Confusion history and 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

Confused patients will not be able to provide a coherent history. Confirming the history with patient’s caregiver is the key to get good history about the patient. Determining the patient’s drug history and co morbid conditions is very important. In young patients drug abuse and withdrawal should be evaluated. Few assessment scales are used to identify and diagnose confusion, and they include the Confusion Assessment Method, Mini Mental Status Examination, and The Neelon and Champagne (NEECHAM) Confusion Scale.

History and Symptoms

In case of confusion, goal of the physician is to determine the cause of the condition and identifying the risk factors. As the person will be disoriented the history has to be checked with his family or caregivers.

History regarding certain aspects has to be inquired.

Onset of Symptom and Progression

If it’s sudden in onset it can be due to stroke or hemorrhage into the brain. If it’s over minutes to hours it can be due drugs or metabolic causes like hypoglycemia, hypokalemia. If it’s over hours to days it can be due to some underlying disease like kidney or liver failure or infections. If it’s gradually progressing over months considering other diagnosis like dementia is essential

Any Previous Episodes

Previous episodes of confusion are important to identify risk factors and determine the prognosis. Repeated episodes can be a clue to underlying structural problem or untreated co morbid conditions or metabolic derangement.

Associated Symptoms

Fever may suggest any infections, abnormal motor activity suggests seizures or post ictal state. Headache is a very important feature to rule out stroke, meningitis or any other intra cranial lesions. Sever diaphoresis indicates dehydration and metabolic disturbance.

Drug History

Changes in recent drug regimen or any other drug usage have to be inquired. Polypharmacy can be a cause or result of confusion in elderly individuals. In young patients any history of illicit drug usage has to be noted. As those drugs can cause confusion and their withdrawal states can manifest the same.

Assessment

Various tools/ assessments are available to evaluate confusion.

• Mini-Mental State Examination

• Confusion Assessment Method

• Neelson and Champagne Confusion Scale

• Mini-Cog

These tools are used as scoring scales. Scoring is based on mental status questions, observational points and symptom checklists. Mental status questions depict the cognitive performance of the patient. Observational points reduce the burden on the patient and demands extra attention from the health care providers.