A historical review of topographical disorientation and its neuroanatomical correlates

Topographical disorientation (TD) refers to impaired orientation and naviga tion in real-world environments. Although numerous cases have been reported , disagreement over neuroanatomical correlates remains. This has been contr ibuted to by concern with the "essential defect," ambiguous terminology, an d incomplete assessments. Attention to three factors permits a coherent und erstanding of the widely divergent descriptions of cognitive deficits and n euroanatomical findings: point in course (acute vs. chronic), characteristi cs of the environment, and a patient's specific cognitive deficits. Defects in visual learning/recognition of topographical scenes or spatial-topograp hical 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 occipitot emporal lesions in either hemisphere, especially posterior parahippocampal gyrus, whereas TD consequent to right parietal damage tends to be time-limi ted. Persistent retrograde TD is attributable to right medial occipitotempo ral lesions.