Confusion overview
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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 refers to mental dysfunction in which a lack of attention and disorientation occurs with the inability to think with normal speed or clarity. It is the inability to maintain a coherent stream of thought or action.
Pathophysiology
Confusion results from global impairment of function of brain. Few areas of brain are identified for various presentations of confusion. Drugs, poisons, chemicals interact with the neurotransmitters and cause confusion. Inflammatory agents are involved in conditions like fever.
Causes
Confusion is a common symptom associated with various diseases and metabolic disorders. Common causes of confusion include insults to the central nervous system (CNS), metabolic disorders, and the side effect of medications or illicit drugs.
Differentiating Confusion from other Diseases
Various conditions such as dementia, depression and amnesia involve confusion as part of their presentation. Obtaining a clear history about the onset of symptoms, and the onset of confusion in association with other symptoms, helps in differentiating confusion from other conditions.
Epidemiology and Demographics
Nearly about 30% of older patients admitted for medical conditions are confused at some point of time during their admission[1]. In surgical wards the chances of confusion ranges from 10-50%[2]. Increasing rates are seen in patients admitted to intensive care units and in hospice care. There is no significant difference in the distribution based upon gender or race.
Risk Factors
Increasing age, admission to the hospital, post-surgical status, alcoholism, and underlying brain lesions are a few important risk factors for confusion. Special care is required for elderly patients who are hospitalized.
Natural History, Complications and Prognosis
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.[3]
Diagnosis
History and Symptoms
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. Confusion Assessment Method, Mini Mental Status Examination, The Neelon and Champagne (NEECHAM) Confusion Scale.
References
- ↑ Francis J (1992). "Delirium in older patients". J Am Geriatr Soc. 40 (8): 829–38. PMID 1634729. Unknown parameter
|month=ignored (help) - ↑ Dyer CB, Ashton CM, Teasdale TA (1995). "Postoperative delirium. A review of 80 primary data-collection studies". Arch. Intern. Med. 155 (5): 461–5. PMID 7864702. Unknown parameter
|month=ignored (help) - ↑ Inouye SK, Charpentier PA (1996). "Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability". JAMA. 275 (11): 852–7. PMID 8596223. Unknown parameter
|month=ignored (help)