Orientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients.
AffiliationDepartment of Geriatric Medicine, Unit 4, Merlin Park University Hospital, Galway, Ireland. email@example.com
Aged, 80 and over
Length of Stay
Sensitivity and Specificity
Severity of Illness Index
MetadataShow full item record
CitationOrientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients. 2011, 82 (5):500-4 J. Neurol. Neurosurg. Psychiatr.
JournalJournal of neurology, neurosurgery, and psychiatry
AbstractTesting of orientation to time is an important part of mental status examination. The validity of errors in different aspects of temporal orientation was examined in older hospital patients as a guide to the presence of dementia or delirium and as a measure of the severity of dementia, as defined by the Global Deterioration Scale.
Inpatients and outpatients attending an acute hospital underwent independent assessments by two doctors on the same day to determine orientation to time and cognitive status. Optimum cut-offs for error scores on the different aspects of temporal orientation were calculated to maximise the sum of sensitivity and specificity for detection of dementia or delirium.
Of the 262 patients assessed, 62 (23.7%) had dementia or delirium. The best cut-offs for detection of these disorders were: any error in identifying the year, month, day of the month or day of the week; and an error of more than 1 h in identifying the time of day. Failure to identify the year correctly was the most valuable single sign of dementia or delirium (sensitivity 86% and specificity 94%); failure to identify either year or month correctly was 95% sensitive and 86.5% specific for the detection of cognitive impairment. Severity of temporal disorientation, measured using a number of approaches, was strongly associated with severity of dementia.
Disorientation to time is a useful guide to the presence and severity of dementia or delirium in older hospital patients. Failure to identify the year or month correctly is a sufficiently sensitive and specific indicator of dementia or delirium to warrant more detailed cognitive assessment in this population.
- Validation of a German version of the Confusion Assessment Method for delirium detection in a sample of acute geriatric patients with a high prevalence of dementia.
- Authors: Hestermann U, Backenstrass M, Gekle I, Hack M, Mundt C, Oster P, Thomas C
- Issue date: 2009
- The use of the Digit Span Test in screening for cognitive impairment in acute medical inpatients.
- Authors: Leung JL, Lee GT, Lam YH, Chan RC, Wu JY
- Issue date: 2011 Dec
- Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults.
- Authors: Fick DM, Steis MR, Waller JL, Inouye SK
- Issue date: 2013 Sep
- Delirium in older medical inpatients and subsequent cognitive and functional status: a prospective study.
- Authors: McCusker J, Cole M, Dendukuri N, Belzile E, Primeau F
- Issue date: 2001 Sep 4
- Evaluating attention in delirium: A comparison of bedside tests of attention.
- Authors: Adamis D, Meagher D, Murray O, O'Neill D, O'Mahony E, Mulligan O, McCarthy G
- Issue date: 2016 Sep