Developmental topographical disorientation: lost every day

Abstract

You'll probably have got lost at least once. Perhaps you couldn't find your way back to your car in a large car park or couldn't get back to your hotel while sightseeing in a foreign country. The experience was undoubtedly frustrating, but one that probably resolved quickly with the help of a map or a stranger and did not otherwise negatively affect your life. However, as director Michelle Coomber's recent documentary Lost Every Day illustrates, some people get lost on a daily basis, and not in unfamiliar surroundings, but rather in places that they know intimately, such as their neighbourhoods or even their own homes. Despite possessing otherwise normal cognitive skills, and without any known brain injuries or neurological disorders, these people have experienced severe topographical orientation problems since childhood. This disabling lifelong disorder is called developmental topographical disorientation. Although the basic issue of getting lost throughout one's life in familiar surroundings is universal to those with developmental topographical disorientation, the specifics of their experiences differ. In Coomber's documentary, Sharon Roseman describes an experience in which the location of her environmental landmarks consistently rotates 90° (ie, places known to be north shift to the east, whereas places located to the east shift south). Other people with developmental topographical disorientation who experience this type of rotational issue have reported shifts of 180°. The resulting mismatch between their (incorrect) expectation of where things are located and the actual location in the environment means that these people find familiar places and landmarks difficult to recognise. Scientists speculate that all topographical orientation defects in people with developmental topographical disorientation relate to a common impairment: an inability to create a reliable mental image of one's spatial surrounding and the environmental landmarks within it. Consistent with this idea, recent studies have shown that people with developmental topographical disorientation struggle to complete various spatial orientation tasks and cannot form a mental representation of their surroundings including environmental landmarks (ie, a cognitive map). Cognitive maps are crucial for orientation because they allow people to reach a target location from anywhere in their environment. Without such a map, people can get lost easily, even in familiar surroundings. A deficit in the proper formation of cognitive maps seems to be the most significant behavioural mechanism related to developmental topographical disorientation. Through its sensitive artistry, Coomber's narrative successfully conveys the astonishing psychosocial impact on people affected by the disorder, as a result of them becoming lost in very familiar surroundings, from a very early age in school through to later stages in life as a spouse or parent. The complexity and effects of this relatively unknown phenomenon have put an enormous social burden on affected people. They have reported feeling isolated, ashamed, and reluctant to disclose their problem for fear of being judged or not accepted. Such reticence has undoubtedly contributed to a delay in this disorder being characterised. Preliminary neuroimaging findings in people with developmental topographical disorientation showed a significant decreased functional connectivity between the right hippocampus and the dorsolateral prefrontal cortex (DLPFC). The hippocampus is crucial for the formation of cognitive maps in both human beings and animals. The DLPFC is responsible for a range of cognitive functions, all of which are essential for spatial orientation, as people move within an environment, become familiar with it, and start to form cognitive maps. In patients with developmental topographical disorientation, decreased functional connectivity between the hippocampus and the DLPFC can substantially impair the ability of these two brain regions to cooperate in monitoring and processing spatial information to create a cognitive map, and therefore prevent the correct formation of a mental representation of the environment. The fact that people with the disorder have severe topographical disorientation despite having no memory or attentional defects could be explained by the ineffective functional connectivity between the hippocampus and the DLPFC, rather than any selective functional defect of the two regions. The steady emergence of patients seemingly affected by developmental topographical disorientation suggests that the disorder might affect a substantial number of people. Researchers are investigating how to train people with the disorder to help them develop specific orientation skills for navigation in familiar surroundings, and are designing diagnostic devices to identify the disorder in children, in the hope that early intervention will be effective. Although no treatments are yet available, increased medical recognition of this disorder, and the fact that it presents in people whose cognitive skills are otherwise intact, is an immeasurable boost to those who have been trying to cope with the psychological isolation caused by this disability for their entire lives. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI1M2UyZjI3MzRmODZiNWM1MzUxZmY1YmVkNWMzY2M5OSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjM1MDkzMTgxfQ.JDh8j4agRKcFgPHLOhNNwthb1rQvGpSTgoxZKCZDrz57bhTdoOgprQ8jpvoz2j_ACioYWubwS1CfHC7KyWf5YRtOUXECFzfabbGXE4-IeIhz_voZ8fEl4AnyKHB4Lq2vebxnPs24neYRfOBvRLvPLfcojd-_0L-7aPZ-G8nLCVNsf9i63WYtyEoXYdLpzVlNGVPov87lFMS8xNdVDVOOZCPStuynBZJ5bfpcpZezZIWjxkQ04xhzi_K2ncG1w7RttMS7EIY5VaH3Ugo2xRks0DS30nUCSs5CGkVNvp-EMzGpMS02AXokh_hZrdsLWpsRcJwZ3OvXFpmFUVx2xF-mNA Download .mp4 (38.18 MB) Help with .mp4 files Supplementary videoLost Every Day