was first reported in a scientific journal 150 years ago and termed 'prosopagnosia' 70 years ago. While the term originally identified a face-selective neurological condition, it is now obscured by a sequence of imprecisions. First, prosopagnosia is routinely used to define symptoms of individual face recognition (IFR) difficulties in the context of visual object agnosia or other neurological conditions, or even in the normal population. Second, this over-expansive definition has lent support to a long-standing within-category recognition account of prosopagnosia, that is, that the impairment of IFR reflects a general impairment in recognizing within-category objects. However, stringent experimental studies of classical cases of prosopagnosia following brain damage show that their core impairment is not in recognizing physically similar exemplars within non-face object categories. Instead, the impairment presents specifically for recognizing exemplars of the category of faces. Moreover, compared to typical observers, the impairment appears even more severe for recognizing individual faces against physically dissimilar than similar distractors. Here, I argue that we need to limit accordingly our definition of prosopagnosia to a clinical (i.e., neurological) condition in which there is no basic-level object recognition impairment. Other criteria for prosopagnosia are proposed, with the hope that this conservative definition enables the study of human IFR processes in isolation, and supports progress in understanding the nature of these processes.

It's Not All About the Face: Variability Reveals Asymmetric Obligatory Processing of Faces and Bodies in Whole-Body Contexts

Researchers have sought to understand the specialized processing of faces and bodies in isolation, but recently they have considered how face and body information interact within the context of the whole body. Although studies suggest that face and body information can be integrated, it remains an open question whether this integration is obligatory and whether contributions of face and body information are symmetrical. In a selective attention task with whole-body stimuli, we focused attention on either the face or body and tested whether variation in the irrelevant part could be ignored. We manipulated orientation to determine the extent to which inversion disrupted obligatory face and body processing. Obligatory processing was evidenced as performance changes in discrimination that depended on stimulus orientation when the irrelevant region varied. For upright but not inverted face discrimination, participants could not ignore body posture variation, even when it was not diagnostic to the task. However, participants could ignore face variation for upright body posture discrimination but not for inverted posture discrimination. The extent to which face and body information necessarily influence each other in whole-body contexts appears to depend on both domain-general attentional and face- or body-specific holistic processing mechanisms.

Preserved Expert Object Recognition in a Case of Visual Hemiagnosia

We examined a stroke patient (HWS) with a unilateral lesion of the right medial ventral visual stream, involving the right fusiform and parahippocampal gyri. In a number of object recognition tests with lateralized presentations of target stimuli, HWS showed significant symptoms of hemiagnosia with contralesional recognition deficits for everyday objects. We further explored the patient's capacities of visual expertise that were acquired before the current perceptual impairment became effective. We confronted him with objects he was an expert for already before stroke onset and compared this performance with the recognition of familiar everyday objects. HWS was able to identify significantly more of the specific (“expert”) than of the everyday objects on the affected contralesional side. This observation of better expert object recognition in visual hemiagnosia allows for several interpretations. The results may be caused by enhanced information processing for expert objects in the ventral system in the affected or the intact hemisphere. Expert knowledge could trigger top–down mechanisms supporting object recognition despite of impaired basic functions of object processing. More importantly, the current work demonstrates that top–down mechanisms of visual expertise influence object recognition at an early stage, probably before visual object information propagates to modules of higher object recognition. Because HWS showed a lesion to the fusiform gyrus and spared capacities of expert object recognition, the current study emphasizes possible contributions of areas outside the ventral stream to visual expertise.

Congenital prosopagnosia without object agnosia? A literature review

A longstanding controversy concerns the functional organization of high-level vision, and the extent to which the recognition of different classes of visual stimuli engages a single system or multiple independent systems. We examine this in the context of congenital prosopagnosia (CP), a neurodevelopmental disorder in which individuals, without a history of brain damage, are impaired at face recognition. This paper reviews all CP cases from 1976 to 2016, and explores the evidence for the association or dissociation of face and object recognition. Of the 238 CP cases with data permitting a satisfactory evaluation, 80.3% evinced an association between impaired face and object recognition whereas 19.7% evinced a dissociation. We evaluate the strength of the evidence and correlate the face and object recognition behaviour. We consider the implications for theories of functional organization of the visual system, and offer suggestions for further adjudication of the relationship between face and object recognition.

