Alternate Names: Mental dysfunction

Considerations: Confusion is generally characterized by bewilderment, lack of orderly thought, and inability to make decisions.

Depending on what causes the confusion, it may come on suddenly or gradually over time. In some cases it is temporary, and in others it is permanent and irreversible.

Confusion is more common in the elderly and often occurs in hospitalized patients. Confusion is often made worse by stress.

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

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 will help keep them oriented. Care givers should frequently reorient 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 If:

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

What To Expect: 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?
• other
  • What other symptoms are also present?