Table of ContentsView AllTable of ContentsDefinitionAlertness LevelsOrientation LevelsUses With DementiaUses With Delirium
Table of ContentsView All
View All
Table of Contents
Definition
Alertness Levels
Orientation Levels
Uses With Dementia
Uses With Delirium
The term “alert and oriented” (AO) is a medical notation describing a person’s level of consciousness and cognition (the ability to understand and learn through thought, experiences, and the senses). It provides a general first impression as to whether a person iscognitively impairedand able to make decisions for themselves. It is commonly used whendementiais suspected or known.
Verywell / Laura Porter
What Alert and Oriented Means
Alertness and orientation help document where a person’s consciousness and cognitive function are at that moment in time. It is not a diagnosis but rather an indication of how alert and oriented a person is based on their responses to several questions or physical prompts.
By definition:
An AO mental assessment is useful in situations where an EMT or social worker is approaching an unknown individual and needs to quickly ascertain whether they have the capacity to make medical decisions for themselves.
The assessment also helps healthcare providers establish in what state of cognition a person with dementia is at that moment in time. (With certain types of dementia, likeAlzheimer’s disease, the AO can fluctuate and doesn’t always reflect the person’s overall status.)
The AO assessment is also used in legal situations to decide whether a person is alert and aware enough to show legal capacity to sign legal documents,
The assessment is commonly performed using an AVPU scale. APVU is an anagram for four different levels of alertness, described as:
Based on the APVU scale of 1 to 5, a person’s alertness may be notated as:
Orientation levels are determined based on open-ended questions that check a person’s memory and thinking abilities. The questions check for awareness of four domains: person, place, time, and event.
Examples of questions commonly used include:
Based on what the person may or may not be aware of, the EMT or healthcare provider will notate AO in one of four ways:
In legal practice, anything less than an AO x3 may limit a person’s capacity to sign legal documents.
Alertness and orientation are often assessed as part of a mental status exam (MSE) to evaluate cognitive functioning and to screen for dementia.
Dementia is the irreversible deterioration in two or more domains of cognitive function—memory, language skills, ability to focus and pay attention, ability to reason and solve problems, or visual perception—which affects a person’s ability to perform everyday tasks.
There are several causes for dementia, the most common of which include:
An AO mental assessment is useful in people with dementia. Although it is not meant to diagnose dementia, it can provide insights into which stage of Alzheimer’s a person is in.
With progressive forms of dementia, such as Alzheimer’s, the loss of orientation usually follows the same pattern wherein event, time, and place are lost (in this order) before person.
As such, orientation to person is almost invariably an indication that an individual is in the most advanced stages of dementia.
AO Assessment With Delirium
Causes of delirium include:
If a person’s orientation is rapidly impaired, this may be a sign that they are experiencing delirium.
Summary
Alertness and orientation (AO) are medical notations of a person’s level of consciousness and cognition based on a series of questions or physical prompts. Alertness can be described on an AVPE scale of 1 to 5. Orientation can be described on an AO scale of 1 to 5.
Low orientation scores indicate a loss of cognition, such as can occur with Alzheimer’s and other forms of dementia as well as delirium.
15 Sources
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Alzheimer’s Society.Changes in behaviour in the later stages of dementia.
American Psychological Association.Assesment of older adults with diminished capacities.
Peer M, Salomon R, Goldberg I, Blanke O, Arzy S.Brain system for mental orientation in space, time, and person.Proc Natl Acad Sci U S A.2015 Aug 17;112(35):11072–11077. doi:10.1073/pnas.1504242112
National Certification Board Alzheimer Care.What does oriented x1, x2, x3 and x4 mean in dementia?
15th Judicial Circuit of Florida.AO divisional instructions.
University of North Carolina School of Government.Mental status exams.
Centers for Disease Control and Prevention.What is dementia?
National Institute on Aging.What is dementia? Symptoms, types, and diagnosis.
MedlinePlus.Delirium.
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