Face Blindness: A Closer Look at Two Types of Cognitive Dysfunction

How embarrassing.

While I was feeding pop cans into the return depository at the grocery store the other day, a woman suddenly planted herself in front of me and said “Hi, how are you?” in a very familiar manner. I didn’t know her from Adam.

“Fine thanks, and you?” I said, trying to act cordial while I racked my brain to remember where I’d seen her. But she wasn’t fooled.

“I’m Patty, Ann’s daughter,” she reminded me, looking a bit uncomfortable. I can’t say I blamed her. The same thing happened to me once, only the recipient wasn’t friendly and I turned three shades of purple before walking away. I felt bad that I’d rattled her, too. And really stupid that I hadn’t retained a memory of her face. Ann was my neighbor, and I’d seen Patty a few of times very briefly in passing whenever she walked through the grass behind my apartment complex on her way to her mother’s patio door.

“Oh, yes, of course, I’m sorry,” I said, smiling through my embarrassment. I vowed to emblazon her face on my brain promptly thereafter. Two weeks later, I was sitting in the waiting room of my doctor’s office. A door opened directly in front of me and a woman emerged, looking straight at me with a hesitant look, but said nothing. Then an older woman emerged behind her. It was my neighbor, Ann, whom I recognized immediately, and we said hello. At once I realized that yet again I’d failed to recognize the first woman as being Patty. What could I do? The next time I encountered her was at my apartment complex, walking past her near Ann’s patio in the backyard again. I knew she was Patty and said hello, noting that location had everything to do with the recognition. She was heading to her mother’s patio door to go inside and from her stride, hair and body shape I knew she was Patty and not some other relative or friend, but no other details. I’m not sure I’ll ever recognize her out in public, away from these identifying clues. This kind of lapse has happened before with neighbors when I lived in other venues, and only after I was diagnosed with MS in 2005.

If this kind of thing has happened to you, know that there can be MS-related reasons for it. Studies have shown that problems in structural integrity of the ILF and IFOF, which are white matter tracts, are present in those subjects having facial recognition dysfunction—but only if they exist in the right brain. For more details, see Ed Yong’s article in the reference section at the bottom of the page.

In an article written for MSFocus magazine, author and PwMS Jeffrey N. Gingold described failing to recognize his own wife, Terri, as a manifestation of this kind of cognitive dysfunction. He calls it “delayed recognition,” which can occur randomly. The episode with his wife happened while they were sitting on their couch and he suddenly felt what he called a “loss of presence.” He looked over at the woman seated next to him and struggled to figure out who she was. It took several minutes to re-orient himself and complete the connection between his wife’s face and its historical/emotional context that ultimately made her familiar and endearing.

Gingold went on to state unequivocally the importance of revealing delayed recognition to his loved ones. He substantiates his position by turning the tables on himself and realizing that if a loved one had a recognition problem, he would want to know about it so he could help out and they could work through it together. “I’ve learned to not challenge the lapses,” he writes. “Fortunately, they quickly vanish, unless I prolong the disorienting moment by dwelling on it. If I challenge the instinct to go on with life, then I become more of a bystander, not wanting to do or say anything wrong.”

Another form of cognitive dysfunction among people with multiple sclerosis is impaired ability to recognize emotional facial expressions. A 2014 study tested a cohort of 61 MS patients with unimpaired visual acuity and 53 healthy controls. Also investigated were possible relationships between impaired facial expression recognition and other clinical features such as depression. The result showed that MS patients were not impaired in facial identity discrimination, but showed a poor performance in all subtests that required emotion recognition. The study concluded that impaired recognition of facial emotions by patients with MS seems to be associated with both cognitive and affective (depression) aspects of the disease. (See complete study abstract below)

Whether we struggle with face recognition or emotional facial expression recognition, the biggest impact is felt in our confidence to remain social despite these difficulties. If we bravely choose to get back in the ring and participate, we must also remind ourselves to reveal our problems to those around us. Doing so can make it so much easier to enjoy being in the company of others. It also gives others the opportunity to help out on their end, and to learn something new about how MS affects us.1-3

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