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What is confusion?

Confusion is a general state of unclear thinking. Other words for confusion are mixed up, bewildered, or uncertain. Dictionary definitions of confusion can vary a lot, but all definitions suggest that confusion is an unhealthy state. Confused people have trouble responding correctly to questions. They also have trouble making choices or acting correctly.

How does it occur?

Normal, healthy people can get confused if:

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

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

Any medical, psychiatric, or emotional condition that blocks thinking or a person's ability to take in information can cause confusion. This may result in puzzling or odd behavior or responses. A confused person may not be aware of what is going on around them. They may not know where they are or what time it is. They may see or hear things that are not there. They may have trouble remembering things. Confused people may find it hard to speak or understand what others say. Their attention wanders and they are easily distracted. They cannot think clearly and have trouble making decisions.

Confusion may come on gradually over time or it may happen suddenly. Confusion that happens as a sudden change is called acute confusion.

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.

Other things that can cause confusion are:

  • changes in the body's oxygen level or blood chemistry
  • some medicines
  • very low blood sugar
  • serious infections with high fever
  • using drugs or alcohol (confusion can also happen if you have been drinking a lot of alcohol or using drugs and then suddenly stop using these substances)
  • stress or too little sleep
  • some herbal remedies
  • a lack of certain vitamins, especially in older adults
  • severe emotional upset
  • head injury or a tumor or disease in the brain
  • some mental illnesses.

What are the symptoms?

Signs and symptoms of confusion can include:

  • 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
  • misunderstanding 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 to the healthcare provider symptoms they have observed.

The 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 new illness. For example, fever caused by infection can cause confusion. The following tests may be done:

  • blood tests, especially for blood oxygen, low sodium or other chemistry problems, and drugs or alcohol levels
  • chest X-ray or abdominal X-ray
  • 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, 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 nearby people.
    • 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 person's healthcare provider advises taking the person to the emergency room or urgent care center, follow that advice right away.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File neur3407.htm Release 13/2010

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