Topographical disorientation: Towards an integrated framework for assessment

Abstract

Topographical disorientation, the inability to find one's way in large-scale environments, is a relatively common disorder. However, there are relatively few cognitive neuropsychological studies that investigate the nature of topographical cognition. Theoretical progress has been hindered by a number of factors including: terminological confusion; lack of theoretically driven assessment; the use of broad classifications for the nature of underlying impairments; and an ongoing failure to examine topographical skills in real-life settings. As a result, there is currently no well-established or widely accepted theoretical framework encompassing all aspects of this multifaceted area of cognition. In addition, there is a relative paucity of published case studies that include a comprehensive, theoretically based assessment of topographical disorientation, and treatment of the disorder has received virtually no formal investigation (with the exception of Davis & Coltheart, 1999). Thus, the current paper focuses on the development of a broad framework for understanding topographical cognition that integrates a number of recent theories of topographical orientation and mental imagery (Farah, 1984; Kosslyn, 1980; Riddoch & Humphreys, 1989). The aim of the paper is to present a preliminary framework that can be used as a basis for further refinement and development of theoretical proposals, and be employed by clinicians as a starting point for assessment planning.

Acknowledgments

Ruth Brunsdon was supported by a Department of Education, Science and Training Australian Post Graduate Award and Lyndsey Nickels by an Australian Research Council QEII Fellowship during the preparation of this paper.

Notes

¹Balint-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).

²Case SE, following an episode of viral encephalitis, complained of great difficulty finding his way around previously familiar environments (such as his home town) which he now described as appearing unfamiliar. He was unable to recognise familiar buildings (including his own house), but produced a remarkably detailed and accurate map drawing of his home town. In addition, however, case SE had difficulty providing semantic information about famous buildings when their names were presented verbally. Thus, SE's difficulties may have resulted from an underlying semantic deficit rather than from a pure recognition deficit.

³Assuming that long-term visual memories used in image generation are the same memories that are used in visual recognition (Farah, 1984).