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Topgraphical Disorientation
Topgraphical Disorientation
2007, 17 (1), 34 – 52
# 2007 Psychology Press, an imprint of the Taylor & Francis Group, an informa business
http://www.psypress.com/neurorehab DOI:10.1080/09602010500505021
TOPOGRAPHICAL DISORIENTATION: AN INTEGRATED FRAMEWORK 35
INTRODUCTION
Topographical orientation refers to the ability of individuals to find their way
from one location to another in large-scale environments such as the home, work-
place or neighbourhood. A disorder of topographical orientation will be referred
to as “topographical disorientation” (or TD) in this paper and refers to individuals
who are unable to navigate or find their way around large-scale environments in a
normal manner. This definition is all encompassing. However, as will be dis-
cussed later topographical disorientation (TD) is a multifaceted and complex
disorder that can arise from a number of different underlying impairments.
Topographical disorientation is relatively common in adults with acquired
brain injury or dementia. It often occurs as part of a global delirium, dementia
or amnesia but can also occur as a more specific cognitive disorder (e.g.,
Davis & Coltheart, 1999; della Rocchetta, Cipolotti, & Warrington, 1996;
Landis, Cummings, Benson, & Palmer, 1986; Suzuki, Yamadori, Hayakawa,
& Fujii, 1998). There have been over 100 years of confusion in the research
literature regarding the exact nature of TD which has been perpetuated by
terminological confusion (for review papers, see Barrash, 1998 or Farrell,
1996). Theoretical progress has been slow with many published studies provid-
ing no more than a general description of patients’ topographical disorientation
and/or associated neuropsychological impairments and/or neuroanatomical
correlates (e.g., Botez-Marquard & Botez, 1992; Cogan, 1979; De Renzi,
Faglioni, & Villa, 1977; Kase et al., 1977; Landis et al., 1986; Mazzoni, Del
Torto, Vista, & Maretti, 1993; Paterson & Zangwill, 1945).
Relatively few studies have investigated the nature of topographical cog-
nition itself. One reason for this may relate to the fundamental complexity
of topographical cognition. In addition, TD rarely occurs as an isolated
disorder, and commonly occurring comorbid deficits (such as visual field
loss, visual agnosia, prosopagnosia, visuo-spatial disturbance, visual
memory impairments and/or constructional difficulties) can cloud underlying
cognitive dissociations (e.g., Benton, 1969; Botez- Marquard & Botez, 1992;
Clarke, Assal, & De Tribolet, 1993; Cogan, 1979; DeRenzi, 1982; Katayama,
Takahashi, Ogawara, & Hattori, 1999; Paterson & Zangwill, 1945). Perhaps
the most significant reason, however, relates to limitations in assessment of
TD. For the most part, assessment has lacked theoretical structure, has
been inconsistent across studies, and has failed to employ functionally
relevant assessment methods.
TABLE 1
Topographical disorientation and cognitive dissociations: A brief overview
(e.g., Bottini, Cappa, Geminiani, & Sterzi, 1990; della Rocchetta et al., 1996;
De Renzi et al., 1977; Habib & Sirigu, 1987; Hecaen, Tzoerzis, & Rondot,
1980; Landis et al., 1986; Suzuki et al., 1998). However, TD in unfamiliar
environments (i.e., the inability to learn new topographical information)
can occur in patients who have no reported difficulties with navigating
familiar environments. Habib and Sirigu (1987) report a case of TD with
striking disorientation in new surroundings (such as the hospital ward, new
places and new neighbourhoods). However, no difficulties were reported in
his home environment, local neighbourhood or even larger familiar cities
(e.g., TD was able to navigate familiar routes in Paris by car).
Moreover, cases have been reported for whom recognition of landmarks is
relatively intact and route descriptions are intact (demonstrating intact recog-
nition and memory skills for topographical information), but they have TD in
real-life settings because landmarks fail to convey directional information
(e.g., Suzuki et al., 1998). For example, case TY (Suzuki et al., 1998) was
able to identify single objects, sets of objects and her house accurately
from normal and different viewpoints. She was also able to draw a complete
plan of her house and local environment and describe routes accurately.
However, when asked to point to the standpoint from which the photo was
taken (on a plan of the stimulus and photographic angles), she was able to
do so for non-topographic objects, but not for photos of her own house.
So, in sum, within recognition and memory impairments there is evidence
to suggest relatively distinct processing of topographical spatial information
and topographical visual landmark information with probable further dis-
sociations within each domain (e.g., according to type of topographical
stimuli (e.g., scenes/buildings) or type of processing (e.g., encoding/
retrieval).
1
Balint-Holmes’ syndrome is characterised by apraxia of gaze, optic ataxia, disorders of
visual attention and defective estimation of distance (De Renzi, 1985) and in general presents
as an impairment in the scanning of space and inability to attend appropriately to a target(s).
