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.

Prosopagnosia (face blindness) and child health during the COVID-19 pandemic.

Prosopagnosia or 'face blindness' is the inability to recognise people's faces. There are two types: congenital or developmental prosopagnosia, which is the most common, and acquired prosopagnosia, which may occur secondary to brain tumours, stroke or other brain disorders. The authors of this article explored if mask wearing as a result of the restrictions imposed by the coronavirus disease 2019 (COVID-19) pandemic may affect social and developmental outcomes in children, including the development of prosopagnosia. Limited research on this topic is available and, although some relevant publications were found, no definitive evidence of mask-induced prosopagnosia in children was identified. However, nurses should be aware of this issue and discuss coping strategies to support children with the condition. Longitudinal studies on outcomes in children from different age groups who grew up during the COVID-19 pandemic will provide further insight.

Spatial Integration in Normal Face Processing and Its Breakdown in Congenital Prosopagnosia.

Congenital prosopagnosia (CP), a life-long impairment in face processing that occurs in the absence of any apparent brain damage, provides a unique model in which to explore the psychological and neural bases of normal face processing. The goal of this review is to offer a theoretical and conceptual framework that may account for the underlying cognitive and neural deficits in CP. This framework may also provide a novel perspective in which to reconcile some conflicting results that permits the expansion of the research in this field in new directions. The crux of this framework lies in linking the known behavioral and neural underpinnings of face processing and their impairments in CP to a model incorporating grid cell-like activity in the entorhinal cortex. Moreover, it stresses the involvement of active, spatial scanning of the environment with eye movements and implicates their critical role in face encoding and recognition. To begin with, we describe the main behavioral and neural characteristics of CP, and then lay down the building blocks of our proposed model, referring to the existing literature supporting this new framework. We then propose testable predictions and conclude with open questions for future research stemming from this model.

First the nose, last the eyes in congenital prosopagnosia: Look like your father looks.

OBJECTIVE: To contribute to the limited body of eye movement (EM) studies of children and family members with congenital prosopagnosia (CP), a task requiring a verbal response for the identification of personally familiar faces was used for the 1st time. METHOD: EMs were recorded in a father and his son (both diagnosed with CP) and controls (N = 2). In the identification tasks they watched personally familiar faces and distracters and responded by saying the names of the familiar faces or saying "I don't know." Two discrimination tasks were added to distinguish the specificity of the EM pattern for the recognition tasks. In all tasks, faces were presented 1 by 1 until the response onset; thus, the EM pattern was not saturated by overexposure to the stimulus. The 1st fixation position was examined to localize the 1st area of the face attended to. The spatial-temporal fixation pattern was examined to evaluate the attention devoted to specific regions. RESULTS: Both family members were inaccurate and slower than controls in the identification but not the discrimination tasks. In all tasks, they made a number of fixations comparable to those of controls but showed longer fixation durations than controls did. In the identification tasks, they showed poor spatial-temporal distribution of fixations on the eyes and rare 1st fixations on the eyes. CONCLUSIONS: Consistent with the literature, both family members showed the typical reduced sampling of the eyes. Nevertheless, our protocol based on explicit verbal responses (which included EM only until response onset) showed that they did not increase the spatial sampling overall by making more fixations than controls did. Instead, they showed longer fixation durations across tasks; this was interpreted as a generalized problem with face processing in affording a more robust sampling of information. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Self-face and self-body advantages in congenital prosopagnosia: evidence for a common mechanism.

Prosopagnosia is a disorder leading to difficulties in recognizing faces. However, recent evidence suggests that individuals with congenital prosopagnosia can achieve considerable accuracy when they have to recognize their own faces (self-face advantage). Yet, whether this advantage is face-specific or not is still unclear. Here, we aimed to investigate whether individuals with congenial prosopagnosia show a self-advantage also in recognizing other self body-parts and, if so, whether the advantage for the body parts differs from the one characterizing the self-face. Eight individuals with congenital prosopagnosia and 22 controls underwent a delayed matching task in which they were required to recognize faces, hands and feet belonging to the self or to others. Controls showed a similar self-advantage for all the stimuli tested; by contrast, individuals with congenital prosopagnosia showed a larger self-advantage with faces compared to hands and feet, mainly driven by their deficit with others' faces. In both groups the self-advantages for the different body parts were strongly and significantly correlated. Our data suggest that the self-face advantage showed by individuals with congenital prosopagnosia is not face-specific and that the same mechanism could be responsible for both the self-face and self body-part advantages.

