Don't let confusion linger. Discover its causes, symptoms, and effective solutions. Get clarity for a healthier life with insights from Meri Sehat.

Confusion

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Confusion is an altered mental status, a decline in the ability to learn, think, and understand. 
&nbsp;

Delirium is a prevalent condition in hospital settings. Studies indicate that it occurs in about 1/5 of general hospital inpatients, particularly in those with prior cognitive impairment.<a href="#accordion">[5]</a> 
&nbsp;

Confusion can be classified into the following subtypes based on its clinical presentation:<a href="#accordion">[3]</a>&nbsp;

<ul>
	<li>Hyperactive (High Activity) -&nbsp;It is characterized by agitation, mood fluctuations, restlessness, refusal to cooperate, and hallucinations</li>
	<li>Hypoactive (Low Activity) -&nbsp;It is characterized by lethargy, reduced psychomotor activity, and withdrawal</li>
	<li>Mixed -&nbsp;This refers to rapid fluctuations between the hypoactive and hyperactive types of confusion, or normal levels of psychomotor activity with disturbed awareness and attention.</li>
</ul>

Mixed mental confusion is the most common type. 2 in every 3 people who have mental confusion move between the different types.<a href="#accordion">[6]</a> 
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Sign and Symptoms

Confusion or decline in cognitive ability is usually related to dementia. Symptoms of confusion include:

<ul>
	<li>Difficulty carrying out tasks</li>
	<li>Unable to think clearly</li>
	<li>Memory disruptions, especially problems with short-term memory</li>
	<li>Difficulty following a conversation and unclear speech</li>
	<li>Reduced awareness of or uncertainty about time and surroundings</li>
</ul>

These symptoms may vary from mild to severe and may develop quickly or over time.

Sometimes, they may be temporary, and the person will get better on their own. However, they may persist in some individuals, indicating a permanent or long-term condition. 
&nbsp;

Causes

There are many causes of confusion. The common ones can be summarized by a mnemonic &ndash; AEIOU-TIPS:<a href="#accordion">[8]</a>

<ul>
	<li>Alcohol</li>
	<li><a href="https://merisehat.pk/disease/epilepsy">Epilepsy</a></li>
	<li>Insulin</li>
	<li>Oxygen deficiency or overdose</li>
	<li>Uremia or toxins due to kidney failure</li>
	<li>Trauma, such as head injury or shock</li>
	<li>Infection</li>
	<li>Poisoning or psychosis</li>
	<li><a href="https://merisehat.pk/disease/stroke">Stroke</a></li>
</ul>

Additionally, certain medications, particularly antidepressants, chemotherapy, and opioids, have been associated with an increased risk of delirium due to their effects on neurotransmission and cognitive function.

15-25% of elderly patients experience confusion as the effects of anesthesia wear off after minor surgeries. The number jumps to around 50% for individuals experiencing confusion after major surgeries.<a href="#accordion">[9]</a> 
&nbsp;

Diagnosis

The diagnosis of delirium involves a comprehensive assessment of the patient&#39;s cognitive and mental status. The first and very basic test is to ask the patient about their name, current location, current time, and a recent event that they can recall.

Standardized assessment tools, such as CAM-ICU, have been advocated to improve the accuracy and reliability of delirium diagnosis in clinical practice.<a href="#accordion">[4]</a>

After the physical examination of the patient, the doctor may order blood tests, EEG, urine tests, chest x-rays, or a CT scan of the head to assess the condition. 
&nbsp;

Treatment

The treatment of confusion involves addressing the underlying causes and providing supportive care. For instance, a study on confusion in COVID-19 patients highlighted the need for tailored strategies based on patient profiles and disease characteristics.<a href="#accordion">[10]</a>

In some cases, pharmacological interventions may be necessary to manage agitation, hallucinations, or severe distress. Medications such as dexmedetomidine and quetiapine have been identified as preferred agents for the prevention and treatment of delirium in specific patient populations, including trauma patients and those in the intensive care unit.<a href="#accordion">[11]</a>

However, nonpharmacological interventions, including environmental modifications, reorientation strategies, and cognitive stimulation, are essential components of delirium management. 
&nbsp;

According to a study, 50-80% of patients develop delirium during their ICU stay.<a href="#accordion">[1]</a> Delirium is a severe type of confusion wherein the brain is overwhelmed to the extent that it stops working as it should. The onset is sudden, and symptoms may change from time to time.

