Confusion and delirium

Definition

Confusion is a loss of orientation (not knowing where, when, who and what you are), often combined with a loss of memory. Delirium is a short term state of confusion, accompanied with altered consciousness.

Epidemiology

Very common, especially in the elderly, or very ill.

Pathophysiology

As far as we can ascertain:

• If your body is a bit messed up, ie. electrolyte imbalances etc, you get confused.
• If your brain isn't working properly, ie. alzheimer's disease, etc, you get confused.
• If your brain is getting squashed, ie. massive brain tumour, etc, you get confused.

Clinical and Associated Features

• Impaired cognitive function
• Hallucination
• Thought disturbances
• Aggression
• Agitation
• Retardation
• Sleep disturbance
• Mood disturbance

Dementia rears its ugly head

It's important to know the difference between dementia and delirium, although Lewy Body dementia can be misleading because it can fluctuate so wildly:

Dementia

• Chronic onset and progressive
• Usually primary
• Relatively constant state

Delirium

• Acute Onset
• Secondary to something else.
• Sleep disturbance
• Fluctuates rapidly
• Related to consciousness.

Differential Diagnosis

• Sepsis
• Dementia
• Drug and alcohol abuse
• Stroke
• Alcohol withdrawal
• Trauma
• Brain cancer (either a brain tumour or a brain met)
• Metabolic syndrome