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Updated 11 February 2013

Confusion

Confusion is when one is unable to think or process thoughts with normal swiftness or lucidity.

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Definition

  • Confusion is when one is unable to think or process thoughts with normal swiftness or lucidity.

  • It's often accompanied by feelings of disorientation and the person may experience difficulty focusing their attention on anything.

  • There are varying levels of confusion which range from mild to severe and there are many different causes of this condition.

  • Depending on the underlying cause of the confusion, it may come on suddenly, or gradually.

  • Some confused people tend to be aggressive.

  • Confusion can be temporary, but at other times permanent and incurable.

  • Confusion can often be an indication of the first symptoms relating to a serious illness, especially when an elderly person is concerned.

Other names
Disorientation, decreased alertness.

Possible causes

  • Confusion in an elderly person is often linked to illness and many times it first occurs during hospitalisation. Alzheimer's disease is also a cause of confusion, especially in the elderly.
  • High levels of toxins in the blood as a result of kidney or liver failure.

  • Thyroid problems.

  • It can also be brought on by intoxication from alcohol or drugs, low blood sugar, head trauma/ injury, such as concussion.

  • Reduced blood flow as a result of cardiac problems such as heart failure, coronary heart disease, or irregular heart beat can also lead to confusion.

  • Diabetes can sometimes lead to confusion.

  • Fluid and electrolyte imbalances and nutritional deficiencies can also lead to confusion.

  • Often people who are running a fever, or have hypothermia, show signs of confusion.

  • People with lung disorders who subsequently have low levels of oxygen can also suffer from confusion.

  • Certain medications can lead to confusion: overmedicating, a combination of alcohol and medicine, abuse or misuse of medicines or alcohol, intoxication or withdrawal from drugs.

  • Depression, schizophrenia and other mental health disorders.

  • Confusion can also stem from an infection such as: sexually transmitted infections, (specifically syphilis and HIV); a brain abscess; encephalitis; meningitis; sepsis.

  • People who have a brain tumour also often show signs of confusion.

  • Asthma or COPD can also trigger confusion if there is a decrease in oxygen or an increase of carbon dioxide in the blood.

  • Sleep deprivation can also cause confusion.

  • Head injury or concussion.

  • If there is a decreased blood flow to the brain, as can happen during a stroke.

  • In younger people, Reyes syndrome can lead to confusion.

Home care/ Self treatment
A person who is confused should not be left alone and should be in a calming, quiet environment which may help soothe the confusion. It's recommended to ask the confused person questions such as their name, age and so forth to check the level of their confusion.

Should the confusion stem from a chronic disease, you should always introduce yourself each and every time you see them and keep the person up to date by means of calendars and clocks in the room.

Should you be taking care of someone who is suffering confusion due to a chronic condition, it's advisable to remind them regularly where they are, the plans for the day and so on.

If the confusion is due to low blood pressure, make sure they drink something sweet to regulate their blood sugar levels, but if the confusion lasts for more than 10 minutes, you should call a doctor.

When to call a doctor
It's important to seek medical assistance if:

  • The confusion comes on abruptly

  • If it's accompanied by other symptoms such as a headache, dizziness or if the person is feeling faint

  • If the person has a rapid pulse, slow/rapid breathing, has cold or clammy skin or an uncontrolled shivering or fever

  • The person is diabetic

  • The person has recently suffered a head injury or concussion.

  • The person becomes unconscious.

It's also important to remember when at the doctor to inform him/her about other symptoms which occur during the confusion, as this can help them get to the root of the cause.

What to expect at the doctor
A doctor will perform a thorough physical examination and may carry out neurologic tests and cognitive tests.

This may include an MRI of the head, blood and urine tests and an EEG.

Treatment
The type of treatment is dependent on the cause of the confusion.

 
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