What Medical Conditions Cause Confusion? (2024)

Confusion is a common cause of hospital admission, occurring in 5% to 10% of adult emergency room visits. Sometimes, confusion comes on gradually, such as with the development of dementia. Other times, confusion occurs suddenly and in response to an immediate medical problem.

This article discusses medical terminology related to confusion and its symptoms, causes, treatment, complications, and related issues.

Medical Definition of Confusion

Medical terminology around the word “confusion” can be complicated and inconsistent. Here are some ways you may hear healthcare providers refer to confusion:

• Altered mental status: Healthcare providers use this phrase to indicate broad changes from a person’s typical mental state. Depending on the context, this might include confusion or other characteristics, like changes in mood or activity choices.
• Delirium: Sometimes, altered mental status starts suddenly, within hours or days, from an issue in the brain or elsewhere in the body. Healthcare providers call this “delirium” or “acute confusional state.” With treatment, it often resolves within a few weeks.
• Dementia: With dementia, people gradually develop memory problems that worsen over time. For example, someone with Alzheimer’s disease might be confused about time, location, or their own or others’ identity.
• Mild cognitive impairment: This form of confusion is characterized by mild and transient symptoms of confusion. Some, but not all, people with mild cognitive impairment eventually develop dementia.
• Psychosis: This form of altered mental status can cause profound confusion. During an episode of psychosis, a person’s thoughts and perceptions become distorted, and they have trouble recognizing what is real.

Symptoms of Confusion

“Confusion” isn’t a diagnosis or a clear-cut medical category, but most people intuitively understand what it means. Confusion is a way to describe a symptom or group of symptoms.

People may experience mild, temporary confusion, such as mixing up dates, calling someone by the wrong name, or forgetting directions. This can be a normal part of life, or in some cases, it might indicate mild cognitive impairment.

Symptoms that can occur with confusion include:

• Difficulty reasoning
• Fear
• Anxiety
• Agitation

People who are confused because of a medical issue often have other symptoms. For example, they may not be able to pay attention as easily, or they might be sleepy and hard to rouse. These additional signs can give healthcare providers clues about the cause.

Recognizing Signs in Someone Else

Recognizing confusion in others is straightforward when symptoms are severe. Signs include being disoriented and not knowing their name, where they are, or the correct month and year.

However, signs of confusion from a medical condition are more subtle and can be mistaken for signs of normal aging. When assessing whether someone else has signs of confusion, consider the following questions:

• Can they follow and participate in conversation normally, with reasonable responses?
• Are they clear about the situation, where they are, who they are, and what is happening?
• Are they forgetting appointments or not following through on daily tasks?
• Are they having trouble remembering new information?
• Are they having trouble following specific requests?

What Causes Confusion

To determine the cause of confusion, it can help to consider the short- and long-term issues related to the symptom.

Confusion from Short-Term Problems

Various medical situations can cause confusion and other symptoms that begin more rapidly (hours to days). Some noteworthy examples are:

• Recent infection (e.g., urinary tract infection)
• Electrolyte imbalance (e.g., hyponatremia)
• Very high or very low blood sugar in someone with diabetes
• Very low or very high blood pressure
• Stroke
• Traumatic brain injury
• Seizures
• Drug or alcohol withdrawal
• Poisoning or drug overdose
• Severe liver or kidney disease

Confusion From Long-Term Medical Conditions

Confusion can result from various forms of dementia, including Alzheimer’s disease, vascular dementia, and Lewy body dementia. Some forms may be reversible, such as dementia from B12 deficiency or a thyroid hormone imbalance.

An episode of psychosis can also cause profound confusion from a mental health condition such as bipolar depression or schizophrenia.

Some factors increase the risk of confusion from an immediate medical problem. These include:

• Advanced age
• Dehydration
• Intensive medical interventions (e.g., staying in the intensive care unit or recent surgery)
  
• Malnutrition
  
• Retaining urine or stool
  
• Severe pain
• Sleep deprivation
• Sudden blood loss
  

People who already have dementia or mild cognitive impairment are also at higher risk of episodes of delirium, which can temporarily worsen their baseline confusion.In many cases, multiple issues contribute to a person’s confusion.

