Barrash J
Department of Neurology, University of Iowa College of Medicine, Iowa City 52242-1053, USA.
J Clin Exp Neuropsychol. 1998 Dec;20(6):807-27. doi: 10.1076/jcen.20.6.807.1114.
Topographical disorientation (TD) refers to impaired orientation and navigation in real-world environments. Although numerous cases have been reported, disagreement over neuroanatomical correlates remains. This has been contributed to by concern with the "essential defect," ambiguous terminology, and incomplete assessments. Attention to three factors permits a coherent understanding of the widely divergent descriptions of cognitive deficits and neuroanatomical findings: point in course (acute vs. chronic), characteristics of the environment, and a patient's specific cognitive deficits. Defects in visual learning/recognition of topographical scenes or spatial-topographical 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 occipitotemporal lesions in either hemisphere, especially posterior parahippocampal gyrus, whereas TD consequent to right parietal damage tends to be time-limited. Persistent retrograde TD is attributable to right medial occipitotemporal lesions.
地形定向障碍（TD）是指在现实环境中定向和导航能力受损。尽管已有大量病例报道，但关于神经解剖学相关性仍存在分歧。这是由于对“本质缺陷”的关注、术语不明确以及评估不完整所致。关注三个因素有助于连贯理解对认知缺陷和神经解剖学发现的广泛不同描述：病程阶段（急性与慢性）、环境特征以及患者的特定认知缺陷。视觉学习/识别地形场景或空间地形知识方面的缺陷很常见，但“失认症”与“失忆症”的二分法过于简单化：仔细评估通常会发现两个领域均存在损伤。顺行性TD与任一脑半球的枕颞内侧病变高度相关，尤其是海马旁回后部，而右侧顶叶损伤导致的TD往往是限时性的。持续性逆行性TD归因于右侧枕颞内侧病变。
