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Objective To investigate long-term recovery of allocentric and egocentric spatial orientation as a sensitive marker for hippocampal and extrahippocampal network function in transient global amnesia (TGA).
Methods A group of 18 patients with TGA performed an established real-space navigation paradigm, requiring allo- and egocentric spatial orientation abilities, 3 days (postacute stage) and 3 months (follow-up) after symptom onset. Visual exploration behavior and navigation strategy were documented by a gaze-controlled, head-fixed camera. Allo- and egocentric spatial orientation performance was compared to that of 12 age-matched healthy controls. Navigation-induced brain activations were measured using [18F]-fluorodeoxyglucose-PET in a subgroup of 8 patients in the postacute stage and compared to those of the controls.
Results In the postacute stage, the patients navigated worse and had higher error rates than controls in allocentric (p = 0.002), but not in egocentric, route planning (p = 0.30), despite complete recovery of verbal (p = 0.58) and figural memory (p = 0.11). Until follow-up, allocentric navigation deficits improved, but higher error rates and reduced use of shortcuts persisted (p < 0.0001). Patients still exhibited relatively more fixations of unique landmarks during follow-up (p = 0.05). PET measurements during the postacute stage showed increased navigation-induced brain activations in the right hippocampus, bilateral retrosplenial, parietal, and mesiofrontal cortices, and cerebellar dentate nucleus in patients compared to controls (p < 0.005).
Conclusions Patients with TGA show selective and prolonged deficits of allocentric spatial orientation. Activations in right hippocampal and extrahippocampal hubs of the cerebral navigation network functionally substitute for the deficit in creating and updating the internal cognitive map in TGA.
The sustainability of southern Africa’s natural and managed marine and terrestrial ecosystems is threatened by overuse, mismanagement, population pressures, degradation, and climate change. Counteracting unsustainable development requires a deep understanding of earth system processes and how these are affected by ongoing and anticipated global changes. This information must be translated into practical policy and management interventions. Climate models project that the rate of terrestrial warming in southern Africa is above the global terrestrial average. Moreover, most of the region will become drier. Already there is evidence that climate change is disrupting ecosystem functioning and the provision of ecosystem services. This is likely to continue in the foreseeable future, but impacts can be partly mitigated through urgent implementation of appropriate policy and management interventions to enhance resilience and sustainability of the ecosystems. The recommendations presented in the previous chapters are informed by a deepened scientific understanding of the relevant earth system processes, but also identify research and knowledge gaps. Ongoing disciplinary research remains critical, but needs to be complemented with cross-disciplinary and transdisciplinary research that can integrate across temporal and spatial scales to give a fuller understanding of not only individual components of the complex earth-system, but how they interact.