Complications associated with the condition include aggressive behavior, unusual mood swings, frustration, and anxiety due to functional decline, dementia, and increased healthcare utilization. It may also lead to death.<a href="#accordion">[1][2]</a> 
&nbsp;

Several risk factors have been identified as predisposing individuals to the development of delirium, including:

<ul>
	<li>Age -&nbsp;Elderly people are more likely to develop it</li>
	<li>Gender -&nbsp;Males are more susceptible</li>
	<li>Individual Health -&nbsp;Sensory deficits, cognitive impairment, infection, depression, lack of oxygen to the brain, extreme blood sugar levels, cancer, etc.</li>
	<li>Lifestyle -&nbsp;Dehydration, sleep deprivation, alcohol poisoning 
	&nbsp;</li>
</ul>

While confusion itself isn&rsquo;t preventable, it is possible to reduce the risk of developing certain conditions that cause it.

<ul>
	<li>Manage underlying medical conditions as per the doctor&rsquo;s instructions.</li>
	<li>Take any prescription medication as directed.</li>
	<li>Wear safety equipment, like a helmet.</li>
	<li>Ensure adequate hydration, balanced nutrition, and plenty of rest.</li>
	<li>Provide a supportive and familiar environment for patients, engaging them in physical and mind-stimulating activities. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Confusion is a type of altered mental status, a decline in the ability to learn, think, and understand.</li>
	<li>The condition can manifest as hyperactive, hypoactive, or mixed subtypes, each presenting with distinct clinical features.</li>
	<li>Common signs and symptoms of delirium include disturbances in attention and disorganized thinking.</li>
	<li>Causes of confusion include concussion, surgery, medication, and chronic health conditions.</li>
	<li>Treatment of delirium includes pharmacological as well as nonpharmacological interventions.</li>
	<li>Risk factors for delirium include older age, gender, individual health, and lifestyle.</li>
	<li>Preventive measures include providing a supportive environment for patients and managing underlying medical conditions as instructed by a doctor.</li>
</ul>

[1] Elcokany, N. and Ahmed, F. (2019). Effect of family reorientation messages on delirium prevention among critically ill patients. Journal of Nursing Education and Practice, 9(10), 50.

[2] Garcez, F., Avelino-Silva, T., Castro, R., & Inouye, S. (2021). Delirium in older adults. Geriatrics Gerontology and Aging, 15.

[3] Johansson, Y., Bergh, I., Ericsson, I., & Sarenmalm, E. (2018). Delirium in older hospitalized patients—signs and actions: a retrospective patient record review. BMC Geriatrics, 18(1).

[4] Rompaey, B., Schuurmans, M., Shortridge-Baggett, L., Truijen, S., Elseviers, M., & Bossaert, L. (2008). A comparison of the cam-icu and the neecham confusion scale in intensive care delirium assessment: an observational study in non-intubated patients. Critical Care, 12(1), R16

[5] Ryan DJ, O'Regan NA, Caoimh RÓ, et al. Delirium in an adult acute hospital population: predictors, prevalence and detection. BMJ Open. 2013;3(1):e001772. Published 2013 Jan 7.

[6] Mental confusion or delirium. Cancer.Net. December 8, 2020

[7] Confusion. healthdirect.

[8] Rod Brouhard E-P. Learn about the medical causes and the treatment of confusion. Verywell Health. May 13, 2022.

[9] Confusion: What causes it, and why? learn more here. Medical News Today.

[10] Serin, E. K. and Bülbüloğlu, S. (2021). Nursing interventions in management of covid-19-related delirium in intensive care units: literature review. International Journal of Health Services Research and Policy, 6(1), 128-143.

[11] Author links open overlay panelMonika Sadlonova a b c d e, a, b, et al. Pharmacologic treatment of delirium symptoms: A systematic review. General Hospital Psychiatry. October 21, 2022.