The man who mistook his neuropsychologist for a popstar: when configural processing fails in acquired prosopagnosia

Upright and inverted unfamiliar face-matching tasks - everything correlates everywhere all at once

In a key study, Megreya and Burton (Memory & Cognition, 34, 865-876, 2006) argued that identity-matching tasks using unfamiliar faces may not effectively measure general 'real-world' face-processing ability - that is they are "not faces". They observed a high correlation in performance between upright and inverted unfamiliar face matching, a pattern not seen with familiar faces, which they interpreted as indicating unfamiliar face matching is qualitatively different and largely driven by image-specific factors. However, the authors cautioned that this limitation likely applies only to unfamiliar face-matching tasks for identity rather than other types of face judgements (e.g., emotion). The present study replicates and extends these findings by considering within-subject performance for upright/inverted unfamiliar face matching across various paradigms (sequential/simultaneous presentation or sorting) and face-judgement types (identity or emotion), whilst considering different types of measures (accuracy and reaction time). Our results illustrated high correlations for upright/inverted conditions were universally observed within tasks for both accuracy and reaction times. Subsequent factor analyses indicated that upright and inverted conditions loaded together into task-specific latent variables. These results concur with the conclusions of Megreya and Burton (2006) and extend to both identity and emotion matching tasks - that is such tasks exhibit low construct validity for testing hypotheses about much general 'everyday' face processing. We propose that researchers should carefully consider alignment between their test materials and the theoretical 'constructs' they aim to measure, ensuring more accurate and meaningful interpretations of their results.

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.

Different facets of age perception in people with developmental prosopagnosia and "super-recognisers"

The interplay between facial age and facial identity is evident from several scenarios experienced in daily life, such as when recognising a face several decades after the last exposure. However, the link between age and identity processing, and how age perception abilities might diverge in individuals with different face processing abilities, has scarcely been considered. Furthermore, the approach used to test age perception ability may also influence outcome, but the effect of different paradigms on performance is not yet known. Across three studies, we compare super-recognisers (SRs), people with developmental prosopagnosia (DPs), and a group of neurotypical controls, on three age perception paradigms. There were no differences on the numeric age estimation task (i.e. providing precise age estimates for a series of faces; Study 1), and numeric age estimation task with added noise-distortion to stimuli (Study 2). However, SRs were more accurate when instructed to classify ambient faces as either over- or under- the age of 18 compared to both DPs and controls (Study 3). Thus, there may be nuanced differences in age processing which can be tapped into using separate paradigms; however, given that the difference is only with SRs it remains unclear to what extent these are linked to facial identity processing.

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.

Can face recognition be selectively preserved in some cases of amnesia? A cautionary tale

Evidence suggests that some patients with isolated hippocampal damage appear to present with selective preservation of unfamiliar face recognition relative to other kinds of visual test stimuli (e.g., words). Bird and Burgess (2008) formulated a review and secondary analysis of a group of 10 cases all tested on a clinical assessment of word and face recognition memory (RMT, Warrington, 1984), which confirmed the key memory dissociation at the group level. The current work provides an updated secondary analysis of such cases with a larger published sample (N = 52). In addition to group-level analyses, we also re-evaluate evidence using a single case statistical approach (Crawford & Garthwaite, 2005), enabling us to determine how many would make criteria for a 'classical dissociation' (Crawford, Garthwaite, & Gray, 2003). Overall, group-level analyses indicated the key pattern of significant differences confined to words was limited to small control sample comparisons. When using the large control sample provided by Bird and Burgess (2008), hippocampal cases as a group were significantly poorer for both classes of items. Furthermore, our single-case approach indicated few had a performance pattern of a relative difference across face > word categories that would meet statistical significance; namely within individual differences across categories that would warrant a significant 'classical dissociation'. Moreover, these analyses also found several cases with a 'classical dissociation' in the reverse direction: namely preserved recognition of words. Such analyses serve to demonstrate the need for a more conservative statistical approach to be undertaken when reporting selective 'preservation' of a category in recognition memory. Whilst material specificity has important implications for understanding the role of the hippocampus in memory, our results highlight the need for statistical methods to be unquestionably rigorous before any claims are made. Lastly, we highlight other methodological issues critical to group analyses and make suggestions for future work.

