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 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.
Differentiating Confusion from other Symptoms
Confusion : Is the inability to maintain a coherent stream of thought or action. It can be caused by various conditions. An altered level of consciousness is seen in confusion. Confusion can be a 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 an 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 such as absence seizure may appear to be similar to confusion.
A few symptoms which help in differentiating 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 --> Hypoperfusion
Taking a careful history from the people that are with the patient will be important, as the patient themselves are not always able to give a good history due to their confused state. Key features include the onset of symptoms, what might have caused them, the speed of progression of symptoms, and whether this has occurred before. Chronic problems with memory point more towards conditions such as dementia and amnesia. The presence of psychiatric symptoms will warrant further detailed history from the patient or family members. In children, absence seizures may appear to be confusion, as it is accompanied by vague spells of staring and loss of attention. Finding a history of drugs, poisons or chemicals in concordance with the symptoms can provide definitive clues for the diagnosis of confusion.
Some assessment tools, such as the 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.[1]