Confusion history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Confused patients will not be able to provide a coherent history. Confirming the history with a patient’s caregiver is the key to obtaining an accurate history about the patient. Determining the patient’s drug history and co morbid conditions is very important. In young patients drug abuse and withdrawal should be evaluated. Some assessment scales are used to identify and diagnose confusion, and they include the Confusion Assessment Method, Mini Mental Status Examination, and The Neelon and Champagne (NEECHAM) Confusion Scale.

In cases of confusion, the goal of the physician is to determine the cause of the condition and identify any the risk factors. As the person will be disoriented, the history has to be checked with family or caregivers.

History regarding certain aspects of the patient’s past needs to be asked about.

If it’s sudden in onset it can be due to a stroke or hemorrhage into the brain. If it’s over minutes to hours it can be due drugs or metabolic causes like hypoglycemia or hypokalemia. If it’s over hours to days it can be due to some underlying disease like kidney, liver failure, or infections. If it’s gradually progressing over months, other conditions such as dementia need to be considered.

Previous episodes of confusion are important in identifying risk factors and determining the prognosis. Repeated episodes can be a clue to underlying structural problems, untreated co morbid conditions, or metabolic derangement.

If the patient has a fever, it may suggest an infections. Abnormal motor activity may suggest seizures or post ictal state. A headache is a very important feature to rule out stroke, meningitis, or any other intra cranial lesions. Severe diaphoresis indicates dehydration and metabolic disturbances.

Changes in recent drug regimen or any other drug usage have to be asked about. Polypharmacy can be a cause or result of confusion in elderly individuals. In young patients any history of illicit drug usage has to be noted. As those drugs can cause confusion and their withdrawal states can manifest the same.

Various tools/assessments are available to evaluate confusion.

• Mini-Mental State Examination

• Confusion Assessment Method

• Neelson and Champagne Confusion Scale

• Mini-Cog

These tools are used as scoring scales. Scoring is based on mental status questions, observational points, and symptom checklists. Mental status questions depict the cognitive performance of the patient. Observational points reduce the burden on the patient and demands extra attention from the health care providers.

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