In a recent interview, actor Brad Pitt said that he believes he has an extremely rare neurological condition called prosopagnosia, making it difficult for him to recognize different faces. It was also given as a reason that he often likes to stay home.

Dr. James Galvin, professor of neurology, psychology, and behavioral sciences at the University of Miami Miller School of Medicine, as well as director of the Comprehensive Center for Brain Health, unravels some of the details about prosopagnosia. Galvin has written extensively on healthy brain aging, cognitive health, Alzheimer’s disease, Lewy Body dementia, and related disorders.

What is prosopagnosia?

Prosopagnosia (pronounced pra-se-pag-no-zha) is a neurological disorder that affects a person’s ability to recognize faces. Sometimes this includes their own face, while preserving other visual processing abilities such as object recognition and decision-making. Children with prosopagnosia may have difficulties following the plots of television shows and movies because they have trouble recognizing the different characters. But they reportedly do better with cartoons, where the characters are simply drawn, have defining features, and wear the same outfits in every scene. People with prosopagnosia may have a difficult time telling family members apart, recognizing people out of context (e.g., seeing a teacher in a grocery store), or have difficulty recognizing themselves in group photographs.

How common is it?

It is an uncommon condition with an estimated prevalence rate of 2.5 percent of babies and young children.

When does this condition usually arise?

People can be born with this, get it in early childhood, or acquire prosopagnosia as a result of an injury. There are also degenerative forms of it, which are associated with diseases like Alzheimer’s. Congenital or developmental forms appear in childhood, but affected individuals may not realize they have prosopagnosia until later in their adult lives. People with acquired degenerative forms will usually recall a sudden change in their ability to recognize faces. Degenerative forms may not be detectable by the patient.

Does it worsen over time? Or can things improve?

Those who are born with this condition will usually have it throughout their lifetime. But if someone acquires this condition due to a stroke or traumatic brain injury, it is usually a permanent deficit. It may occasionally be resolved (for example, following the removal of a brain tumor). Degenerative forms of this condition are often accompanied by other cognitive deficits.

What causes prosopagnosia?

In those who have this condition at birth, damage often occurs in a part of the brain called the fusiform gyrus, which spans across the base of the temporal and occipital lobes in the middle and back portion of the brain. The damage is usually in the right-side of the brain but can be bilateral. This region is considered a key structure for high-level visual interpretation like facial and object recognition in the right-side of the brain, and for reading comprehension in the left-side of the brain.

For people who are injured or get prosopagnosia from a degenerative disease, the damage is usually found in the right temporal or occipital lobes of the brain, which are critical for memory and visual processing.

How is prosopagnosia diagnosed?

Patients may not be aware they have a problem, but a careful history from the patient and a second source of information can give clues that face recognition is a problem. There are a few neuropsychological assessments that can diagnose prosopagnosia. The Benton Facial Recognition Test, the Cambridge Face Memory Test, and the Famous Faces Test are examples of assessments used by neurologists and neuropsychologists. There is also a self-report questionnaire, the 20-item Prosopagnosia Index, which can be used by an individual who suspects they may have a problem with facial recognition.  

Is there any treatment for prosopagnosia?

There are no specific therapies. Instead, individuals may learn to use other clues to assist with recognition like clothing, voice, body shape, and skin color and tone, as well as hair styles. A clinical trial exploring the use of oxytocin to improve symptoms was suspended. There are ongoing trials to use computer-assisted learning to improve facial recognition. 

How do people adapt to this condition?

Since the face seems to function as an important identifying feature in memory, it can also be difficult for people with this condition to keep track of information about people, and to socialize normally with others. Prosopagnosia has also been associated with other disorders that are associated with nearby brain areas: visual loss, color perception, or topographical disorientation (a loss of environmental familiarity and difficulties in using landmarks). Working with a therapist for cognitive rehabilitation may offer opportunities for patients to develop work-arounds to maximize their daily functioning and quality of life.