Confusion

Definition:

Confusion is an inability to think with customary speed or clarity, marked by some degree of lack of focus of attention and disorientation.

Alternative Names:

Mental dysfunction; Disorientation; Encephalopathy

Considerations:

Confusion is generally characterized by bewilderment, lack of attention, and inability to make decisions. Some confused people may behave aggressively. Depending on what causes the confusion, it may come on suddenly or gradually over time.

In many cases it is temporary, however, in others it is permanent and irreversible. Confusion is more common in the elderly, and often occurs in hospitalized patients.

Common Causes:

Alcohol intoxication
Low blood sugar
Head trauma or head injury
Concussion
Fluid and electrolyte imbalance
Nutritional deficiencies, particularly niacin deficiency, thiamine deficiency, Vitamin C deficiency, or Vitamin B-12 deficiency
Hyperthermia (fever)
Hypothermia (drop in body temperature can cause sudden confusion)
Hypoxemia (chronic pulmonary disorders can produce persistent confusion)
Environmental (such as heat stroke, heavy metal poisoning, hypothermia, or methanol intoxication)
Drugs, such as atropine, chloroquine, cimetidine, CNS depressants in large doses, cycloserine, digitalis medicines -- oral, indomethacin, lidocaine, withdrawal from narcotics and barbiturates
Infections including encephalitis
Brain tumor
Medical illness in an elderly person
Sleep deprivation
Seizures

Home Care:

A confused person should not be left alone. In order to ensure a confused person's safety, physical restraints may be required in some situations. A calm, quiet, and peaceful environment is recommended.

Visitors should always introduce themselves during every encounter with the confused person. Placing a calendar and clock near the confused person can help keep him or her oriented. Care givers should frequently re-orient the confused person (talk to and confirm their location, and so on).

For sudden confusion due to low blood sugar, drink a sweet drink or eat a sweet snack. If the confusion lasts longer than 10 minutes, call the doctor.

Call your health care provider if:

Confusion has come on suddenly, is severe or persistent, or is accompanied by other symptoms.

What to expect at your health care provider's office:

A history will be obtained, which will probably require the help of family members; and a physical examination will be performed.

Medical history questions documenting confusion in detail may include:

Type
- Does the patient get days and nights mixed up (are they awake during their usual sleep time)?
- Do they recognize people?
- Do they know where they are?
- Do they know the date and time?
- Can they answer questions appropriately?
Time pattern
- Is the person always confused?
- Are there repeated episodes (recurrent)?
- Is the confusion rapidly getting worse?
- Does the confusion come and go (temporary episodes)?
Medical history
- Has there been any recent illness?
- Has there been a recent head injury?
- Is the person diabetic?
- Does the person have COPD, chronic bronchitis, or a similar lung disorder?
- What medications is the patient taking?
- Has there been any exposure to other drugs or alcohol?
Other
- What other symptoms are also present?

The physical examination will include a thorough evaluation of brain and nervous system function. Neurologic tests and cognitive tests may be performed. Tests such as an MRI of the head, blood and urine tests, and an EEG may be indicated, depending upon accompanying signs and symptoms.

Review Date: 1/17/2002
Reviewed By: Galit Kleiner-Fisman MD, FRCPC, Department of Neurology, University of Toronto, Toronto, Ontario, Canada. Review provided by VeriMed Healthcare Network.

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