Topographical disorientation

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Topographical disorientation is the inability to orient oneself in one's surroundings, sometimes as a result of focal brain damage. [1] This disability may result from the inability to make use of selective spatial information (e.g., environmental landmarks) or to orient by means of specific cognitive strategies such as the ability to form a mental representation of the environment, also known as a cognitive map. It may be part of a syndrome known as visuospatial dysgnosia.

Contents

Classification

Topographical disorientation is the inability to find one's way through an environment due to cognitive impairment. [1] Topographical disorientation has been studied for decades using case studies of patients who have selectively lost their ability to find their way within large-scale, locomotor environments. Several dozen case reports of topographical disorientation have been presented over the last century. Studying these people will aid in the understanding of the complex, multi-component behavior of navigation. Topographical disorientation may be a lifelong deficit, it may result from a stroke, or it can occur as part of a progressive illness. Frequently comorbid with this disorder are hemispatial neglect, achromatopsia, prosopagnosia, and Alzheimer's disease.[ citation needed ]

Developmental

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

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

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 amnesiac

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] [9]

Topographagnosia

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. [10]

Diagnosis

Topographical disorientation is usually diagnosed with the use of a comprehensive battery of neuropsychological tests combined with a variety of orientation tasks performed by the participants in both virtual and real surroundings. Performance on certain tests can identify underlying neurological disorders and verify the disorientation as a selective impairment. Brain imaging is used to determine regions of brain damage, if any. Navigational skills can be assessed by tests pertaining to memory, visual-perceptual abilities, object recognition, mental rotation, imagery abilities, and spatial abilities. More direct testing of navigation involves asking the patient to describe a route, read a map, draw a map, follow a route, or point out landmarks. [5] [6] [10] [7]

Treatment

Treatment for topographical disorientation has been achieved through a case by case basis. Prognosis is largely dependent on the organic cause. Neuropsychological assessment followed by an assessment of unaffected cognitive abilities can be employed in therapy. Treatment for recovering navigational skills requires strengthening unaffected navigational strategies to bypass any defective ones.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Agnosia</span> Inability to process sensory information

Agnosia is a neurological disorder characterized by an inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream. Agnosia only affects a single modality, such as vision or hearing. More recently, a top-down interruption is considered to cause the disturbance of handling perceptual information.

<span class="mw-page-title-main">Parietal lobe</span> Part of the brain responsible for sensory input and some language processing

The parietal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The parietal lobe is positioned above the temporal lobe and behind the frontal lobe and central sulcus.

Astereognosis is the inability to identify an object by active touch of the hands without other sensory input, such as visual or sensory information. An individual with astereognosis is unable to identify objects by handling them, despite intact elementary tactile, proprioceptive, and thermal sensation. With the absence of vision, an individual with astereognosis is unable to identify what is placed in their hand based on cues such as texture, size, spatial properties, and temperature. As opposed to agnosia, when the object is observed visually, one should be able to successfully identify the object.

<span class="mw-page-title-main">Spatial memory</span> Memory about ones environment and spatial orientation

In cognitive psychology and neuroscience, spatial memory is a form of memory responsible for the recording and recovery of information needed to plan a course to a location and to recall the location of an object or the occurrence of an event. Spatial memory is necessary for orientation in space. Spatial memory can also be divided into egocentric and allocentric spatial memory. A person's spatial memory is required to navigate around a familiar city. A rat's spatial memory is needed to learn the location of food at the end of a maze. In both humans and animals, spatial memories are summarized as a cognitive map.

<span class="mw-page-title-main">Hemispatial neglect</span> Medical condition

Hemispatial neglect is a neuropsychological condition in which, after damage to one hemisphere of the brain, a deficit in attention and awareness towards the side of space opposite brain damage is observed. It is defined by the inability of a person to process and perceive stimuli towards the contralesional side of the body or environment. Hemispatial neglect is very commonly contralateral to the damaged hemisphere, but instances of ipsilesional neglect have been reported.

<span class="mw-page-title-main">Bálint's syndrome</span> Medical condition

Bálint's syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes, and inability to move the hand to a specific object by using vision. It was named in 1909 for the Austro-Hungarian neurologist and psychiatrist Rezső Bálint who first identified it.

Simultanagnosia is a rare neurological disorder characterized by the inability of an individual to perceive more than a single object at a time. This type of visual attention problem is one of three major components of Bálint's syndrome, an uncommon and incompletely understood variety of severe neuropsychological impairments involving space representation. The term "simultanagnosia" was first coined in 1924 by Wolpert to describe a condition where the affected individual could see individual details of a complex scene but failed to grasp the overall meaning of the image.