Face and Word Recognition Can Be Selectively Affected by Brain Injury or Developmental Disorders

Face and word recognition have traditionally been thought to rely on highly specialised and relatively independent cognitive processes. Some of the strongest evidence for this has come from patients with seemingly category-specific visual perceptual deficits such as pure prosopagnosia, a selective face recognition deficit, and pure alexia, a selective word recognition deficit. Together, the patterns of impaired reading with preserved face recognition and impaired face recognition with preserved reading constitute a double dissociation. The existence of these selective deficits has been questioned over the past decade. It has been suggested that studies describing patients with these pure deficits have failed to measure the supposedly preserved functions using sensitive enough measures, and that if tested using sensitive measurements, all patients with deficits in one visual category would also have deficits in the other. The implications of this would be immense, with most textbooks in cognitive neuropsychology requiring drastic revisions. In order to evaluate the evidence for dissociations, we review studies that specifically investigate whether face or word recognition can be selectively affected by acquired brain injury or developmental disorders. We only include studies published since 2004, as comprehensive reviews of earlier studies are available. Most of the studies assess the supposedly preserved functions using sensitive measurements. We found convincing evidence that reading can be preserved in acquired and developmental prosopagnosia and also evidence (though weaker) that face recognition can be preserved in acquired or developmental dyslexia, suggesting that face and word recognition are at least in part supported by independent processes.

Seeing the eyes in acquired prosopagnosia

Case reports have suggested that perception of the eye region may be impaired more than that of other facial regions in acquired prosopagnosia. However, it is unclear how frequently this occurs, whether such impairments are specific to a certain anatomic subtype of prosopagnosia, and whether these impairments are related to changes in the scanning of faces. We studied a large cohort of 11 subjects with this rare disorder, who had a variety of occipitotemporal or anterior temporal lesions, both unilateral and bilateral. Lesions were characterized by functional and structural imaging. Subjects performed a perceptual discrimination test in which they had to discriminate changes in feature position, shape, or external contour. Test conditions were manipulated to stress focused or divided attention across the whole face. In a second experiment we recorded eye movements while subjects performed a face memory task. We found that greater impairment for eye processing was more typical of subjects with occipitotemporal lesions than those with anterior temporal lesions. This eye selectivity was evident for both eye position and shape, with no evidence of an upper/lower difference for external contour. A greater impairment for eye processing was more apparent under attentionally more demanding conditions. Despite these perceptual deficits, most subjects showed a normal tendency to scan the eyes more than the mouth. We conclude that occipitotemporal lesions are associated with a partially selective processing loss for eye information and that this deficit may be linked to loss of the right fusiform face area, which has been shown to have activity patterns that emphasize the eye region.

Impaired holistic processing of left-right composite faces in congenital prosopagnosia

Congenital prosopagnosia (CP) refers to a lifelong impairment in face processing despite normal visual and intellectual skills. Many studies have suggested that the key underlying deficit in CP is one of a failure to engage holistic processing. Moreover, there has been some suggestion that, in normal observers, there may be greater involvement of the right than left hemisphere in holistic processing. To examine the proposed deficit in holistic processing and its potential hemispheric atypicality in CP, we compared the performance of 8 CP individuals with both matched controls and a large group of non-matched controls on a novel, vertical composite task. In this task, participants judged whether a cued half of a face (either left or right half) was the same or different at study and test, and the two face halves could be either aligned or misaligned. The standard index of holistic processing is one in which the unattended face half influences performance on the cued half and this influence is greater in the aligned than in the misaligned condition. Relative to controls, the CP participants, both at a group and at an individual level, did not show holistic processing in the vertical composite task. There was also no difference in performance as a function of hemifield of the cued face half in the CP individuals, and this was true in the control participants, as well. The findings clearly confirm the deficit in holistic processing in CP and reveal the useful application of this novel experimental paradigm to this population and potentially to others as well.

