Topographical disorientation

Developmental topographical disorientation (DTD) refers to the inability to orient from childhood despite the absence of any apparent brain damage, neurological condition or general cognitive defects. Individuals affected by DTD are unable to generate a mental representation of the environment (i.e. a cognitive map) and therefore unable to make use of it while orienting (a process that usually people go through while orienting). Not to be confused with healthy individuals who have a poor sense of direction, individuals affected by DTD get lost in very familiar surroundings, such as their house or neighborhood, daily.[2][3]

3% of the sample had DTD in a study of 1,698 Italians aged between 18 and 35 years (to exclude people with cognitive decline). It was more prevalent in males than females, although, in general, males use more complex navigational strategies. The sense of direction was closely related to gender, navigational strategies adopted, and town knowledge.[4]

Egocentric disorientation is marked by the inability to represent the location of objects with respect to self. This is usually due to lesions in the posterior parietal lobe. Patients experience no difficulty recognizing or naming people or objects. They are unable to accurately reach for visual objects and are unable to state the relationship between objects and oneself (above, below, left, right, nearer or farther).[1] In a case study presented by Stark and colleagues, a patient named GW described the inability to accurately reach for visual targets despite normal vision. She had no difficulty recognizing and naming objects presented to her, but was unable to point to locations of targets defined by visual, proprioceptive, or audio input. The loss of an egocentric spatial representation system left her unable to position herself in space. Most indicative of her disability is that she often turned in the wrong direction when greeted by someone who she was not facing.[5]

Heading disorientation is marked by the inability to represent direction of orientation with respect to external environment. This is usually due to lesions in the posterior cingulate. Patients show no signs of visuo-spatial agnosia. Patients are able to determine their location using landmarks, but are unable to determine which direction to proceed from those landmarks in order to reach their destination. They are also impaired in map drawing tasks and are unable to describe routes between familiar locations.[1] Takahashi and colleagues presented three cases of focal brain damage to the right retrosplenial region through a cerebral hemorrhage that caused a loss in sense of direction. All three patients showed normal visual perception, were able to identify familiar buildings and landscapes, were able to determine and remember locations of objects that could be seen from where they were standing, but were unable to recall direction from selective familiar landmarks. Symptoms of topographical disorientation disappeared in all three patients after two months.[6]

Anterograde disorientation is marked by the inability to orient in new environments. This is usually due to lesions in the parahippocampus. Patients were able to navigate through and draw maps of environments learned at least 6 months before the damage.[1][7] Teng and colleagues tested a profoundly amnesic patient who has complete bilateral damage to the hippocampus and extensive damage to adjacent structures in the medial temporal lobe. The patient was able to recall the spatial layout of his hometown where he moved away from 50 years ago, before he became amnesic. The patient has no knowledge of his current neighborhood, where he moved to after his injury. The finding indicates that the medial temporal lobe is not needed for the retrieval of spatial maps learned prior to injury. The hippocampus and other surrounding structures are essential for the formation of long-term declarative memories, including spatial memories.[8]

Landmark agnosia, also known as topographical agnosia and topographagnosia, is marked by the inability to recognize salient environmental stimuli such as landmarks. This is usually due to lesions in the lingual gyrus. Patients are able to draw detailed maps and visualize places familiar to them before the illness. They can distinguish between classes of buildings, such as house or skyscraper, but are unable to identify specific buildings, such as their own house or famous landmarks. Patients can navigate using strictly spatial information and specific details of landmarks such as house number or door color.[1] C. A. Pallis described a patient, A.H., who presented with color, face and landmark agnosia as a result of a cerebral embolism.[9]