The covert priming effect of faces in prosopagnosia

Background: There are many methods of testing covert face recognition in prosopagnosia, but it is not clear whether different types of covert recognition share a common mechanism. Objective: To determine whether direct forced-choice techniques and indirect face-priming methods yielded similar behavioral estimates of covert ability in a series of prosopagnosic patients. Methods: The authors tested seven control subjects and seven prosopagnosic patients. Six patients had an apperceptive prosopagnosia: one with childhood onset, three with bilateral lesions, and two with unilateral occipitotemporal lesions. The last had an associative prosopagnosia from bilateral anterior temporal lesions. The direct tests of covert function involved sorting faces by occupation or the forced choosing of which of two faces was famous with a name cue. The indirect test assessed name classification by occupation after priming with a facial stimulus. Results: In normal subjects, the chief priming effect was facilitation by the true face. In the six patients with apperceptive prosopagnosia, direct covert measures were correlated with the face-priming effect, with better covert ability in patients with unilateral posterior lesions. In the patient with associative prosopagnosia, there was a dissociation between excellent direct covert function and absent face priming. Conclusions: Direct and indirect covert functions likely share similar mechanisms in patients with apperceptive prosopagnosia and may reflect residual activity in anterior and left hemispheric components of the normal face-processing network. However, face priming may be ineffectual in patients with severely degraded facial memories from anterior temporal damage. This may indicate a difference between residual patterns of face-related activity in associative and apperceptive prosopagnosia.