Face processing improvements in prosopagnosia: successes and failures over the last 50 years

Clinicians and researchers have widely believed that face processing cannot be improved in prosopagnosia. Though more than a dozen reported studies have attempted to enhance face processing in prosopagnosics over the last 50 years, evidence for effective treatment approaches has only begun to emerge. Here, we review the current literature on spontaneous recovery in acquired prosopagnosia (AP), as well as treatment attempts in acquired and developmental prosopagnosia (DP), differentiating between compensatory and remedial approaches. We find that for AP, rather than remedial methods, strategic compensatory training such as verbalizing distinctive facial features has shown to be the most effective approach (despite limited evidence of generalization). In children with DP, compensatory training has also shown some effectiveness. In adults with DP, two recent larger-scale studies, one using remedial training and another administering oxytocin, have demonstrated group-level improvements and evidence of generalization. These results suggest that DPs, perhaps because of their more intact face processing infrastructure, may benefit more from treatments targeting face processing than APs.

A meta-analysis and review of holistic face processing

The concept of holistic processing is a cornerstone of face recognition research, yet central questions related to holistic processing remain unanswered, and debates have thus far failed to reach a resolution despite accumulating empirical evidence. We argue that a considerable source of confusion in this literature stems from a methodological problem. Specifically, 2 measures of holistic processing based on the composite paradigm (complete design and partial design) are used in the literature, but they often lead to qualitatively different results. First, we present a comprehensive review of the work that directly compares the 2 designs, and which clearly favors the complete design over the partial design. Second, we report a meta-analysis of holistic face processing according to both designs and use this as further evidence for one design over the other. The meta-analysis effect size of holistic processing in the complete design is nearly 3 times that of the partial design. Effect sizes were not correlated between measures, consistent with the suggestion that they do not measure the same thing. Our meta-analysis also examines the correlation between conditions in the complete design of the composite task, and suggests that in an individual differences context, little is gained by including a misaligned baseline. Finally, we offer a comprehensive review of the state of knowledge about holistic processing based on evidence gathered from the measure we favor based on the 1st sections of our review-the complete design-and outline outstanding research questions in that new context.

Holistic face training enhances face processing in developmental prosopagnosia

Prosopagnosia has largely been regarded as an untreatable disorder. However, recent case studies using cognitive training have shown that it is possible to enhance face recognition abilities in individuals with developmental prosopagnosia. Our goal was to determine if this approach could be effective in a larger population of developmental prosopagnosics. We trained 24 developmental prosopagnosics using a 3-week online face-training program targeting holistic face processing. Twelve subjects with developmental prosopagnosia were assessed before and after training, and the other 12 were assessed before and after a waiting period, they then performed the training, and were then assessed again. The assessments included measures of front-view face discrimination, face discrimination with view-point changes, measures of holistic face processing, and a 5-day diary to quantify potential real-world improvements. Compared with the waiting period, developmental prosopagnosics showed moderate but significant overall training-related improvements on measures of front-view face discrimination. Those who reached the more difficult levels of training ('better' trainees) showed the strongest improvements in front-view face discrimination and showed significantly increased holistic face processing to the point of being similar to that of unimpaired control subjects. Despite challenges in characterizing developmental prosopagnosics' everyday face recognition and potential biases in self-report, results also showed modest but consistent self-reported diary improvements. In summary, we demonstrate that by using cognitive training that targets holistic processing, it is possible to enhance face perception across a group of developmental prosopagnosics and further suggest that those who improved the most on the training task received the greatest benefits.