Confusion as a Medication Side Effect

Medications often cause confusion, especially in older individuals taking multiple drugs with combined side effects. A selection of such drugs include the following:

• Some medications for allergies, like Benadryl (diphenhydramine)
• Some medications for urinary incontinence, like Oxytrol (oxybutynin)
• Some medications for psychosis and mental illness, like Clozaril (clozapine)
• Some medications for Parkinson’s, like Mirapex (pramipexole) and Requip (ropinirole)
• Medications for motion sickness, like Dramamine (dimenhydrinate)
• Medications for nausea, like Reglan (metoclopramide)
• Certain antibiotics, like Cipro (ciprofloxacin) and Erythrocin (erythromycin)
• Benzodiazepines for anxiety, such as Valium (diazepam) or Ativan (lorazepam)
• Narcotic drugs like Demerol (meperidine) for pain
  
• Corticosteroids, such as methylprednisolone
• Nonsteroidal anti-inflammatory drugs, like Advil (ibuprofen)
  
• Beta-blockers for high blood pressure, like Lopressor (metoprolol)
• Tricyclic antidepressants like Tofranile (imipramine)
• Antivirals like Zovirax (acyclovir)

This isn’t a complete list. Talk to a healthcare provider about whether certain medications may contribute to confusion in you or someone you care for. Do not stop taking any prescribed medications without consulting a healthcare provider.

How to Improve Confusion

It’s essential to receive a diagnosis and treatment for any underlying medical issues causing confusion. For example, this might mean receiving an antibiotic for an infection, fluids and electrolytes for an electrolyte imbalance, or antipsychotic medications for someone experiencing psychosis from a mental health disorder.

In dementia, symptoms like confusion and agitation may occur in the afternoon or late evening (called “sundowning"). Other support professionals, like occupational therapists, are often a great source of ideas and tools to help reduce confusion during these times and throughout the day.

For example, some of the following might help:

• Use familiar objects, like photos of loved ones, to help keep people oriented.
• Avoid excess clutter, and keep such objects and furniture in the same place.
• Maintain routines so it’s easier for the person to know what’s coming next.
• Provide plenty of visual clues to help with remembering the time and place.
• Keep the room well-lit; use softer lights in the afternoon and evening.
• Engage in soothing leisure activities that the person can still enjoy, like listening to their favorite music.
• Eliminate alcohol and limit caffeine.
• Get exercise every day.
• Limit naps, and keep them early in the day.

Complications of Worsening Confusion

Complications of worsening confusion are often the result of an inability to care for oneself.

When someone experiences confusion from delirium, they may act in ways that make their condition worse (e.g., not drinking fluids and becoming dehydrated). When in a delirious state, they may not seek the medical attention that they need, which can worsen their medical problem and make it harder to treat.

Complications can also arise in people with long-term conditions, leading to increased confusion. They may become unable to care for themselves, skipping meals or medications, not performing needed chores, missing appointments, and making unwise financial decisions.

Ultimately, a condition like Alzheimer’s increases the risk of complications that may be indirectly related to confusion, like incontinence, infections like pneumonia, dehydration, falls, constipation, and foot and dental problems.

When to Consult a Healthcare Provider

If you notice confusion in a loved one that’s come on relatively quickly, seek immediate medical attention. They may have another medical problem that needs treatment, like a urinary tract infection or a stroke. Some people may experience fever or muscle weakness alongside confusion. Someone with dementia whose symptoms are suddenly worse than their baseline needs prompt medical attention.

People with gradually increasing confusion should schedule an appointment with a healthcare provider. A provider can perform a full assessment or refer them to a specialist to get a correct diagnosis and treatment. You should especially seek medical attention for confusion that seems to be progressively worsening or any confusion that is interfering with daily life.

Summary

Confusion is a common medical symptom, especially for older individuals, and it’s one of the most common reasons for hospitalization. It isn’t a specific medical condition but can occur as a temporary or more long-term symptom in various situations.

"Delirium" is the term medical professionals often use for someone in an altered mental state, which may include confusion caused by something temporarily affecting the brain. Confusion also occurs in dementia, a group of related conditions that cause severe memory issues and other problems in older individuals.

Confusion that begins relatively suddenly is a potential medical emergency. However, if a loved one is gradually becoming confused more often, they also need medical attention. A specialist can help diagnose a possible disease and form a multidisciplinary treatment approach to reduce confusion and improve overall quality of life.