What do the x1, x2, x3, and x4 orientations mean in dementia?


Counseling is what healthcare providers check when they screen for dementia and assess cognitive ability. It refers to the level of consciousness of a person about himself, the place, the time and the situation.

When testing a person's guidance, the doctor asks standard questions that can seem like small talk. But these questions are useful to see how well a person can recall recent and longer-term memories. Typical questions include:

  • What's your name?
  • Where are you?
  • What is the date?
  • What time is it right now?
  • What just happened to you?

This article includes information on what the different levels of counseling mean and how they relate to Alzheimer's, dementia, and delirium.

Get Medical Information / Laura Porter

Orientation levels

In some health assessments, counseling is sometimes called "alert and oriented" (AO or A&O) or "awake, alert and oriented" (AAO). It is usually followed by a multiplication symbol (x) and a number. For example, it can be written as "AOx3" or "AAOx4".

The level (x1, x2, x3 or x4) is a way of measuring the degree of consciousness of a person. Here's what each level of guidance means:

  • x1: Human-centered. A person knows your name and can recognize loved ones.
  • x2: Focused on the person and the place. A person knows not only his name, but also his location.
  • x3: Focused on person, place and time. A person knows not only their name and location, but also the date, the day of the week, and the time of year.
  • x4: Focused on the person, the place, the time and the situation. In addition to knowing their name, location, and time, they can explain why they are in a medical facility.

Sometimes a person can answer some information, but not all. For example, they may know their name and date, but they cannot know where they are. In this case, it will be indicated as x3 less space.

In some cases, healthcare providers may only ask about the person, place, and time. In this situation, x3 is the highest level of guidance tested. However, when the doctor makes the situation known, the highest level will be x4.

In addition to the meaning (for example, x3), the health care provider's notes should also include the specific questions asked and responses received.

Alzheimer disease

Alzheimer 's is a type of dementia that can disorient people. In Alzheimer's disease, orientation can be affected in the following ways:

  • Timing : It is not uncommon for people with dementia to feel particularly confused about the timing. They may believe that this was many years ago, or that they are much younger than they really are.
  • Location : As Alzheimer's disease progresses, people may also wonder where they are. For example, when asked about the city and state they live in, they can respond by indicating where they grew up, not where they have lived for the past 30 years.
  • Location : If someone with Alzheimer's loses location orientation, they may wander and try to escape. This is due to the fact that they do not understand their place and their time. For example, a person may think they have to go to work and then get lost on their way to a job they left years ago.
  • Person : In the advanced stages of Alzheimer's disease, a person may not remember their name or recognize themselves in the mirror.

Disorientation can be a safety hazard and can lead to stress and anxiety . Therefore, it is important that there are close people who understand the person's condition and can support them.

Other types of dementia

Interestingly, not all types of dementia affect orientation to the same extent as Alzheimer's.

A 2012 study published in the Journal of Alzheimer's Disease found:

  • Alzheimer's disease constantly affects orientation and memory.
  • People with frontotemporal dementia (also called Pick's disease) often had no orientation problems, but they did have memory problems.


Orientation can also be influenced by delirium , that is, a sudden decrease in a person's cognitive abilities. Delirium is often caused by something temporary, such as a reaction to a medication or an infection.

If the person is suddenly misguided, this could be a sign that they are delusional. In this case, they should see a doctor immediately.


Doctors use orientation tests to assess a person's cognitive ability. Orientation is measured by person, place, time, and situation. Values range from x1 to x4. The higher the score, the greater the person's awareness.

Low orientation scores can indicate memory impairment such as Alzheimer's, dementia, or delirium. If you or a loved one suddenly feel disoriented, you should seek medical attention immediately.

Get the word of drug information

If you have memory problems or confusion, it is important to speak with your doctor. Many things can cause confusion for a person, such as stress, depression, memory problems, medications, trauma, and health problems.

It is normal to feel anxious or frustrated if you or your loved one experience memory loss or confusion. Be kind to yourself and your family, and always kindly remind someone of the date, time of year, place, or time of day.

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