<span class="mw-page-title-main">Associative visual agnosia</span> Medical condition

Associative visual agnosia is a form of visual agnosia. It is an impairment in recognition or assigning meaning to a stimulus that is accurately perceived and not associated with a generalized deficit in intelligence, memory, language or attention. The disorder appears to be very uncommon in a "pure" or uncomplicated form and is usually accompanied by other complex neuropsychological problems due to the nature of the etiology. Affected individuals can accurately distinguish the object, as demonstrated by the ability to draw a picture of it or categorize accurately, yet they are unable to identify the object, its features or its functions.

The two-streams hypothesis is a model of the neural processing of vision as well as hearing. The hypothesis, given its initial characterisation in a paper by David Milner and Melvyn A. Goodale in 1992, argues that humans possess two distinct visual systems. Recently there seems to be evidence of two distinct auditory systems as well. As visual information exits the occipital lobe, and as sound leaves the phonological network, it follows two main pathways, or "streams". The ventral stream leads to the temporal lobe, which is involved with object and visual identification and recognition. The dorsal stream leads to the parietal lobe, which is involved with processing the object's spatial location relative to the viewer and with speech repetition.

Visual agnosia is an impairment in recognition of visually presented objects. It is not due to a deficit in vision, language, memory, or intellect. While cortical blindness results from lesions to primary visual cortex, visual agnosia is often due to damage to more anterior cortex such as the posterior occipital and/or temporal lobe(s) in the brain.[2] There are two types of visual agnosia: apperceptive agnosia and associative agnosia.

Auditory verbal agnosia (AVA), also known as pure word deafness, is the inability to comprehend speech. Individuals with this disorder lose the ability to understand language, repeat words, and write from dictation. Some patients with AVA describe hearing spoken language as meaningless noise, often as though the person speaking was doing so in a foreign language. However, spontaneous speaking, reading, and writing are preserved. The maintenance of the ability to process non-speech auditory information, including music, also remains relatively more intact than spoken language comprehension. Individuals who exhibit pure word deafness are also still able to recognize non-verbal sounds. The ability to interpret language via lip reading, hand gestures, and context clues is preserved as well. Sometimes, this agnosia is preceded by cortical deafness; however, this is not always the case. Researchers have documented that in most patients exhibiting auditory verbal agnosia, the discrimination of consonants is more difficult than that of vowels, but as with most neurological disorders, there is variation among patients.

Akinetopsia, also known as cerebral akinetopsia or motion blindness, is a term introduced by Semir Zeki to describe an extremely rare neuropsychological disorder, having only been documented in a handful of medical cases, in which a patient cannot perceive motion in their visual field, despite being able to see stationary objects without issue. The syndrome is the result of damage to visual area V5, whose cells are specialized to detect directional visual motion. There are varying degrees of akinetopsia: from seeing motion as frames of a cinema reel to an inability to discriminate any motion. There is currently no effective treatment or cure for akinetopsia.

Autotopagnosia from the Greek a and gnosis, meaning "without knowledge", topos meaning "place", and auto meaning "oneself", autotopagnosia virtually translates to the "lack of knowledge about one's own space," and is clinically described as such.

<span class="mw-page-title-main">Integrative agnosia</span> Medical condition

Integrative agnosia is a sub-disease of agnosia, meaning the lack of integrating perceptual wholes within knowledge. Integrative agnosia can be assessed by several experimental tests such as the Efron shape test, which determines the specificity of the disease being Integrative. This disease is often caused by brain trauma, producing medial ventral lesions to the extrastriate cortex. Affecting this region of the brain produces learning impairments: the inability to integrate parts such as spatial distances or producing visual images from short or long-term memory.

Apperceptive agnosia is a neurological disorder characterized by failures in recognition due to a failure of perception. In contrast, associative agnosia is a type of agnosia where perception occurs but recognition still does not occur. When referring to apperceptive agnosia, visual and object agnosia are most commonly discussed; this occurs because apperceptive agnosia is most likely to present visual impairments. However, in addition to visual apperceptive agnosia there are also cases of apperceptive agnosia in other sensory areas.

Auditory agnosia is a form of agnosia that manifests itself primarily in the inability to recognize or differentiate between sounds. It is not a defect of the ear or "hearing", but rather a neurological inability of the brain to process sound meaning. While auditory agnosia impairs the understanding of sounds, other abilities such as reading, writing, and speaking are not hindered. It is caused by bilateral damage to the anterior superior temporal gyrus, which is part of the auditory pathway responsible for sound recognition, the auditory "what" pathway.