Evidence of taxonomy for Developmental Topographical Disorientation: Developmental Landmark Agnosia Case 1.

We report Developmental Landmark Agnosia (DLA) in a 6-year-old boy (L.G.) who was referred to us for congenital prosopagnosia (see Pizzamiglio et al., 2017 , in which both testing and rehabilitation of Congenital Prosopagnosia are reported). We investigated his performance using a neuropsychological battery and eye movement recordings. The assessment showed the presence of deficits in recognizing familiar places (along with Congenital Prosopagnosia), but not common objects. Eye movement recordings confirmed his problems in recognizing familiar landmarks and misrecognition of unfamiliar places. L.G. is the first evidence of a DLA, suggesting identification of taxonomy of navigational disorders in Developmental Topographical Disorientation is possible, as in the Acquired Topographical Disorientation.

Mapping self-face recognition strategies in congenital prosopagnosia.

OBJECTIVE: Recent evidence showed that individuals with congenital face processing impairment (congenital prosopagnosia [CP]) are highly accurate when they have to recognize their own face (self-face advantage) in an implicit matching task, with a preference for the right-half of the self-face (right perceptual bias). Yet the perceptual strategies underlying this advantage are unclear. Here, we aimed to verify whether both the self-face advantage and the right perceptual bias emerge in an explicit task, and whether those effects are linked to a different scanning strategy between the self-face and unfamiliar faces. METHOD: Eye movements were recorded from 7 CPs and 13 controls, during a self/other discrimination task of stimuli depicting the self-face and another unfamiliar face, presented upright and inverted. RESULTS: Individuals with CP and controls differed significantly in how they explored faces. In particular, compared with controls, CPs used a distinct eye movement sampling strategy for processing inverted faces, by deploying significantly more fixations toward the nose and mouth areas, which resulted in more efficient recognition. Moreover, the results confirmed the presence of a self-face advantage in both groups, but the eye movement analyses failed to reveal any differences in the exploration of the self-face compared with the unfamiliar face. Finally, no bias toward the right-half of the self-face was found. CONCLUSIONS: Our data suggest that the self-face advantage emerges both in implicit and explicit recognition tasks in CPs as much as in good recognizers, and it is not linked to any specific visual exploration strategies. (PsycINFO Database Record

Ensemble coding of face identity is present but weaker in congenital prosopagnosia.

Individuals with congenital prosopagnosia (CP) are impaired at identifying individual faces but do not appear to show impairments in extracting the average identity from a group of faces (known as ensemble coding). However, possible deficits in ensemble coding in a previous study (CPs n = 4) may have been masked because CPs relied on pictorial (image) cues rather than identity cues. Here we asked whether a larger sample of CPs (n = 11) would show intact ensemble coding of identity when availability of image cues was minimised. Participants viewed a "set" of four faces and then judged whether a subsequent individual test face, either an exemplar or a "set average", was in the preceding set. Ensemble coding occurred when matching (vs. mismatching) averages were mistakenly endorsed as set members. We assessed both image- and identity-based ensemble coding, by varying whether test faces were either the same or different images of the identities in the set. CPs showed significant ensemble coding in both tasks, indicating that their performance was independent of image cues. As a group, CPs' ensemble coding was weaker than controls in both tasks, consistent with evidence that perceptual processing of face identity is disrupted in CP. This effect was driven by CPs (n= 3) who, in addition to having impaired face memory, also performed particularly poorly on a measure of face perception (CFPT). Future research, using larger samples, should examine whether deficits in ensemble coding may be restricted to CPs who also have substantial face perception deficits.

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.

Altered topology of neural circuits in congenital prosopagnosia.