Natural experience modulates the processing of older adult faces in young adults and 3-year-old children

Just like other face dimensions, age influences the way faces are processed by adults as well as by children. However, it remains unclear under what conditions exactly such influence occurs at both ages, in that there is some mixed evidence concerning the presence of a systematic processing advantage for peer faces (own-age bias) across the lifespan. Inconsistency in the results may stem from the fact that the individual's face representation adapts to represent the most predominant age traits of the faces present in the environment, which is reflective of the individual's specific living conditions and social experience. In the current study we investigated the processing of younger and older adult faces in two groups of adults (Experiment 1) and two groups of 3-year-old children (Experiment 2) who accumulated different amounts of experience with elderly people. Contact with elderly adults influenced the extent to which both adult and child participants showed greater discrimination abilities and stronger sensitivity to configural/featural cues in younger versus older adult faces, as measured by the size of the inversion effect. In children, the size of the inversion effect for older adult faces was also significantly correlated with the amount of contact with elderly people. These results show that, in both adults and children, visual experience with older adult faces can tune perceptual processing strategies to the point of abolishing the discrimination disadvantage that participants typically manifest for those faces in comparison to younger adult faces.

First fixations in face processing: the more diagnostic they are the smaller the face-inversion effect

Hills, Ross, and Lewis (2011) introduced the concept that the face-inversion effect may, in part, be carried by the first feature attended to, since the first feature fixated upon is different for upright and inverted faces. An eye-tracking study that directly assesses this hypothesis by using fixation crosses to guide attention to the eye or mouth region of the to-be-presented upright and inverted faces was devised. Recognition was better when the fixation cross appeared at the eye region than at the mouth region. The face-inversion effect was smaller when the eyes were cued than when the mouth was cued or when there was no cueing. The eye-tracking measures confirmed that the fixation crosses attracted the first fixation but did not affect other measures of eye-movements. Furthermore, the location of the first fixation predicted recognition accuracy: when the first fixation was to the eyes, recognition accuracy was higher than when the first fixation was to the mouth, irrespective of facial orientation. The results suggest that the first facial feature attended to is more predictive of recognition accuracy than the face orientation in which they are presented.

Bilateral hemispheric processing of words and faces: evidence from word impairments in prosopagnosia and face impairments in pure alexia

Considerable research has supported the view that faces and words are subserved by independent neural mechanisms located in the ventral visual cortex in opposite hemispheres. On this view, right hemisphere ventral lesions that impair face recognition (prosopagnosia) should leave word recognition unaffected, and left hemisphere ventral lesions that impair word recognition (pure alexia) should leave face recognition unaffected. The current study shows that neither of these predictions was upheld. A series of experiments characterizing speed and accuracy of word and face recognition were conducted in 7 patients (4 pure alexic, 3 prosopagnosic) and matched controls. Prosopagnosic patients revealed mild but reliable word recognition deficits, and pure alexic patients demonstrated mild but reliable face recognition deficits. The apparent comingling of face and word mechanisms is unexpected from a domain-specific perspective, but follows naturally as a consequence of an interactive, learning-based account in which neural processes for both faces and words are the result of an optimization procedure embodying specific computational principles and constraints.

Focal electrical intracerebral stimulation of a face-sensitive area causes transient prosopagnosia

Face perception is subtended by a large set of areas in the human ventral occipito-temporal cortex. However, the role of these areas and their importance for face recognition remain largely unclear. Here we report a case of transient selective impairment in face recognition (prosopagnosia) induced by focal electrical intracerebral stimulation of the right inferior occipital gyrus. This area presents with typical face-sensitivity as evidenced by functional neuroimaging right occipital face area (OFA). A face-sensitive intracerebral N170 was also recorded in this area, supporting its contribution as a source of the well-known N170 component typically recorded on the scalp. Altogether, these observations indicate that face recognition can be selectively impaired by local disruption of a single face-sensitive area of the network subtending this function, the right OFA.

Individuation experience predicts other-race effects in holistic processing for both Caucasian and Black participants

Same-race (SR) faces are recognized better than other-race (OR) faces, and this other-race effect (ORE) is correlated with experience. SR faces are also processed more holistically than OR faces, suggesting one possible mechanism for poorer performance on OR faces. Studies of object expertise have shown that individuating experiences are necessary for holistic processing to develop; yet thus far no studies have investigated the role of quality of experience and the ORE for holistic processing. In the present study, we found a strong negative correlation between a self-report of individuating experience and the ORE in holistic processing in both Caucasian and Black participants, indicating that the more individuating experience a person has, the less ORE in holistic processing. This confirms the critical role of individuating experience in development of holistic processing for faces and suggests that quality of experience is a key determinant of the manner in which OR faces are processed.

