A historical review of topographical disorientation and its neuroanatomical correlates

Topographical disorientation (TD) refers to impaired orientation and navigation in real-world environments. Although numerous cases have been reported, disagreement over neuroanatomical correlates remains. This has been contributed to by concern with the "essential defect," ambiguous terminology, and incomplete assessments. Attention to three factors permits a coherent understanding of the widely divergent descriptions of cognitive deficits and neuroanatomical findings: point in course (acute vs. chronic), characteristics of the environment, and a patient's specific cognitive deficits. Defects in visual learning/recognition of topographical scenes or spatial-topographical knowledge are common, but the "agnosia" versus "amnesia" dichotomy is an oversimplification: Careful assessment typically reveals impairment in both realms. Anterograde TD is most highly associated with medial occipitotemporal lesions in either hemisphere, especially posterior parahippocampal gyrus, whereas TD consequent to right parietal damage tends to be time-limited. Persistent retrograde TD is attributable to right medial occipitotemporal lesions.