Using a novel, fMRI-based inter-subject functional correlation (ISFC) approach, which isolates stimulus-locked inter-regional correlation patterns, we compared the cortical topology of the neural circuit for face processing in participants with an impairment in face recognition, congenital prosopagnosia (CP), and matched controls. Whereas the anterior temporal lobe served as the major network hub for face processing in controls, this was not the case for the CPs. Instead, this group evinced hyper-connectivity in posterior regions of the visual cortex, mostly associated with the lateral occipital and the inferior temporal cortices. Moreover, the extent of this hyper-connectivity was correlated with the face recognition deficit. These results offer new insights into the perturbed cortical topology in CP, which may serve as the underlying neural basis of the behavioral deficits typical of this disorder. The approach adopted here has the potential to uncover altered topologies in other neurodevelopmental disorders, as well.

Italian normative data and validation of two neuropsychological tests of face recognition: Benton Facial Recognition Test and Cambridge Face Memory Test.

The Benton Facial Recognition Test (BFRT) and Cambridge Face Memory Test (CFMT) are two of the most common tests used to assess face discrimination and recognition abilities and to identify individuals with prosopagnosia. However, recent studies highlighted that participant-stimulus match ethnicity, as much as gender, has to be taken into account in interpreting results from these tests. Here, in order to obtain more appropriate normative data for an Italian sample, the CFMT and BFRT were administered to a large cohort of young adults. We found that scores from the BFRT are not affected by participants' gender and are only slightly affected by participant-stimulus ethnicity match, whereas both these factors seem to influence the scores of the CFMT. Moreover, the inclusion of a sample of individuals with suspected face recognition impairment allowed us to show that the use of more appropriate normative data can increase the BFRT efficacy in identifying individuals with face discrimination impairments; by contrast, the efficacy of the CFMT in classifying individuals with a face recognition deficit was confirmed. Finally, our data show that the lack of inversion effect (the difference between the total score of the upright and inverted versions of the CFMT) could be used as further index to assess congenital prosopagnosia. Overall, our results confirm the importance of having norms derived from controls with a similar experience of faces as the "potential" prosopagnosic individuals when assessing face recognition abilities.

What do eye movements tell us about the visual perception of individuals with congenital prosopagnosia?

OBJECTIVE: The lack of inversion effect for face recognition in congenital prosopagnosia (CP) is consistent with the hypothesis of a failure in holistic processing. However, although CPs' abnormal gaze behavior for upright faces has already been demonstrated, neither their scanning strategy for inverted faces, nor the possibility that their abnormal gaze behavior with upright faces is because of reasons other than the holistic deficit have been investigated yet. METHOD: We recorded the eye movements of a congenital prosopagnosic and a control group during the encoding of unknown faces, objects, and flowers. Two types of stimuli (faces and objects) were presented upright and inverted. RESULTS: CPs explored upright and inverted faces in the same way (i.e., similar number of fixations of the same duration and similarly distributed), whereas controls increased the number of fixations and their duration during the presentation of inverted faces. By contrast, the 2 groups showed a similar inversion effect during the encoding of objects. Finally, CPs showed anomalous exploration of within-class objects (i.e., flowers) and impairment in subordinate-level object discrimination. CONCLUSIONS: Our results demonstrate that: (a) CPs use the same part-based strategy in encoding both upright and inverted faces, suggesting a possible interpretation of the lack of inversion effect in this population; (b) CPs' lack of inversion effect is face-specific and does not affect objects; (c) however, CPs' deficit seems not to be limited to faces, and to extend to individual-item recognition within a class. (PsycINFO Database Record

Congenital prosopagnosia in a child: Neuropsychological assessment, eye movement recordings and training.

Here we report the assessment and treatment of a 6-year-old boy (L.G.) who was referred to us for congenital prosopagnosia (CP). We investigated his performance using a test battery and eye movement recordings pre- and post-training. L.G. showed deficits in recognising relatives and learning new faces, and misrecognition of unfamiliar people. Eye movement recordings showed that L.G. focused on the lower part of stimuli in naming tasks based on familiar or unfamiliar incomplete or complete faces. The training focused on improving his ability to explore internal features of faces, to discriminate specific facial features of familiar and unfamiliar faces, and to provide his family with strategies to use in the future. At the end of the training programme L.G. no longer failed to recognise close and distant relatives and classmates and did not falsely recognise unknown people.

More than just a problem with faces: altered body perception in a group of congenital prosopagnosics.

