Orientation to time as a guide to the presence and severity of cognitive impairment in older hospital patients.

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.

Three-dimensional transesophageal echocardiographic demonstration of anatomical defects in AV septal defect patients presenting for reoperation.

We present two- and three-dimensional transesophageal echocardiographic findings of two adult patients who presented for reoperation after previous repair of a partial atrioventricular (AV) septal defect. Both patients had a cleft in the left AV valve with severe regurgitation. One patient had an additional 10 x 5 mm defect connecting the left ventricle to the right atrium through the AV junction. Three-dimensional echocardiography was superior to two-dimensional echocardiography in comprehensively delineating the anatomical defects in the left AV valve and the AV junction.

Transesophageal color Doppler three-dimensional echocardiographic assessment of left circumflex coronary artery fistula.

We describe an adult patient with a left circumflex coronary artery fistula in whom color Doppler three-dimensional transesophageal echocardiography demonstrated clearly the exact site of the communication with the coronary sinus near the left atrial appendage. This could not be delineated definitively by multiplane two-dimensional transesophageal echocardiography.

Prosthetic aortic valve abscess producing total right coronary artery occlusion: diagnosis by transesophageal three-dimensional echocardiography.

We present a patient with total right coronary artery occlusion produced by a prosthetic aortic valve abscess. The diagnosis was made by transesophageal three-dimensional echocardiography.

Transesophageal two- and three-dimensional echocardiographic diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture.

Two- (2-D) and three-dimensional (3-D) transesophageal echocardiography (TEE) were useful in making the diagnosis of combined left ventricular pseudoaneurysm and ventricular septal rupture in an elderly patient presenting with mediastinitis and worsening heart failure following coronary artery bypass graft surgery. The diagnosis was not suspected clinically. Three-dimensional TEE served to increase the confidence level with which the diagnosis of this combined lesion was made. Additionally, 3-D TEE proved superior to 2-D TEE in assessing the size of the left ventricular rupture site.

Three-dimensional color Doppler transpharyngeal echocardiographic reconstruction of the left common, internal, and external carotid arteries.

To our knowledge, we report the first cases of successful three-dimensional reconstruction of the left common, internal, and external carotid arteries using color Doppler transpharyngeal echocardiography.

Transesophageal Three-Dimensional Echo Assessment of Sinus Venosus Atrial Septal Defect.

The incremental value of three-dimensional echocardiography over transesophageal multiplane two-dimensional imaging in the assessment of sinus venosus atrial septal defect is demonstrated in the present study.