Altered mental status classification
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Altered mental status On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
Altered mental status is a common chief complaint among older emergency department (ED) patients. Despite the frequency of this complaint, the term “altered mental status” is vague and has several synonyms such as confusion, not acting right, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. Such lack of standardized terminology not only hinders the assessment and appropriate management of patients with altered mental status.
Classification
- Altered mental status may be classified according to its origin into 4 major groups: dementia, delirium, psychosis, and neurologic causes.[1]
Dementia
- Typically, dementia is a slow and progressive decline in cognitive function due to damage or disease in the brain beyond what might be expected from normal aging. Individuals usually present normal vital signs, normal level of conscioussness.
Delirium
- Delirium is an acute and relatively sudden (developing over hours to days) decline in attention-focus, perception, and cognition. It is not synonymous with drowsiness, and may occur without it. It is commonly associated with a disturbance of consciousness (e.g., reduced clarity of awareness of the environment). The change in cognition (memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance, must be one that is not better accounted by a preexisting, established, or evolving dementia. Usually the rapidly fluctuating time course of delirium is used to help in the latter distinction.
Psychosis
- Psychosis is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality". Stedman's Medical Dictionary defines psychosis as "a severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning."[2]
Neurologic causes
- Some focal neurological deficits can produce changes in perception, psychomotor skills or behavior. This group's presentation vary widely depending on the localization and cause of impairment.