It has been estimated that one out of 40 people in the general population suffer from congenital prosopagnosia (CP), a neurodevelopmental disorder characterized by difficulty identifying people by their faces. CP involves impairment in recognizing faces, although the perception of non-face stimuli may also be impaired. Given that social interaction depends not only on face processing, but also on the processing of bodies, it is of theoretical importance to ascertain whether CP is also characterized by body perception impairments. Here, we tested 11 CPs and 11 matched control participants on the Body Identity Recognition Task (BIRT), a forced-choice match-to-sample task, using stimuli that require processing of body-specific, not clothing-specific, features. Results indicated that the group of CPs were as accurate as controls on the BIRT, which is in line with the lack of body perception complaints by CPs. However, the CPs were slower than controls, and when accuracy and response times were combined into inverse efficiency scores (IESs), the group of CPs were impaired, suggesting that the CPs could be using more effortful cognitive mechanisms to be as accurate as controls. In conclusion, our findings demonstrate that CP may not generally be limited to face processing difficulties, but may also extend to body perception.

Congenital prosopagnosia is associated with a genetic variation in the oxytocin receptor (OXTR) gene: An exploratory study.

Face-recognition deficits, referred to with the term prosopagnosia (i.e., face blindness), may manifest during development in the absence of any brain injury (from here the term congenital prosopagnosia, CP). It has been estimated that approximately 2.5% of the population is affected by face-processing deficits not depending on brain lesions, and varying a lot in severity. The genetic bases of this disorder are not known. In this study we tested for genetic association between single-nucleotide polymorphisms (SNPs) in the oxytocin receptor gene (OXTR) and CP in a restricted cohort of Italian participants. We found evidence of an association between the common genetic variants rs53576 and rs2254298 OXTR SNPs and prosopagnosia. This association was also found when including an additional group of German individuals classified as prosopagnosic in the analysis. Our preliminary data provide initial support for the involvement of genetic variants of OXTR in a relevant cognitive impairment, whose genetic bases are still largely unexplored.

Phasic alertness enhances processing of face and non-face stimuli in congenital prosopagnosia.

Congenital prosopagnosia (CP) is a severe face processing impairment that occurs in the absence of any obvious brain damage and has often been associated with a more general deficit in deriving holistic relations between facial features or even between non-face shape dimensions. Here we further characterized this deficit and examined a potential way to ameliorate it. To this end we manipulated phasic alertness using alerting cues previously shown to modulate attention and enhance global processing of visual stimuli in normal observers. Specifically, we first examined whether individuals with CP, similarly to controls, would show greater global processing when exposed to an alerting cue in the context of a non-facial task (Navon global/local task). We then explored the effect of an alerting cue on face processing (upright/inverted face discrimination). Confirming previous findings, in the absence of alerting cues, controls showed a typical global bias in the Navon task and an inversion effect indexing holistic processing in the upright/inverted task, while CP failed to show these effects. Critically, when alerting cues preceded the experimental trials, both groups showed enhanced global interference and a larger inversion effect. These results suggest that phasic alertness may modulate visual processing and consequently, affect global/holistic perception. Hence, these findings further reinforce the notion that global/holistic processing may serve as a possible mechanism underlying the face processing deficit in CP. Moreover, they imply a possible route for enhancing face processing in individuals with CP and thus shed new light on potential amelioration of this disorder.

Temporal lobe contribution to perceptual function: A tale of three patient groups.

There has been growing recognition of the contribution of medial and anterior temporal lobe structures to non-mnemonic functions, such as perception. To evaluate the nature of this contribution, we contrast the perceptual performance of three patient groups, all of whom have a perturbation of these temporal lobe structures. Specifically, we compare the profile of patients with focal hippocampal (HC) lesions, those with more extensive lesions to the medial temporal lobe (MTL) that include HC and perirhinal cortex (PrC), and those with congenital prosopagnosia (CP), whose deficit has been attributed to the disconnection of the anterior temporal lobe from more posterior structures. All participants completed a range of'oddity' tasks in which, on each trial, they determined which of four visual stimuli in a display was the'odd-one-out'. There were five stimulus categories including faces, scenes, objects (high and low ambiguity) and squares of different sizes. Comparisons were conducted separately for the HC, MTL and CP groups against their matched control groups and then the group data were compared to each other directly. The group profiles were easily differentiable. Whereas the HC group stood out for its difficulty in discriminating scenes and the CP group stood out for its disproportionate difficulty in discriminating faces with milder effects for scenes and high ambiguity objects, the MTL group evinced a more general discrimination deficit for faces, scenes and high ambiguity objects. The group differences highlight distinct profiles for each of the three groups and distinguish the signature perceptual impairments following more extended temporal lobe alterations. In the recent reconsideration of the role of the hippocampus and neocortex, Moscovitch and colleagues (Moscovitch et al., 2016) note that the medial temporal lobe structures play a role in non-mnemonic functions, such as perception, problem solving, decision-making and language. Here, we address this exact issue, specifically with respect to perception, and we dedicate this paper to Morris Moscovitch in recognition of his profound contribution to science, to his students and to his colleagues.