Does acquisition of Greeble expertise in prosopagnosia rule out a domain-general deficit?

According to the expertise account of face specialization, a deficit that affects general expertise mechanisms should similarly impair the expert individuation of both faces and other visually homogeneous object classes. To test this possibility, we attempted to train a prosopagnosic patient, LR, to become a Greeble expert using the standard Greeble expertise-training paradigm (Gauthier & Tarr, 2002). Previous research demonstrated that LR's prosopagnosia was related to an inability to simultaneously use multiple features in a speeded face recognition task (Bukach, Bub, Gauthier, & Tarr, 2006). We hypothesized that LR's inability to use multiple face features would manifest in his acquisition of Greeble expertise, even though his basic object recognition is unimpaired according to standard neuropsychological testing. Although LR was eventually able to reach expertise criterion, he took many more training sessions than controls, suggesting use of an abnormal strategy. To further explore LR's Greeble processing strategies, we assessed his ability to use multiple Greeble features both before and after Greeble training. LR's performance in two versions of this task demonstrates that, even after training, he relies heavily on a single feature to identify Greebles. This correspondence between LR's face recognition and post-training Greeble recognition supports the idea that impaired face recognition is simply the most visible symptom of a more general object recognition impairment in acquired prosopagnosia.

Featural versus configural face processing in a rare genetic disorder: Williams syndrome

BACKGROUND

Williams syndrome (WMS) is a rare genetic disorder with an estimated prevalence of 1 in 20 000 live births. Among other characteristics, WMS has a distinctive cognitive profile with spared face processing and language skills that contrasts with impairment in the cognitive domains of spatial cognition, problem solving and planning. It remains unclear whether individuals with WMS process faces using a featural strategy that focuses on features or a configural strategy that takes into consideration the contour of a face and spatial relations between features.

METHODS

To investigate face processing in WMS, the tasks specifically probe unfamiliar face matching by using a design that includes manipulations in face presentation (thatcherised and non-thatcherised), face orientation (upright and inverted) and face valence (happy and neutral expression) in a match-to-target face recognition design. The sample consisted of 20 participants with WMS, 10 participants with non-specific developmental delay (IQ-matched) and 10 normal control participants (chronological age-matched).

RESULTS

Similar to normal controls, WMS performed best when faces were presented upright. The results show while the WMS group did not perform as well as their typically developing counterparts, they did significantly better than the IQ-matched developmentally delayed group. WMS did not show an accuracy advantage for inverted faces commonly understood as an index for featural face processing, nor did they perform better on thatcherised inverted face conditions whereby featural processing is forced. Furthermore, no accuracy advantage was observed for positively valenced (happy) faces in the WMS group.

CONCLUSION

These results are consistent with previous work showing a configural face processing approach in WMS, a strategy that is also utilised by normal controls.

Training with own-race faces can improve processing of other-race faces: evidence from developmental prosopagnosia

Faces of one's own race are discriminated and recognized more accurately than faces of an other race (other-race effect - ORE). Studies have employed several methods to enhance individuation and recognition of other-race faces and reduce the ORE, including intensive perceptual training with other-race faces and explicitly instructing participants to individuate other-race faces. Unfortunately, intensive perceptual training has shown to be specific to the race trained and the use of explicit individuation strategies, though applicable to all races, can be demanding of attention and difficult to consistently employ. It has not yet been demonstrated that a training procedure can foster the automatic individuation of all other-race faces, not just faces from the race trained. Anecdotal evidence from a training procedure used with developmental prosopagnosics (DPs) in our lab, individuals with lifelong face recognition impairments, suggests that this may be possible. To further test this idea, we had five Caucasian DPs perform ten days of configural face training (i.e. attending to small spacing differences between facial features) with own-race (Caucasian) faces to see if training would generalize to improvements with other-race (Korean) faces. To assess training effects and localize potential effects to parts-based or holistic processing, we used the part-whole task using Caucasian and Korean faces (Tanaka, J. W., Kiefer, M., & Bukach, C. M. (2004). A holistic account of the own-race effect in face recognition: evidence from a cross-cultural study. Cognition, 93(1), B1-9). Results demonstrated that after training, DPs showed a disproportionate improvement in holistic processing of other-race faces compared to own-race faces, reducing their ORE. This suggests that configural training with own-race faces boosted DPs' general configural/holistic attentional resources, which they were able to apply to other-race faces. This provides a novel method to reduce the ORE and supports more of an attentional/social-cognitive model of the ORE rather than a strictly expertise model.

