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Confusion

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Alternative Names:

Disorientation; Thinking - unclear; Thoughts - cloudy

Home Care:

A good way to test to see if a person is confused is to ask the person his or her name, age, and the date. If they are unsure or answer incorrectly, they are confused.

A confused person should not be left alone. To ensure a confused person's safety, physical restraints may be required in some situations. Try to keep the surroundings calm, quiet, and peaceful.

When visiting a person whose confusion is from a chronic disease, you should always introduce yourself each time you see them, no matter how well he or she once knew you. Placing a calendar and clock near the person can help keep him or her oriented. When taking care of someone who is confused, frequently remind the person of his or her location. Talk to him or her about current events and plans for the day.

For sudden confusion due to low blood sugar (for example, from diabetes medication), the person should drink a sweet drink or eat a sweet snack. If the confusion lasts longer than 10 minutes, call the doctor.

Call your health care provider if:

Call 911 if:

• Confusion has come on suddenly or is accompanied by other symptoms like headache, feeling dizzy or faint, rapid pulse, slow or rapid breathing, cold or clammy skin, uncontrolled shivering, or fever.
• Confusion has come on suddenly in someone with diabetes.
• Confusion came on following a head injury.
• The person becomes unconscious at any time.

If you have had ongoing confusion that came on gradually, call for an appointment with your doctor if you have never been evaluated for this problem.

What to expect at your health care provider's office:

The doctor will perform a physical examination and ask questions such as:

• Does the person get days and nights mixed up? Are they awake during their usual sleep time?
• Do they recognize people?
• Do they know where they are?
• Do they know the date and time?
• Can they answer questions appropriately?
• Is the person always confused?
• Are there repeated episodes?
• Is the confusion rapidly getting worse?
• Does the confusion come and go?
• Has there been any recent illness?
• Has there been a recent head injury ?
• Is the person diabetic?
• Does the person have COPD , chronic bronchitis , or a similar lung disorder?
• What medications is the person taking?
• Has there been any exposure to other drugs or alcohol?

The physical examination will include a thorough evaluation of brain and nervous system function. Neurologic tests and cognitive tests may be performed. Tests such as an MRI of the head, blood and urine tests, and an EEG may be indicated, depending upon accompanying signs and symptoms.

Prevention:

• Obtain a regular amount of sleep
• Eat a balanced diet with plenty of vitamins and minerals.
• Don't drink alcohol in excess.
• Keep careful control of your blood sugar if you have diabetes.
• Quit smoking, which puts you at greater risk for lung diseases.

References:

Leclerc S, Lassonde M, Delaney J S et al. Recommendations for grading of concussion in athletes. Sports Med . 2001; 31: 629-636.

Bazakis AM, Kunzler C. Altered Mental Status Due to Metabolic or Endocrine Disorders. Emer Med Clinics of North America . 2005; 23(3): 901-908.

Biem J. Out of the cold: management of hypothermia and frostbite. CMAJ . 2003; 168(3): 305-311.

• Review Date: 5/16/2006
• Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

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