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Identification, diagnosis and treatment of prosopagnosia

Published online by Cambridge University Press:  02 January 2018

Punit Shah*
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK. Email: punit.shah@kcl.ac.uk
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Abstract

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Copyright © Royal College of Psychiatrists, 2016 

Prosopagnosia is characterised by impaired face recognition in the absence of brain injury. There is a growing corpus of research on prosopagnosia, which helps elucidate the neurocognitive mechanisms underlying typical and atypical face perception. Reference Susilo and Duchaine1 Prevalence rates are estimated to be as high as 2% and it can have far-reaching psychosocial consequences. However, despite consideration as a ‘neurodevelopmental disorder’, prosopagnosia has received little attention from clinicians. There are no formal diagnostic criteria and there is a lack of awareness about the condition. To begin addressing such issues, I suggest that we start with (a) practical ways to identify prosopagnosia, moving towards (b) better awareness and (c) treatment of the condition by appropriately trained practitioners.

The lack of information about prosopagnosia within clinical contexts may, in part, be due to the difficulties with identifying patients with prosopagnosia, as it has traditionally relied on lengthy neuropsychological testing. Reference Fine2 Therefore, a short, validated and freely available questionnaire was recently developed to help identify individuals with the disorder. Reference Shah, Gaule, Sowden, Bird and Cook3 Although it was designed for prosopagnosia research, the instrument may enable clinicians – when presented with individuals with face-processing impairments – to screen for prosopagnosia as part of their diagnostic procedures. Patients may then, for example, be referred to specialists to undergo neuropsychological examination if required.

It is hoped that referrals to mental health practitioners will not only help individuals with prosopagnosia manage their impairments (and secondary conditions – e.g. anxiety), but also improve awareness of the disorder among clinicians. Reference Kitamura, Egawa and Someya4 Efforts are also underway to improve awareness of prosopagnosia more generally. Psychologists have produced informational videos (https://www.youtube.com/watch?v=/p2A_r40QMvU) and web pages (www.troublewithfaces.org; http://prosopagnosiaresearch.org; www.faceblind.org), including a listing in the A–Z of health conditions on NHS Choices (www.nhs.uk/conditions/prosopagnosia). Although designed for the public, these resources contain information that may inform clinical research and practice, and thereby facilitate development of formal diagnostic criteria for prosopagnosia.

Garnering interest in prosopagnosia from clinicians is of timely importance because psychopharmacological treatment studies are underway and programmes for enhancing face recognition are being patented. Reference Degutis, Cohan and Nakayama5 It is beyond the scope of this letter to address the potential promise and pitfalls of such developments, but treatment regimens will invariably benefit from scrutiny by clinicians, ensuring that interventions are designed with the rigorous standards observed in clinical trials.

Taken together, this is a clarion call for clinicians to extend investigation of prosopagnosia from cognitive psychology into psychiatry. This is necessary to reliably identify individuals with prosopagnosia, generate (urgently needed) formal diagnostic criteria, and most importantly, help individuals with prosopagnosia manage their condition.

References

1 Susilo, T, Duchaine, B. Advances in developmental prosopagnosia research. Curr Opin Neurobiol 2013; 23: 423–9.CrossRefGoogle ScholarPubMed
2 Fine, DR. We need a simple test for prosopagnosia. BMJ 2011; 342: d1736.CrossRefGoogle Scholar
3 Shah, P, Gaule, A, Sowden, S, Bird, G, Cook, R. The 20-item prosopagnosia index (PI20): a self-report instrument for identifying developmental prosopagnosia. R Soc Open Sci 2015; 2: 140343.CrossRefGoogle ScholarPubMed
4 Kitamura, H, Egawa, J, Someya, T. Developmental prosopagnosia referred to outpatient psychiatric service. Psychiatry Clin Neurosci 2015; 69: 238.CrossRefGoogle ScholarPubMed
5 Degutis, J, Cohan, S, Nakayama, K. Holistic face training enhances face processing in developmental prosopagnosia. Brain 2014; 137: 1781–98.CrossRefGoogle ScholarPubMed
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