Confusion?
DefinitionConfusion is the inability to think with your usual speed or clarity, including feeling disoriented and having difficulty paying attention, remembering, and making decisions.See also: Dementia, for more information about chronic or long-term confusion.Alternative NamesDisorientation; Thinking - unclear; Thoughts - cloudyConsiderationsConfusion may come on quickly or slowly over time, depending on the cause. Many times, confusion is temporary. Other times it is permanent and not curable. It may be associated with delirium or dementia.Confusion is more common in the elderly, and often occurs during a hospital stay.Some confused people may have strange or unusual behavior or may act aggressively.Common CausesAlcohol intoxicationBrain tumorConcussionFeverFluid and electrolyte imbalanceHead trauma or head injuryIllness in an elderly personIllness in a person with existing neurological disease such as a strokeInfectionsLack of sleep (sleep deprivation)Low blood sugarLow levels of oxygen (for example, from chronic lung disorders)MedicationsNutritional deficiencies, especially niacin, thiamine, vitamin C, or vitamin B12SeizuresSudden drop in body temperature (hypothermia)Home CareA good way to find out if someone is confused is to ask the person his or her name, age, and the date. If they are unsure or answer incorrectly, they are confused.For sudden confusion due to low blood sugar (for example, from diabetes medication), the person should drink a sweet drink or eat a sweet snack. If the confusion lasts longer than 10 minutes, call the doctor.A confused person should not be left alone. For safety, the person may need physical restraints.To help a confused person:Always introduce yourself, no matter how well the person once knew you.Often remind the person of his or her location.Place a calendar and clock near the person.Talk about current events and plans for the day.Try to keep the surroundings calm, quiet, and peaceful.For sudden confusion due to low blood sugar (for example, from diabetes medication), the person should drink a sweet drink or eat a sweet snack. If the confusion lasts longer than 10 minutes, call the doctor.See also: Dementia - home careCall your health care provider ifCall 911 if:Confusion has come on suddenly or there are other symptoms such as: Cold or clammy skinDizziness or feeling faintFast pulseFeverHeadacheSlow or rapid breathingUncontrolled shiveringConfusion has come on suddenly in someone with diabetes.Confusion came on after a head injury.The person becomes unconscious at any time.If you have been experiencing confusion, call for an appointment with your doctor.What to expect at your health care provider's officeThe doctor will do a physical examination and ask questions such as:Does the person get days and nights mixed up? Is he or she awake during the usual sleep time?Does the person have trouble recognizing people?Does the person know where he or she is?Does he or she know the date and time?Can the person answer questions correctly?Is the person always confused?Are there many episodes of confusion?Is the confusion quickly getting worse?Does the confusion come and go?Has there been any recent illness?Has there been a recent head injury?Is the person diabetic?Does the person have chronic obstructive pulmonary disease (COPD), chronic bronchitis, or a similar lung disorder?What medications is the person taking?Has there been any exposure to other drugs or alcohol?Tests may include:Blood testsCT scan of the headElectroencephelogram EEGMental status testsNeuropsychological testsUrine testsPreventionDon't drink too much alcoholEat a balanced diet with plenty of vitamins and mineralsGet enough sleepKeep careful control of your blood sugar if you have diabetesQuit smoking, which puts you at greater risk for lung diseasesTake your medications as prescribedReferencesInouye SK. Delirium and other mental status problems in the older patient. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 26.Knopman DS. Alzheimer's disease and other dementias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 425.