Intracranial Electroencephalography and Deep Neural Networks Reveal Shared Substrates for Representations of Face Identity and Expressions

According to a classical view of face perception (Bruce and Young, 1986; Haxby et al., 2000), face identity and facial expression recognition are performed by separate neural substrates (ventral and lateral temporal face-selective regions, respectively). However, recent studies challenge this view, showing that expression valence can also be decoded from ventral regions (Skerry and Saxe, 2014; Li et al., 2019), and identity from lateral regions (Anzellotti and Caramazza, 2017). These findings could be reconciled with the classical view if regions specialized for one task (either identity or expression) contain a small amount of information for the other task (that enables above-chance decoding). In this case, we would expect representations in lateral regions to be more similar to representations in deep convolutional neural networks (DCNNs) trained to recognize facial expression than to representations in DCNNs trained to recognize face identity (the converse should hold for ventral regions). We tested this hypothesis by analyzing neural responses to faces varying in identity and expression. Representational dissimilarity matrices (RDMs) computed from human intracranial recordings (n = 11 adults; 7 females) were compared with RDMs from DCNNs trained to label either identity or expression. We found that RDMs from DCNNs trained to recognize identity correlated with intracranial recordings more strongly in all regions tested-even in regions classically hypothesized to be specialized for expression. These results deviate from the classical view, suggesting that face-selective ventral and lateral regions contribute to the representation of both identity and expression.SIGNIFICANCE STATEMENT Previous work proposed that separate brain regions are specialized for the recognition of face identity and facial expression. However, identity and expression recognition mechanisms might share common brain regions instead. We tested these alternatives using deep neural networks and intracranial recordings from face-selective brain regions. Deep neural networks trained to recognize identity and networks trained to recognize expression learned representations that correlate with neural recordings. Identity-trained representations correlated with intracranial recordings more strongly in all regions tested, including regions hypothesized to be expression specialized in the classical hypothesis. These findings support the view that identity and expression recognition rely on common brain regions. This discovery may require reevaluation of the roles that the ventral and lateral neural pathways play in processing socially relevant stimuli.

Twenty years of investigation with the case of prosopagnosia PS to understand human face identity recognition. Part II: Neural basis

Patient PS sustained her dramatic brain injury in 1992, the same year as the first report of a neuroimaging study of human face recognition. The present paper complements the review on the functional nature of PS's prosopagnosia (part I), illustrating how her case study directly, i.e., through neuroimaging investigations of her brain structure and activity, but also indirectly, through neural studies performed on other clinical cases and neurotypical individuals, inspired and constrained neural models of human face recognition. In the dominant right hemisphere for face recognition in humans, PS's main lesion concerns (inputs to) the inferior occipital gyrus (IOG), in a region where face-selective activity is typically found in normal individuals ('Occipital Face Area', OFA). Her case study initially supported the criticality of this region for face identity recognition (FIR) and provided the impetus for transcranial magnetic stimulation (TMS), intracerebral electrical stimulation, and cortical surgery studies that have generally supported this view. Despite PS's right IOG lesion, typical face-selectivity is found anteriorly in the middle portion of the fusiform gyrus, a hominoid structure (termed the right 'Fusiform Face Area', FFA) that is widely considered to be the most important region for human face recognition. This finding led to the original proposal of direct anatomico-functional connections from early visual cortices to the FFA, bypassing the IOG/OFA (lulu), a hypothesis supported by further neuroimaging studies of PS, other neurological cases and neuro-typical individuals with original visual stimulation paradigms, data recordings and analyses. The proposal of a lack of sensitivity to face identity in PS's right FFA due to defective reentrant inputs from the IOG/FFA has also been supported by other cases, functional connectivity and cortical surgery studies. Overall, neural studies of, and based on, the case of prosopagnosia PS strongly question the hierarchical organization of the human neural face recognition system, supporting a more flexible and dynamic view of this key social brain function.

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.

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.