Agnosias visuales / Visual agnosia

Las agnosias visuales se definen como una alteración en la capacidad de reconocer objetos con la vista, en ausencia de pérdida de agudeza visual o disfunción cognitiva que explique esta alteración. Están producidas por lesiones de la corteza visual asociativa, respetando la corteza visual primaria. Existen 2 vías principales de procesamiento de la información visual: la vía ventral, encargada del reconocimiento de objetos, y la vía dorsal, encargada de su localización en el espacio. Las agnosias visuales pueden, por tanto, dividirse en 2 grandes grupos dependiendo de cuál de las 2 vías esté lesionada. El objetivo de este artículo es realizar una revisión narrativa sobre los diferentes síndromes agnósicos visuales, incluyendo los últimos avances realizados en algunos de ellos (AU)

Visual agnosia is defined as an impairment of object recognition, in the absence of visual acuity or cognitive dysfunction that would explain this impairment. This condition is caused by lesions in the visual association cortex, sparing primary visual cortex. There are 2 main pathways that process visual information: the ventral stream, tasked with object recognition, and the dorsal stream, in charge of locating objects in space. Visual agnosia can therefore be divided into 2 major groups depending on which of the two streams is damaged. The aim of this article is to conduct a narrative review of the various visual agnosia syndromes, including recent developments in a number of these syndromes (AU)

Visual expertise for horses in a case of congenital prosopagnosia.

A major question in the domain of face perception is whether faces comprise a distinct visual category that is processed by specialized mechanisms, or whether face processing merely represents an extreme case of visual expertise. Here, we examined O.H, a 22 years old woman with congenital prosopagnosia (CP), who despite her severe deficits in face processing, acquired superior recognition skills for horses. To compare the nature of face and horse processing, we utilised the inversion manipulation, known to disproportionally affect faces compared to other objects, with both faces and horses. O.H's performance was compared to data obtained from two control groups that were either horse experts, or non-experts. As expected, both control groups exhibited the face inversion effect, while O.H did not show the effect, but importantly, none of the participants showed an inversion effect for horses. Finally, gaze behaviour toward upright and inverted faces and horses was indicative of visual skill but in a distinct fashion for each category. Particularly, both control groups showed different gaze patterns for upright compared to inverted faces, while O.H presented a similar gaze pattern for the two orientations that differed from that of the two control groups. In contrast, O.H and the horse experts exhibited a similar gaze pattern for upright and inverted horses, while non-experts showed different gaze patterns for different orientations. Taken together, these results suggest that visual expertise can be acquired independently from the mechanisms mediating face recognition.

Right perceptual bias and self-face recognition in individuals with congenital prosopagnosia.

The existence of a drift to base judgments more on the right half-part of facial stimuli, which falls in the observer's left visual field (left perceptual bias (LPB)), in normal individuals has been demonstrated. However, less is known about the existence of this phenomenon in people affected by face impairment from birth, namely congenital prosopagnosics. In the current study, we aimed to investigate the presence of the LPB under face impairment conditions using chimeric stimuli and the most familiar face of all: the self-face. For this purpose we tested 10 participants with congenital prosopagnosia and 21 healthy controls with a face matching task using facial stimuli, involving a spatial manipulation of the left and the right hemi-faces of self-photos and photos of others. Even though congenital prosopagnosics performance was significantly lower than that of controls, both groups showed a consistent self-face advantage. Moreover, congenital prosopagnosics showed optimal performance when the right side of their face was presented, that is, right perceptual bias, suggesting a differential strategy for self-recognition in those subjects. A possible explanation for this result is discussed.