Some people have absolutely no sense of direction: Topographical agnosia

the fogThere are people who have absolutely no sense of direction. Their disorientation can be so comprehensive that they may not be able to navigate around their own home and can get utterly lost in their own street. This neurologically based impairment in finding one’s way around is called topographic agnosia.

Acquired topographical agnosia
The first study of the disorder was published in 1900 by Meyer, who described a 49-year-old man, who was severely disoriented following a vascular damage in his brain. His intellect was intact and his memory and visual perception normal. Despite that, he was unable to find his way around his hometown or learn his way around the hospital. He could neither describe nor draw the route between his home and any of the public places in his hometown.


In 1978, Whiteley and Warrington described a 46-year-old male, who developed this condition following a head injury in a car accident:

“His present complaint, four years after the accident, is of a failure to recognize buildings, streets, and other landmarks, which incapacitates him to the extent that he gets lost in familiar surroundings. He describes looking at a building, being able to see and describe it clearly, yet, if he looks away and then looks back again, it looks different as though someone had put another unfamiliar building in its place. The street in which he lives seems unfamiliar and each day he might be going along it as if for the first time. He recognizes his own house by the number or by his car when parked at the door. … He complains of considerable difficulty in getting about, and says that learning new routes presents a real problem. He can, however, use a map easily and follow verbal instructions. He relies heavily on street names, station names, and house numbers. “

Congenital/developmental topographical agnosia
But acquired brain injury does not seem to be necessary for this condition to occur. Some people, with otherwise normal cognitive functions, seem to be born with it. Iaria and his coworkers (2009) published the first case-study of someone with what they termed developmental topographical disorientation. They described Pt1, a 43-year-old woman:

“Despite normal cognitive development, Pt1 has never been able to orient in the environment. She recalls from about the age of 6 years onwards panicking at the grocery store each time her mother disappeared from sight. For the 12 years of her schooling, her sisters or parents brought her to school. She never left home by herself because she got lost each time she tried: as a teenager, she relied on friends to accompany her when she left her parents’ house. Neither she nor her parents know of similar navigational difficulties in other family members. At present she lives with her father. She follows strict stereotyped directions to get to the office where she has worked for 5 years. She knows which bus to take downtown, recognizes a large distinctive square at which she must exit the bus, and then follows a straight route of about 30m to locate the tall building where her office is situated. She follows the same path in reversed fashion to get home, although sometimes she gets lost in her neighborhood and needs to phone her father to ask him to come and get her. Aside from this specific path, she cannot find her way to other locations, such as stores or theaters, and gets lost each time she tries. She reports, however, no difficulties in right–left discrimination and no impairments in recognizing familiar places or environmental landmarks.”

The authors concluded that Pt1’s difficulties resulted from her inability to form a mental representation, a cognitive map, of her environment.

Topographical agnosia is possibly not as rare as previously thought
After the publications of the study of Pt1’s condition, the authors were contacted by people all over the world who claimed to have had the same kind of difficulties as long as they could remember. To be able to study these people, Iaria and his colleagues created a website where people could complete a battery of tests assessing different cognitive skills. They have now published a paper based on the first 120 participants.

Developmental topographical agnosia in people without known brain injury seems to have gone unnoticed by the scientific community for a long time. Scientific papers on the congenital form are scarce, but an internet search reveals many narratives from people who suffer from this condition, see for example here: http://www.guardian.co.uk/notesandqueries/query/0,5753,-58770,00.html. One funny blogger writes: “I have had this dysfunction since approximately birth. It’s a miracle I made it down the birth canal in the correct direction. To my knowledge, that was the last time I went in the correct direction to get anywhere.”  Another blogger describes his travels with the assistance of a service dog (named Reykjavik, presumably after my hometown in Iceland!).

Here is a video from YouTube where a young women explaines her condition:

Built on:

Iaria, G. og Barton, J. Developmental topographical disorientation: a newly discovered cognitive disorder. Experimental Brain Research, 206(2), 189-196.

Iaria G, Bogod N, Fox CJ, Barton JJ (2009) Developmental topographical disorientation: case one. Neuropsychologia 47:30–40.

Meyer, О. (1900) Ein- und doppelseitige homonyme Hemianopsie mit Orientierungsstörungen. Mschr. Psychiat. Neurol. 8, 440-456.

Whiteley, A. M. og Warrington, E. K. (1978). Selective impairment of topographical memory: a single case study. Journal of Neurology, Neurosurgery & Psychiatry, 41(6), 575-578

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One Response to Some people have absolutely no sense of direction: Topographical agnosia

  1. My sense of direction is so bad that I always turn the wrong way in my own home. When leaving one upstairs room to go to another I turn the wrong way. The hall way is small, so very frustrating.Forget restaurants…finding my way out or to the restroom, even thought I’ve been there many times.

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