Confusion and delirium
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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
Investigations
- History, to screen for dementia and drug or alcohol abuse.
- Septic screen.
- CT scan of brain, to check for bleeds or clots.