Dr. Jeff Hersh

Q: Is Brad Pitt’s condition, where he can’t recognize faces, a real medical thing?

A: We’ve all met someone who either says “I never forget a face” or “I’m not that good with faces”. While not all colloquialisms like these have a real medical explanation, they just might!

It turns out the brain works quite hard, involving a number of interconnected brain processes and areas (mostly on the right side of the brain, but with a functional MRI showing left hemisphere areas are also involved), to identify and recognize faces. Prosopagnosia (a fancy medical word often referred to as “face blindness”) is a condition in which a person has limitations, to any degree, in recognizing faces. Prosopagnosia is an example of “agnosia,” a class of conditions in which a person has difficulty interpreting information from one or more of their senses (hearing, taste, smell, touch, or sight).

The degree of facial recognition limitation in patients with prosopagnosia is highly variable; for example, some people may only have difficulty interpreting facial expressions (apperceptive prosopagnosia) while others may even have trouble recognizing someone they know well (associative prosopagnosia).

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Prosopagnosia can be a congenital disease (a person is born with it), an acquired disease (as a result of brain damage caused by stroke, Alzheimer’s disease or other dementias, brain tumours, exposure to toxins or other causes) or may simply develop over time for unknown reasons (developmental prosopagnosia).

Overall, prosopagnosia is quite common, with some data indicating that it may affect up to 1 in 50 people, at least to some degree! However, due to the exact variability of its effect in a person and the difficulties in making a firm diagnosis, the exact prevalence of prosopagnosia is not precisely known.

Prosopagnosia is diagnosed based on the patient’s history, including their subjective experiences. Parents may suspect this if their child fails to recognize people they should know, especially when they meet them unexpectedly (eg by losing the associative cue that “Aunt Jan is visiting”), becomes nervous in public places, has social problems at school or in other situations, waits for someone to wave at them when meeting a friend, has difficulty following characters in a movie, or a TV show, etc. Patients may notice this because they seem to usually confuse one person with another person (even if these people don’t really look alike), or simply note that they often don’t recognize someone they think they should recognize.

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Although there is no specific test for prosopagnosia, an assessment by a clinician (e.g. using the Cambridge Face Memory Test or another tool), including examination of the ability to patient interpretation for other sensory cues, can be performed. Imaging (eg an MRI or CT scan) may be done to assess the possibility of any of the conditions that can lead to acquired prosopagnosia (as discussed above). In some cases, other tests may be indicated.

Not only can prosopagnosia directly cause problems with social interactions, but it can also lead to more generalized anxiety, especially in certain social situations. Likewise, it may affect work and/or social relationships and/or have other psychosocial effects.

Prosopagnosia is usually a lifelong condition. The only direct treatment for prosopagnosia is to treat any underlying conditions (see above) that may be causing it. However, people affected by this condition can learn coping skills and improve other perceptual skills to help them recognize people (for example, learning to recognize other identifying characteristics in people such as hairstyle, voice, gait, etc.).

If you have trouble recognizing people’s faces, especially if it’s severe or new/progressing, you should talk to your health care provider. Prosopagnosia is common, and in some cases may be a clue to the development of another underlying condition.

Jeff Hersh, Ph.D., MD, can be reached at [email protected]

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