Confusion

What is confusion?

Confusion is a general state of unclear thinking. Other words for confusion are mixed up, bewildered, or uncertain. Confused people have trouble responding correctly to questions. They also have trouble making choices or acting in a way that fits where they are.

Medical terms for thinking problems that show confusion vary.

• Delirium is temporary confusion. It goes away with treatment of the problem causing it.
• Dementia is gradual loss of mental abilities, such as thinking, remembering, reasoning, and planning. It is a more permanent state of confusion than delirium.
• Psychosis is very unreal thinking, like imagining the hearing of voices, trying to live in an imaginary world, or holding to a wrong idea about your life or relationships.

Confusion may come on slowly over time, or it may happen suddenly. Confusion that happens suddenly is called acute confusion.

What is the cause?

Even if you are normal and healthy, you can get confused if:

• You are given too much information or conflicting information.
• You are not listening when something is said.
• You are not paying attention to something happening around you.

Usually, healthy people are no longer confused when they get better information or have more time to think about the situation.

Any medical, psychiatric, or emotional condition that blocks thinking or your ability to take in information can cause confusion. Examples of things that can cause confusion are:

• severe emotional upset
• head injury or a tumor or disease in the brain
• some mental illnesses
• some medicines and herbal remedies
• very low blood sugar
• serious infections with high fever
• use of or withdrawal from drugs or alcohol
• stress or too little sleep
• a lack of certain vitamins, especially in older adults

What are the symptoms?

Signs and symptoms of confusion can include:

• odd behavior or responses
• not being able to concentrate or pay attention
• not being able to remember things
• sleepiness
• not knowing who you are, where you are, or what day or year it is
• trouble speaking or understanding what you see or hear
• being restless or agitated

How are the causes of confusion diagnosed?

A problem with confusion may be found during a medical exam. However, some people don’t show their confusion right away. Family members or friends may need to describe the symptoms they have seen.

The healthcare provider will check for possible causes of the symptoms, such as a medical problem. The provider may also ask some questions to test memory and thinking and to check for depression. Key questions to test for confusion are:

• Does the person know where they are, the date, and the time?
• Does the person know why they are where they are?
• Can they describe current events in the news or in their own life? Verifying the person’s story often requires checking with family, friends, or caregivers.

A careful physical exam is done to look for illness. The following tests may be done:

• blood tests
• X-rays
• CT or MRI scan of the brain
• electroencephalogram (EEG) to check for problems in the brain
• electrocardiogram (ECG or EKG) to check for heart problems
• urine tests

How is it treated?

Treatment depends on what is causing the confusion. For example, changing medicines, treating a medical problem, or reducing stress may take care of the problem.

If someone has confusion that is new and any of the following also are happening, help the confused person get medical help right away:

• The person is clearly sick in some way. For example, he or she has a high fever, is throwing up, cannot walk, or has lost their sight or ability to say words clearly.
• The person’s confusion is dangerous to them or to you. For example:
  • They are very afraid and are striking out at others.
  • They are wandering into dangerous places like a busy street.

If a confused person is not sick, and the confused talking or behavior is manageable, call their healthcare provider to make an appointment. The appointment should be soon if the confusion has just started--within a day or two, if possible. Don’t leave a confused person alone before they have seen their provider. If the provider advises taking the person to the emergency room or urgent care center, do so right away.