Confusion

Head trauma

Definition

Confusion 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 Names

Disorientation; Thinking - unclear; Thoughts - cloudy

Considerations

Confusion 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 Causes

• Alcohol intoxication
• Brain tumor
• Concussion
• Fever
• Fluid and electrolyte imbalance
• Head trauma or head injury
• Illness in an elderly person
• Illness in a person with existing neurological disease such as a stroke
• Infections
• Lack of sleep (sleep deprivation)
• Low blood sugar
• Low levels of oxygen (for example, from chronic lung disorders)
• Medications
• Nutritional deficiencies, especially niacin, thiamine, vitamin C, or vitamin B12
• Seizures
• Sudden drop in body temperature (hypothermia)

Home Care

A 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 care

Call your health care provider if

Call 911 if:

• Confusion has come on suddenly or there are other symptoms such as:
  • Cold or clammy skin
  • Dizziness or feeling faint
  • Fast pulse
  • Fever
  • Headache
  • Slow or rapid breathing
  • Uncontrolled shivering
• Confusion 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 office

The 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 tests
• CT scan of the head
• Electroencephelogram EEG
• Mental status tests
• Neuropsychological tests
• Urine tests

Prevention

• Don't drink too much alcohol
• Eat a balanced diet with plenty of vitamins and minerals
• Get enough sleep
• Keep careful control of your blood sugar if you have diabetes
• Quit smoking, which puts you at greater risk for lung diseases
• Take your medications as prescribed

References

Inouye 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.

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Review Date: 2/6/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, CA, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.