Lessons

10c - Topographic Agnosia

Posted by Helen St Clair Tracy in Level 10 - Temporal Lobe
Published: 25/09/2021, 12:08am | Updated: 22/10/2021, 11:30am

Video Link: https://vimeo.com/589922421

What is Topographic Agnosia?

The term 'topography' is commonly understood in terms of showing hills and mountains on maps.

Topographical map of Japan.  Yellow and orange indicate areas of the land that have a higher terrain, including hills and mountains.Topographical map of Japan. Yellow and orange indicate areas of the land that have a higher terrain, including hills and mountains.

The topography in topographic agnosia is slightly different, but connected.

Topographic agnosia is an inability or difficulty remembering or recollecting routes, even though they may be well known, and seen clearly.

The confusion is because the terms topography and routes immediately bring up images of maps, so we need to explain some important differences.

The difference between a route and a map in terms of your brain.

Maps come in all shapes and sizes...

You may use a map on your phone to find somewhere local, or a world map to learn about the location of different countries.

In Lesson 1e we explained that the right and left temporal lobes store different types of memories.

Image from Lesson 1e giving examples of the different types of memories typically stored in the left and right temporal lobes.Image from Lesson 1e giving examples of the different types of memories typically stored in the left and right temporal lobes.

Maps, as described above, are diagrams and lines and words, and are left temporal lobe memory processes.

Whilst a map may show you a way to get from one place to another, your experience and memory of the same route is a very different process. That memory of the route is a right temporal lobe process, and it is that process that is impaired with topographic agnosia.

To explain, come on a little journey with us, on Scotland's West Highland Way. Below is a part of the map we have been using, showing the end of the walk, finishing at the town of Fort William.

The map is very detailed, and our ability to follow and understand that map has helped guide us.

Our path and the path marked with a line on the map, whilst accurately matching each other, are not the same. One is a line on a piece of paper, the other a real path.

This is our real path (images above), it has taken us across countryside, through dark woods, over rivers and up steep hills.

The visual memory of the route we have followed can be thought as a bit like video filming the journey, and it is of course tied in with many other sensory experiences and how we are feeling from that journey. That is why it is such a complex memory, and processed for most in the right temporal lobe.

Route Memory

Your memory of that journey is a form of route memory. Having only walked the West Highland Way once, the route memory will probably not be good enough to remember it accurately to be able to walk it again without a map, but if you walked it often, the memory would be reinforced and get stronger, and become a better guide, as is the case with all memories.

Think of routes you know and how you first learnt them. Maybe walking to your local school, or driving to a town centre. Can you remember the first time you did it, when everything was unfamiliar, it probably felt longer.

Think of a local shop and how you get there from home. Go through that journey from home to the shop in your mind. What you are recollecting is the route, that is your route memory. Do you see now, why we say it is a bit like a video film in your mind? Do you see also why your memory of that route is completely different to the lines that indicate the same route on a map?

With topographic agnosia, it is that ability to recollect or remember those routes that is impaired, and it is a right temporal process.

Other issues can affect the route recognition process, particularly where it is not seen clearly enough. We explained this in lesson 8d Impaired Route Recognition.

Topographic agnosia applies when the cause is not because the memory is impaired due to not being seen clearly enough. When the route is not learnt because it is not seen clearly enough, unquestionably this causes an impairment of the route recognition process which in some can be severe, but in terms of the technical definitions, this would not be considered as topographic agnosia.

Topographic agnosia is a right temporal lobe processing issue.

Another right temporal lobe processing condition is prosopagnosia, as explained in lesson 10a. Our memories of faces and routes are both stored in the same part of the brain. This is why it is easier to recognise someone when they are somewhere you expect to see them, and often less easy when they are somewhere unexpected, or 'out of place'. Because faces and places are matched together in the same part of the brain as part of the memory and recognition process.

As with the other forms of agnosia we have explained in this level (prosopagnosia lesson 10a and shape & object agnosia lesson 10b), topographic agnosia can be mild or severe, and from birth or acquired.

In lesson 10b we explained Integrative Agnosia, where both temporal lobes are affected, due to, for example hydrocephalus (also explained in lesson 10b). Topographic agnosia is likely to be a part of these combined recognition difficulties. See 'Visual Behaviours' below for examples of difficulties.

Routes can be short or long, and simple or complex, and everything in between. Going to your kitchen to fetch a cup from the cupboard requires a degree of route memory.

Think of where you are and where the cups are. If you don't have that route to link the two, how do you get to the cups? You can have a perfect picture of the cups in your mind. You may well be able to make an excellent cup of tea or coffee - but you need to get to the cups, and to do that, you need a route memory. The route memory should be an accurate match of the actual route to the cupboard with the cups.

To get to the cupboard where the cups are kept in your home, from another room, requires a route memory.To get to the cupboard where the cups are kept in your home, from another room, requires a route memory.

Imagine across your day how many things would be difficult or even impossible if you had topographic agnosia.

Everything that has a 'place', including cups kept in a cupboard and socks kept in a drawer, needs a route to get to it.

Visual Behaviours

At its most severe level, where the ability to recognise routes is completely absent, the person is likely to be often disorientated and struggle with simple tasks, because so much of what we do involves getting something from somewhere, which requires a route.

The person may resort to a lot of guess work, and sometimes get things right, and sometimes not.

