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.