42 BRUNSDON, NICKELS, COLTHEART
and imagery (e.g., Farah, 1984; Kosslyn, 1980). But to our knowledge the
framework proposed by Riddoch and Humphreys (1989) represents the
only cognitive neuropsychological framework dedicated to explaining
topographical cognition as a whole. The following discussion will focus on
theories of imagery proposed by Farah (1984) and Kosslyn (1980) and the
theoretical proposal by Riddoch and Humphreys (1989) as these form the
basis of the integrated framework used in this paper.
Visual imagery
There is a consensus of opinion in the literature that visual imagery is import-
ant in normal topographical orientation (Farah, 1989). Visual imagery refers
to the “short term memory representations that lead to the experience of
‘seeing with the mind’s eye’” (Kosslyn et al., 1993). It is presumed that
individuals employ mental visual images in many aspects of topographical
cognition (Davis & Coltheart, 1999; Farah, 1989; Riddoch & Humphreys,
1989) such as when drawing maps (or floor plans) of familiar environments,
describing well-known routes, describing familiar landmarks and presumably
when encoding and learning new routes. Recognition of landmarks, scenes
and maps also requires matching the environmental stimuli with stored
visual images. Individuals also manipulate and change mental images when
following topographical routes (i.e., when they are required to constantly
update the image in terms of their current position and perspective).
Kosslyn’s (1980) framework of visual object imagery includes two main
structures, a long-term visual memory structure (that stores information
about the appearances of objects) and a visual memory buffer (that acts as
a temporary visual store during processing). Kosslyn (1980) also proposes
three main processes that occur during normal visual object imagery. The
“generate” process retrieves the visual image from long-term memory and
represents its parts in the visual memory buffer. The “inspect” process con-
verts the pattern of activation in the visual buffer into an organised coherent
percept of an object, identifying parts and relations within the image ready for
further processing. The “transform” process allows for manipulations of the
image including transformations and rotations (Kosslyn, 1980; 1987).
Kosslyn (1987) proposes a complex framework for mental imagery involving
12 subsystems (including those just outlined) hypothesised to be used in both
visual imaging and visual perception. A detailed review of all 12 subsystems
is not necessary for the purposes of this current paper.
Farah’s (1984) information-processing model of imagery expands the
model proposed by Kosslyn (1980) to allow for the development of theoreti-
cally driven assessment, by explicitly stating input and output processes.
Farah’s (1984) model adds three new components: “describe” (for question
and answer tasks that require inspection of the image in the visual buffer);
TOPOGRAPHICAL DISORIENTATION: AN INTEGRATED FRAMEWORK 43
Topographical cognition
Riddoch and Humphreys (1989) provide the most comprehensive framework
of topographical cognition and an excellent foundation for a cognitive neu-
ropsychological model of topographical orientation. Their conceptualisation
of topographical cognition begins with early perception of visual stimuli
across the visual field in both 2D and 3D space, including perception of
depth, perception of spatial location of single objects and also the spatial
relationship between multiple objects. They consider these visual and
spatial perceptual skills as important for recognition of topographical
stimuli. They acknowledge the need for more research investigating the
effect of early perceptual impairments on topographical orientation, but
propose that some more severe forms of early perceptual impairment
certainly could impact on topographical orientation and need to be considered
and assessed as possible factors affecting performance (Riddoch &
Humphreys, 1989). They also acknowledge the need for a spatial working
memory system to provide a flexible and temporary store for one’s current
position on a route (which is constantly changing) to allow for planning of
future movements. They propose that this ability to maintain one’s position
on a route while also updating and planning future movements is a joint
function of the spatial sketch pad and central executive systems. Attentional
processes are also considered important for “initiation and co-ordination of
actions in response to the appropriate environmental cues”. Finally they
discuss the need for access to long-term stored memories of familiar
landmarks and routes and stress the importance of the distinction between
loss of actual knowledge and difficulty with accessing or retrieving it.
In summary, Riddoch and Humphreys (1989) break down TD into:
impairments in viewpoint-dependent representations (early perception of
visual characteristics, depth perception and perception of distances between
44 BRUNSDON, NICKELS, COLTHEART
McCarthy, Evans, and Hodges (1996) in their report of case SE, who pre-
sented with impaired topographical recognition, provide evidence for a
core underlying central semantic deficit.2
large-scale space is essential, not just for treatment studies but also for
detailed case investigations.
Map reading
Finally, assessment of map-following skills can provide useful insights into
the more complex high level demands of interactions between working
memory, executive, attention and spatial skills in combination and in practice.
Information regarding map-following skills is also useful for treatment
planning.
FINAL COMMENTS
The integrated framework outlined above, at this stage, represents a broad
sketch of cognitive processes thought to be involved in topographical cogni-
tion. The aim of the current paper was to develop a preliminary framework
that could provide a rationale for assessment planning and interpretation. It
is hoped that the current framework will stimulate further research in this
area and particularly more cases studies of topographical disorientation that
include a comprehensive theoretically based assessment (including assess-
ment of real-life route finding). Cognitive neuropsychological studies that
carefully evaluate all aspects of topographical cognition as well as real-life
route-finding skills will be invaluable for future development and refinement
of this framework, hopefully leading to a more widely accepted cognitive
neuropsychological model of normal topographical cognition in the future.
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