Routes may take longer to learn and need to be repeated more often, which can look like a person is a slow learner.

People may not be recognised when somewhere unexpected.

In school, children may struggle to find their classrooms and other rooms like the canteen, toilets, gym etc. It can make a child stressed as they become disorientated. Do you have any memories of really feeling very lost? Maybe as a child? The signals your brain sends are alarm bells, because when disorientated you are not sure where you are, and possibly not safe . So those alarm bells of extreme alert are to make you stop doing whatever you are doing and deal with what you brain has decided is the immediate most important matter - it has overridden everything else and is forcing you to deal with being 'lost'. Recovering from this feeling can take time, meaning that lessons can be affected.

In children this difficulty is likely to be a part of the combined difficulties created by integrative agnosia (see below and explained in lesson 10b).

Topographic Agnosia & Integrative Agnosia

Think about our example of getting a cup from the cupboard to make a drink...

You need both a route to get to the cupboard, and the ability to recognise the shape of the cup, to recognise the object of the cup, to recognise and locate the cup. This requires both left and right recognition processes, working together.

We take very simple tasks like this for granted, but they require multiple synchronised brain processes.

Even if just mildly impaired, what might everyday tasks look like with integrative agnosia?

It can definitely mean tasks are difficult to learn and to do, which can look like a learning difficulty, and certainly create learning difficulties if not identified, understood and appropriately supported.

Targeted Support

Use A Map
Using a map when out and about can help, if the difficulty is limited to the right temporal lobe. By using a map or satellite navigation system, you are using the other temporal lobe. If the topographic agnosia is part of an integrative agnosia, this approach may not work so well.

Practice
For some where the issues are less severe, routes may just need a little more repetition before they are learnt. Where a route is important to remember, like getting to school, work or the shops independently, you could try:

  • Repeating it starting with quiet times.
  • Sticking to the same routine, for example crossing the roads at the same points.
  • Allow time, you may have to stop and think.
  • Look for notable points you can remember.
  • Have a back-up plan in case difficulties, for example a rehearsed safe place to wait whilst calling for assistance.

Colour coding
Some families have found that painting doors different colours has enabled their child to link the colour to the room, and so find their way around the house much more easily.

Use A Rhyme
This might sound odd but we have heard great stories of the success of this approach.

It does not have to be an elaborate rhyme or ever a very good rhyme, and you don't have to say it out lout. It just needs to be easy to remember, so for example to go to the shops...

Outside home is a red post box
Walk towards the door with a fox
Look for the window with curtains blue
The shop's next door, buy something new

A rhyme can help remember a route, it does not have to be good or said out loud, just easy to remember.A rhyme can help remember a route, it does not have to be good or said out loud, just easy to remember.

The little rhyme is providing a guide using a different part of your brain. It doesn't have to be good - just easy to remember.

Checklist:

Before moving on please check you have understood the following:

  • What the word topographic means.
  • What topographic agnosia relates to.
  • The difference between a route and a map.
  • The link between topographic agnosia and prosopagnosia.
  • That routes can be long and complex or short and less complex.
  • That topographic agnosia can be mild or severe.
  • That topographic agnosia can be from birth (congenital) or acquired.
  • That topographic agnosia is likely a part of integrative agnosia.
  • Why using a map may not always be helpful.
  • Different suggestions for support with topographic agnosia.

Next lesson, Level 11a Brain Disorders of Visual Processing, Palinopsia

Level 10 Full Checklist

You should understand...

  • What the word prosopagnosia means
  • That prosopagnosia is sometimes called face blindness
  • That prosopagnosia is a cause of impaired facial recognition, not the only cause
  • Why 'see / memory / match' are needed to recognise a face
  • Which of 'see / memory / match' can be a factor with prosopagnosia
  • That prosopagnosia can be from birth or acquired
  • The part of the brain where most people's stores of faces are located
  • How many people are affected by prosopagnosia
  • Other difficulties people affected by prosopagnosia may have
  • That to recognise a face is different from not knowing the person the face is attached to
  • What a shape is
  • That shape is a property of the object
  • By objects we mean inanimate objects and why in relation to regions of the brain
  • The importance of recognising shapes
  • Shape and object agnosia can be from birth or acquired
  • Shape and object agnosia can be mild or severe
  • What hydrocephalus is
  • Why hydrocephalus can lead to shape and object agnosia
  • What integrated agnosia is
  • Why shape and object agnosia is easily missed
  • Why shape and object agnosia can cause profound learning difficulties
  • Ways to adapt when affected by shape and object agnosia
  • Why language can be a useful adaptive strategy
  • What the word topographic means
  • What topographic agnosia relates to
  • The difference between a route and a map
  • The link between topographic agnosia and prosopagnosia
  • That routes can be long and complex or short and less complex
  • That topographic agnosia can be mild or severe
  • That topographic agnosia can be from birth (congenital) or acquired
  • That topographic agnosia is likely a part of integrative agnosia
  • Why using a map may not always be helpful
  • Different suggestions for support with topographic agnosia

Congratulations on completing level 10!Congratulations on completing level 10!

HELP SUPPORT US

Your generous donations will be put to immediate use in supporting our charity...

Donate Here

About Us

At CVI Scotland we are devoted to helping people understand cerebral visual impairments, and together working towards developing the understanding of this complex condition.