Clinically, the orientation of a patient is determined by asking questions such as,
“What day is today? What is the date (or day of the week)?”
“Where are you right now? The name of this place?” These questions test orientation as to place.
If the patient does not know, then s/he may be asked, “Are you in a hospital (or a doctor’s office), but may not know the name of the hospital or clinic, which indicates a milder degree of dysfunction than not knowing the nature of the place or confusing it with somewhere else, such as a hotel room.
The next question (orientation as to self) might be, “What is your name?”
Mild disorientation as to time (e.g., not knowing the date) is common even among normal persons, but severe disorientation Opens in new window (e.g., not knowing the month and year) is indicative of cerebral dysfunction.
Dysfunction in orientation proceeds in an orderly manner from time to place to person. In fact, except in cases of very severe brain disease, orientation as to self is usually well preserved. Of course, a delusional patient may have a distorted orientation as to self, for example, “I am Napoleone Bonaparte.”
In case of insufficiency in the cerebral cortical functions for any reason (most often due to metabolic derangement of the brain or neuronal destruction), orientation may be impaired to varying degrees.
Impairment of orientation Opens in new window usually occurs in the order of time, place, and person. In hospitalized patients, disorientation as to date is not uncommon, perhaps due to the change in daily schedule following hospitalization, distractions by the medical procedures, and other disruptions in the patient’s usual routine. In the absence of cerebral insufficiency, however, most patients are oriented to the month and year if not to the exact date.
Orientation as to person, especially to the patient himself, usually is not impaired until the very latest stage of cerebral insufficiency, although the patient may often forget the names of others, especially those persons encountered recently.
Disorientation to the self despite relatively normal mental-status examination Opens in new window in other areas strongly suggests a dissociative disorder rather than cerebral insufficiency (organic brain syndrome, pathological processes which interfere directly with brain tissue function as reflected in demonstrable changes in chemistry, physiology, or anatomy).
