Dec 6, 2017

Holistic Facial Perception Impairment in Alzheimer’s

Alzheimer’s affects one’s ability to distinguish facial features even of familiar people!



By Elaine C Pereira
Alzheimer's Reading Room

A 2016 study confirmed what I and many others involved in Alzheimer’s care have already witnessed.

“As Alzheimer’s disease and related forms of dementia advance, the ability to recognize the faces of loved ones diminishes.”




Holistic Facial Perception Impairment in Alzheimer’s

Don’t Despair - Use Other Senses

Our family’s trifecta of tragedies, especially affecting my mother, began in 1995 when my dad suffered a moderate stroke. Next, their daughter-in-law (my brother’s wife) was diagnosed with two sites of inoperable glioblastoma in 2000. My brother Jerry’s world imploded with the subsequent death a month later of his beloved Wendie

The last of our three major crises occurred in April 2003 when Jerry was diagnosed with “stage IV esophageal cancer with a year to live!”


More than five decades earlier, my parent’s son David, at 19 months of age, was killed in a horrific car accident. I couldn’t fathom telling our mother the devastating news that she would have to bury yet another “child.”

A Daughter's Story of Her Mother's Arduous and Humorous Journey through Dementia

Facing Reality…

My brother and I orchestrated the best plan possible to meet together and share his grim situation with our parents. My daughter Christie picked her uncle up at the airport and my husband and I drove over.

When my daughter called my cell to say they were in the lobby waiting for the elevator, I popped out of my parent’s apartment to meet Jerry. I just happened to have my back to the elevator doors when I heard his upbeat voice boom out “Elaine, it’s great to see you!”

I spun around ready for my big brother bear hug and then abruptly stopped, paralyzed by what I saw. The person whose familiar voice had just greeted me looked nothing like my brother! Jerry was already bloated, ashen white, bald and severely compromised! Overwhelming shock was an understatement.


My dad was likely too affected by post stroke to recognize Jerry’s physical deterioration, but my mother would. She was about to totally freak out! I readied myself for the avalanche of tears and drama as we entered their apartment.

Nothing! Mom said nothing! She jumped out of her chair, gave Jerry a hug and said she was glad he made it.

I was still numb. How could she not see how awful Jerry looked? Why didn’t Mom say something?


…but not Recognizing It!

Holistic Facial Perception Impairment! My mother’s shocking inability to recognize the distinct deterioration in her own son’s facial features was the very first indication of Alzheimer’s yet to be diagnosed. Only in retrospect did this strange but notable incident make sense.

I share this story with my audiences as part of the presentations that I give. The head nods and gentle tears validate that many others have experienced this phenomenon as well.

Research substantiates that even early in the deteriorating process of Alzheimer’s Disease, people may “miss” the subtle features that distinguish one individual from another. However, in what may seem like puzzling irony, it remains vitally important that friends and family continue to visit, talk to and engage with their loved one with dementia.

I’m speculating that the voice, intonation, mannerisms, habits, touch, dress etc. of familiar people may collectively help the person with Alzheimer’s Disease maintain connections. Don’t despair and try other ways to engage using the senses.

Elaine C Pereira donates from every copy of I Will Never Forget to help support Alzheimer’s research. "Help Me Help Others" Buy a Book!

More on Holistic Facial Perception

Why do people with Alzheimer's stop recognizing their loved ones?


Alzheimer's not only steals people's memories but also their ability to recognize faces, which widens the gulf between people with this disease and their loved ones.


A study has demonstrated that, beyond causing memory problems, Alzheimer's disease also impairs visual face perception. This finding may help families better understand their loved one's inevitable difficulties and lead to new avenues to postpone this painful aspect of the disease.

Face perception plays a fundamental role in human communication, which is why humans have evolved into experts at quickly detecting and identifying faces. 

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This faculty is thought to depend on the ability to perceive a face as a whole. Also known as "holistic perception," this ability is in contrast to the local and detailed analysis required to perceive individual facial features, such as the eyes, nose or mouth.
  • For the study, the Montreal team recruited people with Alzheimer's along with healthy seniors to study their ability to perceive faces and cars in photos that were either upright or upside down.
Dr. Joubert explains the team's findings:

"The results for people with Alzheimer's were similar to those in the control group in terms of answer accuracy and the time to process the upside-down faces and cars.

To perform these tasks, the brain must perform a local analysis of the various image components perceived by the eye.

However, with the upright faces, people with Alzheimer's were much slower and made more mistakes than the healthy individuals. This leads us to believe that holistic face recognition in particular becomes impaired.

Subjects with Alzheimer's disease also demonstrated normal recognition of the upright cars, a task that in theory does not require holistic processing. This suggests that Alzheimer's leads to visual perception problems specifically with faces." What's also surprising about this impairment is that it is observed in the early stages of the disease.

Overall, Dr. Joubert's study better explains the mechanism involved in the problem that people with Alzheimer's have with recognizing the faces of family members or celebrities.

The fact that impaired facial recognition might stem from a holistic perception problem--and not just a general memory problem--opens the door to different strategies (such as the recognition of particular facial traits or voice recognition) to help patients recognize their loved ones for longer.

Source
"A qualitative impairment in face perception in Alzheimer's disease: Evidence from a reduced face inversion effect." Journal of Alzheimer's Disease JAD 51(4), April 12, 2016. DOI: 10.3233/JAD-151027

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Definition Holistic Face Processing


A large body of research supports the hypothesis that the human visual system does not process a face as a collection of separable facial features but as an integrated perceptual whole.

One common assumption is that we quickly build holistic representations to extract useful second-order information provided by the variation between the faces of different individuals.

An alternative account suggests holistic processing is a fast, early grouping process that first serves to distinguish faces from other competing objects.

From this perspective, holistic processing is a quick initial response to the first-order information present in every face.

Source Pub Med

The role of holistic processing in face perception: evidence from the face inversion effect

PMID: 21496463
DOI: 10.1016/j.visres.2011.04.002