Differentiating confusion from other symptoms

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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

Various conditions like dementia, depression, amnesia etc present as confusion. Clear history about the onset of symptoms and association with other symptoms helps in differentiating from other conditions.

Differentiating Confusion from other symptoms

Confusion : It is the inability to maintain coherent stream of thought or action. It can be caused by various conditions. Altered level of consciousness is seen in confusion. This can be predecessor for successive stupor or coma.

Delirium : Acute impairment in attention with fluctuating course and altered level of consciousness caused by a medical condition. This is also called as acute confusional state and encephalopathy.

Dementia : Chronic degenerative condition affecting memory, behavior and cognition.

Depression : A clinical term for a state of intense sadness, melancholia or despair that has advanced to the point of being disruptive to an individual's social functioning and/or activities of daily living.

Amnesia : A condition in which memory is disturbed or lost. It can be due to organic or functional.

Seizures : Certain seizures like absent seizures do present like confusion but they are not.

Few symptoms which helps in differentiating from confusion

• Worsening of symptoms at night time --> Sundowning

• Rapid improvement over seconds --> Post syncope

• Rapid improvement over minutes to hours --> Post ictal state

• Worsening of symptoms on standing --> Hypo perfusion

Careful history from the attendants is required as the person will not be in correct mental status to give history. Certain key features like onset of symptoms, rapidity of progression are important in evaluating the confusion. Gaps in memory will be pointing more towards dementia and amnesia. Association of psychiatric symptoms will warrant further detailed history from the patient or his/her attendants. In children absent seizures may looked up as confusion because of vague and staring look into the space. Association of drugs , poisons or chemicals with the symptoms provide definitive clues for the diagnosis of confusion.

Few assessment tools like Confusion Assessment Method(CAM) can be used to differentiate confusion from dementia. This tool is handy for physicians who are not quick in psychiatric assessment.