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Confusion

Dr. Nabi Darya Vali (AIIMS)MBBS

September 14, 2020

September 14, 2020

Confusion
Confusion

Confusion, also known as disorientation or delirium, is a mental state in which a person is unable to think clearly. People with this symptom may not be able to make a decision or to concentrate on a given task or job. In some extreme situations, a person with confusion may have difficulty identifying someone they know or find it difficult to recognise a place they may have been to before.

New or sudden confusion may be a symptom of conditions like a head injury (concussion), carbon monoxide poisoning, alcohol poisoning, COVID-19 and stroke, among other conditions. Chronic or long-term confusion may be linked to conditions like dementia, including Alzheimer's disease.

A state of confusion or disorientation may become worse with age or time, and usually develops later in life. In most cases, these instances are short-lived and go away after a small episode. However, in some other cases, it may become more permanent and the person may not respond to treatment.

Confusion is often a symptom for an underlying mental health condition and is more common among older people, due to deteriorating health over time. It is important to take the person to the doctor if there is a sudden bout of confusion or delirium that has set in. In many cases, early diagnosis or treatment can be beneficial for the patient.

Confusion symptoms

Confusion can be a symptom of various underlying health conditions, such as after-effects of head trauma (accidents), very high fever and dementia. Although the conditions can be very different, confusion shares some of these features:

  • Slurred speech or being unable to speak without taking long pauses
  • Fluctuations in the level of consciousness
  • Forgetting a task while performing it
  • Sudden change in feelings, becoming irritated or aggravated easily
  • Lack of awareness with respect to places, tasks or time
  • Inability to concentrate
  • Being unable to sleep
  • Being unable to think
  • Inability to recognise faces or people

Confusion causes

Various different health conditions or episodes are linked with the state of confusion. Some of the causes include:

  • Concussion or head injury: An injury to the brain, head or a concussion due to head trauma can affect a person's ability to think, focus or make decisions. It can also have an adverse effect on a person's speech and ability to recognise people.
  • Dehydration: Extreme dehydration due to excessive sweating, or not having enough water for prolonged periods of time can lead to changes in the brain chemistry due to the imbalance in the electrolytes inside the body, causing a person to feel confused or disoriented.
  • Lack of sleep: Sleep deprivation can also bring about signs of confusion in a person—it may become difficult for a person who is underslept or has had poor quality sleep to focus on a task or make quick decisions. They may also forget things.
  • Seizures: Also known as convulsions, seizures are caused by abnormal electrical discharges in the brain, and can adversely affect the thinking of a person, leading to a state of confusion.
  • Stroke: Stroke occurs due to a short supply of blood to the brain, and can even lead to permanent brain damage. One symptom of stroke is a confused state of mind.
  • Urinary tract infections (UTIs): Urinary tract infections (UTIs) are also known to cause confusion among older people and people living with degenerative problems such as dementia.
  • Medications: Certain prescription medications are also known to scramble a person's thinking, leading to confusion. Taking medications without a prescription, or not knowing about the side effects they may cause are other reasons for medicine-induced confusion.
    Treatment for cancer, including chemotherapy sessions, are also known to cause confusion or delirium in people. Medications for conditions such as depression, anxiety, sleep disorders, asthma, etc., are also associated with such side effects.
  • Lack of oxygen in the body: Much like dehydration, lower oxygen saturation levels in the body (hypoxia) can also alter the thinking patterns of a person, leading to confusion.
  • Altitude sickness: Disorientation or confusion are also linked with severe cases of altitude sickness. (Read more: Oxygen therapy)
  • Substance abuse: Abuse of substances such as alcohol (alcoholism) and drugs (drug overuse) is also known to have adverse effects on the brain, and confusion is often cited as a symptom in such cases.
  • Degenerative disorders: Degenerative neurological disorders such as dementia and Parkinson's disease are also connected with an altered state of mind, with confusion being a common symptom. Degenerative diseases usually affect people when they're older, though they may start early too.
  • Low blood sugar: People living with low blood sugar problems are often reported to have confusion as one of the primary symptoms.
  • Pain: Too much pain anywhere in the body can also lead to a state of confusion as the person is not able to tolerate it, and cannot focus on any other task at hand.
  • Hypothermia: Exposure to extremely cold weather can lead to hypothermia and hypoxemia (a drop in the blood oxygen levels), which also leads to a state of confusion in people.

Prevention of confusion

Confusion is a symptom rather than a disease. In some cases, like a head injury, there is little one can do to avoid confusion.

That said, it may be possible to take preventive steps against causes of confusion like dehydration, low blood sugar in diabetics and confusion linked with high altitude and low temperatures by drinking enough water throughout the day, monitoring blood sugar levels, and planning as well as possible for cold weather and for a trip/trek/climbing in the mountains.

It may also be possible to slow down the progress of dementia in at-risk people by keeping the mind active. 

Read more: Exercises and activities to prevent dementia

Leading a healthy lifestyle, eating healthily, exercising regularly, staying away from smoking, drinking or drugs, not taking on an unnecessary amount of stress, sleeping on time are all ways to prevent the onset of such symptoms.

Read more: Home remedies to improve memory

Diagnosis of confusion

Confusion is often associated with serious health conditions, hence it should never be ignored. If there has been any instance of a person feeling confused suddenly or has been for some time, it is important to get them checked by a doctor.

The doctor will ask for the person's medical history and perform a physical exam to check for any other signs. The doctor may also ask for imaging tests of the brain or other organs of the body to understand the cause of the confusion and make an accurate diagnosis.

Confusion (as a symptom) can cause a person to react in an aggressive manner or become irritable suddenly. So it is necessary to be with them until at least they have regained their composure and thoughts. You can call their doctor or the emergency services to get help while you are there with them to reassure them that they will get better.

Confusion treatment

Knowing why a person is feeling disoriented, delirious or confused can help in treating them. Home care involves keeping a check on the person to avoid the recurrence of any episode and helping them calm down if they suddenly become aggravated.

The doctor will also take blood samples of the patient to understand whether their altered state of mind is because of certain imbalances in the body, or whether they have been taking any medications which may be causing their symptom. If there are underlying health conditions, the treatment will involve visiting a doctor that specialises in the disorder they have been diagnosed with.

Confusion risks and complications

In some cases, confusion can signal the onset of serious medical conditions which may require urgent attention and treatment. Failure to do so may lead to the aggravation of such symptoms and an elevated risk of permanent damage or disability. Some of the complications if symptoms such as confusion are not treated immediately are:



References

  1. Johnson MH. Assessing confused patients. Neurology, Neurosurgery & Psychiatry. 2001 Sept; 7-12.
  2. Mayne S et al. The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing - a systematic literature review. BMC Geriatrics. 2019 Feb; 19: 32.
  3. Espino D et al. Diagnostic Approach to the Confused Elderly Patient. American Family Physician. 1998 Mar; 57(6): 1358-1366.
  4. Michigan Medicine; University of Michigan. [Internet] Ann Arbor, MI, USA. Confusion, Memory Loss, and Altered Alertness.

Medicines for Confusion

Medicines listed below are available for Confusion. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

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