Confusion natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Overview

Confusion is disturbance in mental status which develops rapidly. If untreated it develops into stupor / coma. Confusion caused due to metabolic changes can be rapidly corrected and have good prognosis compared to the one caused by underlying structural abnormalities of brain. Mortality rate for those who developed confusion at hospital is nearly 39% in first year which nearly twice compared to age matched controls.

Natural history

Confusion is differentiated from similar symptoms by its rapidity of onset unlike dementia or depression. In hospitalized patients certain prodromal signs may be evident. They include irritability, sleep disturbances, excessive fatigue. Detection of these early signs is important in making a difference in the course of the disease. Unnoticed symptoms may lead to behavioral changes leading to hypo active stage later turning into agitated individual. In cases of poisoning or drug overdose onset of symptoms is rapid too and history of abuse or exposure is obtained. Metabolic derangement can be identified with the laboratory tests and necessary precautions can be taken in place avoid confusion. Undetected prodrome or rapid onset of confusion can cause severe cognitive impairment.It can progress from days to weeks depending on the underlying cause. Undetected or untreated confusion leads to stupor/coma.

Prognosis

Prognosis depends on the cause of confusion.

• Confusion due to metabolic derangement like hypoglycemia, hypokalemia can be rapidly corrected and will have good prognosis.
• Confusion due to underlying structural lesions of brain may not have very good prognosis.
• Confusion caused by chemicals and poisons need through assessment of the condition. Detoxification will result in good prognosis.
• Underlying other disease can precipitate confusion , in such cases prognosis depends on the severity of the causative disease.
• Few symptoms can persist longer in patients as long as 6 months.
• Persons who developed confusion during hospital stay can prolong there duration in hospital.