Constructional apraxia is a neurological disorder in which people are unable to perform tasks or movements even though they understand the task, are willing to complete it, and have the physical ability to perform the movements. It is characterized by an inability or difficulty to build, assemble, or draw objects. Constructional apraxia may be caused by lesions in the parietal lobe following stroke or it may serve as an indicator for Alzheimer's disease.

Spatial cognition is the acquisition, organization, utilization, and revision of knowledge about spatial environments. It is most about how animals including humans behave within space and the knowledge they built around it, rather than space itself. These capabilities enable individuals to manage basic and high-level cognitive tasks in everyday life. Numerous disciplines work together to understand spatial cognition in different species, especially in humans. Thereby, spatial cognition studies also have helped to link cognitive psychology and neuroscience. Scientists in both fields work together to figure out what role spatial cognition plays in the brain as well as to determine the surrounding neurobiological infrastructure.

Visuospatial dysgnosia is a loss of the sense of "whereness" in the relation of oneself to one's environment and in the relation of objects to each other. Visuospatial dysgnosia is often linked with topographical disorientation.

Heterotopagnosia is a neuro-psychological syndrome caused by brain damage in the left parietal lobe and corresponding to an acquired inability in pointing at and locating another person's body parts. Its name comes from the Greek: "hetero" which means the other from a pair, "a" combined with "gnosis" which means without knowledge, and "topos" which means location. This clinical syndrome is distinct from autotopagnosia, another group of cognitive deficits associated with difficulties in locating body parts on own's one body. Allotopagnosia is another related disorder in which the patient cannot point at any external targets except his/her own body parts.

References

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  2. ↑ Iaria G, Bogod N, Fox CJ, Barton JJ (January 2009). "Developmental topographical disorientation: case one" (PDF). Neuropsychologia. 47 (1): 30–40. doi:10.1016/j.neuropsychologia.2008.08.021. PMID   18793658. S2CID   207235010.
  3. ↑ Bianchini F, Incoccia C, Palermo L, et al. (May 2010). "Developmental topographical disorientation in a healthy subject" (PDF). Neuropsychologia. 48 (6): 1563–73. doi:10.1016/j.neuropsychologia.2010.01.025. PMID   20144632. S2CID   24124970.
  4. ↑ Laura Piccardi, Massimiliano Palmiero, Vincenza Cofini, Paola Verde, Maddalena Boccia, Liana Palermo, Cecilia Guariglia, Raffaella Nori (July 20, 2022). ""Where am I?" A snapshot of the developmental topographical disorientation among young Italian adults". PLOS ONE. 17 (7): e0271334. Bibcode:2022PLoSO..1771334P. doi: 10.1371/journal.pone.0271334 . PMC   9299294 . PMID   35857777.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. 1 2 Stark, M; Coslett, HB; Saffran, EM (1996). "Impairment of an egocentric map of locations: implications for perception and action". Cognitive Neuropsychology. 13 (4): 481–523. doi:10.1080/026432996381908.
  6. 1 2 Takahashi N, Kawamura M, Shiota J, Kasahata N, Hirayama K (August 1997). "Pure topographic disorientation due to right posterior cingulate lesion". Neurology. 49 (2): 464–9. doi:10.1016/S0010-9452(08)70801-3. PMID   9270578. S2CID   4483900.
  7. 1 2 Ross ED (April 1980). "Sensory-specific and fractional disorders of recent memory in man. I. Isolated loss of visual recent memory". Arch. Neurol. 37 (4): 193–200. doi:10.1001/archneur.1980.00500530031001. PMID   7362483.
  8. ↑ Teng E, Squire LR (August 1999). "Memory for places learned long ago is intact after hippocampal damage" (PDF). Nature. 400 (6745): 675–7. Bibcode:1999Natur.400..675T. doi:10.1038/23276. PMID   10458163. S2CID   204995252.
  9. ↑ Roseman, Moshe; Elias, Uri; Kletenik, Isaiah; Ferguson, Michael A.; Fox, Michael D.; Horowitz, Zalman; Marshall, Gad A.; Spiers, Hugo J.; Arzy, Shahar (2023-12-13). "A neural circuit for spatial orientation derived from brain lesions". Cerebral Cortex: bhad486. doi:10.1093/cercor/bhad486. ISSN   1460-2199. PMID   38100330.
  10. 1 2 Pallis, CA (1955), "Impaired identification of faces and places with agnosia for colours", Journal of Neurology, Neurosurgery, and Psychiatry, 18 (3): 218–24, doi:10.1136/jnnp.18.3.218, PMC   503242 , PMID   13252431

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