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Orientation is defined as the “awareness of self in relation to one’s surroundings” (Lezak & Lezak, 2004). Since deficits in orientation are one of the most common symptoms of brain disease, tests of orientation are included in almost all neuropsychological evaluations. Often, orientation is examined by distinguishing whether a person has a sense of what time it is, who they are, and where they are. This is sometimes referred to being oriented to time, place, person (Lezak & Lezak, 2004; Alverzo, 2006). Orientation of time is most often assessed by asking patients to provide the correct date (day, month, year, and day of the week) as well as the time of day. A sense of temporal continuity may also be assessed by asking questions such as “How long have you been here?” or “How long is it since you last worked?” Orientation of place is similarly examined through a series of questions. Namely, does someone know the type of place he or she is in and can they provide the name of the building? Lastly, orientation to person is assessed through a series of autobiographical questions (e.g., name, age, marital status, etc.,). As noted above, deficits in orientation can be associated with a number of pathological processes, such as: Alzheimer-type dementia, bilateral cerebral lesions, disturbances of consciousness (Lezak & Lezak, 2004). So, one area of research has addressed the question of whether there is a normal decline in orientation among healthy aging adults. A number of studies suggest that orientation does not decline over the lifespan (Brotchie, Brennan, & Wyke, 1985; Hopp, Dixon, Grut, & Bacekman, 1997; Margolis & Scialfa, 1984; Natelson, Haupt, Fleischer, & Grey, 1979). For example, in one study 92% of normal elderly adults (65–84 years) presented with perfect or near perfect orientation (Benton, Eslinger, & Damasio, 1981).

However, there is also data that suggest that mild changes in orientation may be a normal part of aging. For example, normative data from the WMS-R indicate that, even though orientation to time, place, and personal and general information remains relatively stable until the age of 70, the variability in performance increases significantly at that point (Wechsler, 1987). This suggests that a wider range of performances can be considered normal. Furthermore, results from two studies suggest that mild changes in orientation are associated with advanced age (Ishizaki et al., 1998; Sweet, Such, Leahy, Abramowitz, & Nowinski, 1999). For example, Sweet and colleagues concluded that “older persons with normal, healthy memory may have mild orientation difficulties. In contrast, younger people with normal memory have virtually no orientation problems” (p. 505).