Confusion

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Introduction

What is confusion?

Confusion occurs when a person has difficulty understanding a situation or has disordered or unclear thoughts. It can be accompanied by memory loss, disorientation, or the inability to think quickly.

Confusion can increase slowly over time or come on abruptly, depending upon the cause. It may be associated with serious infections, some chronic medical conditions, head injury, brain or spinal cord tumor, delirium, stroke, or dementia. It can also be caused by alcohol or drug intoxication, sleep disorders, chemical or electrolyte imbalances, vitamin deficiencies, or medications. It can also occur in the period following a seizure or as a result of hypothermia.

Confusion in the elderly may be aggravated by environment changes, such as being admitted to the hospital, or as a result of sundowning (confusion occurring late in the day or at night, that may accompany certain types of dementia) in the late afternoon or evening. Behavioral changes can accompany confusion.

Depending upon the cause, confusion may be a temporary, treatable condition or may be progressive.

Seek immediate medical care (call 911)for the rapid onset of confusion, especially if it is accompanied by high fever (higher than 101 degrees Fahrenheit), neck stiffness or rigidity, rash, head injury, changes in level of consciousness or alertness, flushing or dry skin, severe nausea and vomiting, fruity breath, or other symptoms that cause you concern.

Symptoms

What other symptoms might occur with confusion?

Confusion may accompany other symptoms, which vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the brain may also involve other body systems or disorders.

Infection symptoms that may occur along with confusion

Confusion may accompany symptoms related to infection including:

  • Enlarged lymph nodes
  • Fever
  • Headache
  • Malaise or lethargy
  • Nausea with or without vomiting
  • Neck stiffness or rigidity
  • Rash
  • Seizure

Symptoms of chronic illnesses or metabolic disorders that may occur along with confusion

Confusion may accompany symptoms related to chronic illnesses and metabolic disorders including:

  • Abdominal pain

  • Abnormal heart rhythm such as rapid heart rate (tachycardia) or slow heart rate (bradycardia)

  • Ankle swelling

  • Difficulty breathing or rapid breathing

  • Dry skin or changes in skin color

  • Fatigue

  • Feeling very thirsty

  • Frequent urination, or reduced or lack of urination

  • Fruity breath

  • Muscle weakness

  • Nausea with or without vomiting

Other symptoms that may occur along with confusion

Confusion may accompany other symptoms depending upon its cause including:

  • Changes in mood, personality or behavior

  • Changes in sleep patterns

  • Difficulty swallowing

  • Difficulty with memory, thinking, talking, comprehension, writing or reading

  • Dizziness

  • Impaired balance and coordination

  • Loss of consciousness for even a brief moment

  • Loss of vision or changes in vision

  • Numbness, weakness or paralysis

  • Severe headache

Serious symptoms that might indicate a life-threatening condition

In some cases, confusion may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Change in level of consciousness or alertness such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change such as delirium, lethargy, hallucinations or delusions

  • Garbled or slurred speech or inability to speak

  • High fever (higher than 101 degrees Fahrenheit)

  • Paralysis or inability to move a body part

  • Seizure

  • Stiff or rigid neck

  • Sudden change in vision, loss of vision, or eye pain

  • Trauma to the head

  • Worst headache of your life

Causes

What causes confusion?

Confusion may be associated with serious infections, some chronic medical conditions, head injury, brain or spinal cord tumor, delirium, stroke, or dementia. It can be caused by alcohol or drug intoxication, sleep disorders, chemical or electrolyte imbalances, vitamin deficiencies, or medications. It can also occur in the period following a seizure, called the postictal period, or as a result of hypothermia.

Common causes of confusion

Confusion may be caused by conditions including:

  • Anesthesia

  • Chemical or electrolyte imbalances

  • Chronic kidney disease (which includes any type of kidney problem such as kidney stones, kidney failure, and kidney anomalies)

  • Chronic liver disease (which includes any type of liver problem such as hepatitis, cirrhosis, and liver failure)

  • Chronic obstructive pulmonary disease (COPD, which includes emphysema and chronic bronchitis)

  • Congestive heart failure (deterioration of the heart’s ability to pump blood)

  • Dementia

  • Drug or alcohol intoxication

  • Medication side effects (recovery may take time after drug discontinuation)

  • Seizure disorders

  • Severe dehydration

  • Severe trauma

  • Sleep deprivation or disturbances

  • Vitamin deficiencies such as niacin, thiamine, vitamin B12, or vitamin C deficiency

Serious or life-threatening causes of confusion

In some cases, confusion may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Brain or spinal cord injury or tumor

  • Delirium

  • Drug or alcohol overdose

  • Encephalitis (inflammation and swelling of the brain due to a viral infection or other causes)

  • Heat stroke

  • Hypoglycemia (low blood sugar)

  • Kidney failure

  • Meningitis (infection of the membranes that cover the brain and spinal cord)

  • Hypothermia

  • Seizure

  • Sepsis (severe infection of the bloodstream)

  • Stroke

Questions for diagnosing the cause of confusion

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your confusion including:

  • When did you first notice confusion?

  • Do you have any other symptoms?

  • Do you have any difficulty sleeping?

  • Did anything such as an injury or illness precede the symptoms?

  • Do you have any other medical conditions?

  • What medications are you taking? Are you taking any new medications?

  • Have you taken any street drugs?

  • Do you drink alcohol?

What are the potential complications of confusion?

Because confusion can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 25
  1. NINDS dementia information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/dementias/dementia.htm.
  2. Confusion. Medline Plus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/003205.htm.
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