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

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

Impaired holistic processing in congenital prosopagnosia

It has long been argued that face processing requires disproportionate reliance on holistic or configural processing, relative to that required for non-face object recognition, and that a disruption of such holistic processing may be causally implicated in prosopagnosia. Previously, we demonstrated that individuals with congenital prosopagnosia (CP) did not show the normal face inversion effect (better performance for upright compared to inverted faces) and evinced a local (rather than the normal global) bias in a compound letter global/local (GL) task, supporting the claim of disrupted holistic processing in prosopagnosia. Here, we investigate further the nature of holistic processing impairments in CP, first by confirming, in a large sample of CP individuals, the absence of the normal face inversion effect and the presence of the local bias on the GL task, and, second, by employing the composite face paradigm, often regarded as the gold standard for measuring holistic face processing. In this last task, we show that, in contrast with controls, the CP group perform equivalently with aligned and misaligned faces and was impervious to (the normal) interference from the task-irrelevant bottom part of faces. Interestingly, the extent of the local bias evident in the composite task is correlated with the abnormality of performance on diagnostic face processing tasks. Furthermore, there is a significant correlation between the magnitude of the local bias in the GL and performance on the composite task. These results provide further evidence for impaired holistic processing in CP and, moreover, corroborate the critical role of this type of processing for intact face recognition.

Covert face recognition without the fusiform-temporal pathways

Patients with prosopagnosia are unable to recognize faces consciously, but when tested indirectly they can reveal residual identification abilities. The neural circuitry underlying this covert recognition is still unknown. One candidate for this function is the partial survival of a pathway linking the fusiform face area (FFA) and anterior-inferior temporal (AIT) cortex, which has been shown to be essential for conscious face identification. Here we performed functional magnetic, and diffusion tensor imaging in FE, a patient with severe prosopagnosia, with the goal of identifying the neural substrates of his robust covert face recognition. FE presented massive bilateral lesions in the fusiform gyri that eliminated both FFAs, and also disrupted the fibers within the inferior longitudinal fasciculi that link the visual areas with the AITs and medial temporal lobes. Therefore participation of the fusiform-temporal pathway in his covert recognition was precluded. However, face-selective activations were found bilaterally in his occipital gyri and in his extended face system (posterior cingulate and orbitofrontal areas), the latter with larger responses for previously-known faces than for faces of strangers. In the right hemisphere, these surviving face selective-areas were connected via a partially persevered inferior fronto-occipital fasciculus. This suggests an alternative occipito-frontal pathway, absent from current models of face processing, that could explain the patient's covert recognition while also playing a role in unconscious processing during normal cognition.

Perceptual Expertise as a Shift from Strategic Interference to Automatic Holistic Processing

Holistic processing was initially characterized a unique hallmark of face perception (e.g., Young et al., 1987) and later argued a domain-general marker of perceptual expertise (e.g., Gauthier et al., 1998). More recently, evidence for holistic processing - measured by interference from task-irrelevant parts - was obtained in novices, raising questions for its usefulness as a test of expertise. Indeed, recent studies use the same task to make opposite claims: Hsiao & Cottrell (2009) found more interference in novices than experts for Chinese characters, while Wong, Palmeri & Gauthier (2009) found more interference in experts than novices with objects. Offering a resolution to this paradox, our work on the perception of musical notation (Wong & Gauthier, in press) suggests that expert and novice interference effects represent two ends of a continuum: interference is initially strategic and contextual, but becomes more automatic as holistic processing develops with the acquisition of perceptual expertise.