Disorientation Assessment Questionnaire

Why: to determine if acute or chronic. Delirium is an acute confusional state due to many causes e.g. infection, drug intoxication, alcohol withdrawal, liver failure, kidney failure, hypoxia (reduced oxygen levels in the blood), low blood sugar, stroke, heart attack or head injury. If the onset is chronic a diagnosis of dementia may be more likely.

Why: the commonly used categories for assessment of orientation are time, place and person. Impairments usually develop in this order, and if treatable, usually clear in the reverse order.

Why: e.g. disorientation symptoms worse in the late afternoon and at night are typical of delirium.

Why: e.g. physical illness, recent surgery, starting a different medication, abstaining from alcohol - may all cause delirium and thus disorientation.

Why: may suggest subdural haematoma, extradural haematoma or concussion.

Why: may suggest heat exhaustion or heat stroke as a cause of disorientation.

Why: e.g. schizophrenia, bipolar affective disorder, anxiety attacks, post-traumatic stress disorder or dissociative disorder - may suggest a psychiatric cause of disorientation.

Why: e.g. diabetes mellitus (low blood sugar from insulin or hypoglycemic medications may cause disorientation), epilepsy (seizures may cause disorientation), stroke, transient ischemic attacks.

Why: certain medications may cause intoxication and consequent disorientation e.g. anticonvulsants, anticholinergics, anti-anxiety medications, opiates; or may cause disorientation on drug withdrawal; certain medications may interact and cause adverse reactions including disorientation; insulin can cause low blood sugar and disorientation; aspirin given to children with a viral infection may precipitate Reye's syndrome which may cause disorientation.

Why: e.g. high blood pressure, high cholesterol, diabetes, smoking, family history - can help assess risk of multi-infarct dementia or delirium from acute stoke or transient ischemic attack.

Why: e.g. neurotoxic shellfish poisoning can cause disorientation.

Why: e.g. Alzheimer's disease, Huntington's disease, multiple sclerosis, anxiety, stroke, heart attack, psychotic disorders.

Why: to assess chance of alcohol withdrawal, alcohol abuse, Wernicke-Korsakoff syndrome, hepatic encephalopathy, subdural or extradural haematoma due to head injury.

Why: e.g. amphetamine, marijuana, cocaine, LSD, PCP - may cause disorientation.

Why: may determine risk of HIV and syphilis infection which may cause cognitive impairment with disorientation.

Why: e.g. impaired conscious level with onset over hours or days, disorientation in time and/or place, unusually quite, drowsy, agitated, delusions, auditory hallucinations, visual hallucinations.

Why: e.g. impaired memory, impaired judgement and thinking, impaired verbal fluency and impaired ability to perform complex tasks. Personality may change, impulse control may be lost and personal care deteriorates. If onset of disorientation is chronic consider diagnosis of dementia.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination - anxiety and anxiety attacks may cause disorientation.

Why: can suggest any infection that may cause delirium or meningitis, encephalitis, brain abscess or brain hemorrhage.

Why: e.g. limb weakness or paralysis, facial muscle weakness or paralysis, difficulty with speech and swallow.

Why: may suggest brain cancer or acute stroke.

Why: e.g. delusions, hallucinations and disordered thinking - may suggest schizophrenia or bipolar disorder but these symptoms may also be present with delirium.

Why: e.g. symptoms follow exposure to an unusual stress such as a battle, being attacked or raped or a natural disaster. Symptoms include recurrent and intrusive recollections of the stress, recurrent distressing dreams of the event, acting or feeling as if the event was recurring, intense distress on exposure to resembling events, persistent avoidance of events that symbolize or resemble the trauma, increased arousal symptoms such as insomnia, exaggerated startle response, poor concentration and moodiness - Post-traumatic stress disorder may present with disorganization.

Why: may suggest epilepsy, brain cancer or metastasis, encephalitis, stroke.

Why: see balance symptoms.