Background Testing 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. Methods 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. Results 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. Conclusion 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.Disorientation to time is a very common feature of delirium and dementia, and assessment of temporal orientation is a well established and routine part of mental status testing.1 There is no difficulty in recognising abnormality in patients with gross temporal disorientation. However, clinicians are sometimes uncertain about the significance of more minor orientation errors, such as misstating the day of the month or the week by a day or two, as a guide to possible delirium or dementia in older people. 2Studies in young and middle aged subjects show that it is rare for a normal individual to misidentify the year or the month. 3 The most common error is to misidentify the day of the month. However, less than 5% misidentify the day of the month by more than 3 days. Benton et al reported that there was 'no evidence of a decline' in temporal orientation with age in a study of 162 community volunteers aged between 65 and 84 years (1981). 4 Nevertheless, the frequency of temporal disorientation in their study was 1% in 90 patients aged 65e74 years and 6% in 72 patients aged 75e84 years. Brotchie et al used a different questionnaire to study temporal orientation in 235 hospital visitors aged 50e84 years.5 They noted that less than 2% misstated the year or month but that errors in identifying the day of the month became more common with incr...

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We present the case of a patient with a single papillary muscle that is supporting both orifices of a stenotic double orifice mitral valve. With the use of both transthoracic and transesophageal echocardiography, we were able to prospectively define this entity, which was confirmed at surgery.

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