First Aid: The Causes and Treatment of Confusion

By Cristiano Antonino On Jul 4, 2022

Confusion is the inability to think clearly. In this altered mental state, a person may feel disoriented, think more slowly than usual, and have difficulty paying attention, remembering, and making decisions

Confusion is more common in older adults and is associated with dementia and delirium

It may come on quickly or slowly and may last a short while before resolving or may continue for a longer period.

Some people may act strangely or aggressively when confused.3

Sudden onset of confusion is often a sign of a medical emergency

It can mean that something is potentially wrong with the brain and may be life-threatening. In the case of sudden confusion, call 911.

How to Tell If Someone Is Confused

Paramedics usually use a very basic test to determine if a person is confused.5

They’re looking for the brain to be able to recognize person, place, and time.

An additional question of event is often added as well.

Person: What’s your name?

Place: Where are we right now?

Time: What time (or day or month) is it right now?

Event: What happened?

Depending on how a patient answers these questions, you can determine how confused he or she is.

In the best-case scenario, the patient will be oriented and able to answer all questions appropriately.

If the patient is not oriented — confused, in other words — paramedics want to know just how disoriented the patient is.

They do that based on which questions the patient can answer correctly.6

If the patient is able to tell you where he is and what his name is, that’s oriented to person and place only.

Sometimes a healthcare professional might say the patient is oriented x2 (times two), but then you can’t be sure which questions the patient can answer and which ones he can’t.7

Knowing the specifics may make a difference in the patient’s care.

Confusion, Medical Causes

There are several medical causes of confusion. A mnemonic that is used to help remember common causes of confusion is AEIOU-TIPS:8

A: Alcohol

E: Epilepsy

I: Insulin (diabetic emergency)

O: Overdose or oxygen deficiency9

U: Uremia (toxins due to kidney failure)10

T: Trauma (shock or head injury)

I: Infection

P: Psychosis or poisoning

S: Stroke

Confusion, What to Do

If someone around you is experiencing sudden confusion, it is important to stay calm, assess the situation, and call for help if necessary.

For safety, a confused person should not be left alone.11

Having someone nearby can help them stay calm and protect them from injury.

Try to keep the surroundings calm, quiet, and peaceful. Be reassuring and use simple words and short sentences.

In people with diabetes, sudden confusion may be due to low blood sugar, which requires consuming fast-acting sugar, such as juice, soda, or candy.12

Have them eat or drink something sweet. If the confusion continues for more than 10 minutes or they lose consciousness, call Emergency Number.13

When To Call Emergency Number

If a person becomes suddenly confused and has any of the following symptoms, call Emergency Number:

Cold or clammy skin
Dizziness or feeling faint
Fast pulse
Fever
Headache
Slow or rapid breathing
Uncontrolled shivering

In addition, if the confusion comes on as a result of a head injury or the person becomes unconscious or passes out, seek immediate medical help.

Treatment of confusion

The treatment for confusion depends on its cause, so the doctor may perform several tests, such as:14

Mental status tests
Blood tests
CT scan of the head
Electroencephalogram (EEG)15
Neuropsychological tests
Urine tests

Once the cause is determined, then treatment can begin.

For example, if confusion is caused by an infection, treating the infection should resolve it.16

References:

Gallagher J, Luck RP, Vecchio MD. Case 1: Altered mental status – a state of confusion. Paediatr Child Health. 2010;15(5):263–265. doi:10.1093/pch/15.5.263
Fong TG, Davis D, Growdon ME, Albuquerque A, Inouye SK. The interface between delirium and dementia in elderly adults [published correction appears in Lancet Neurol. 2015 Aug;14(8):788]. Lancet Neurol. 2015;14(8):823–832. doi:10.1016/S1474-4422(15)00101-5
National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US). Information about Mental Illness and the Brain.
Gower LE, Gatewood MO, Kang CS. Emergency department management of delirium in the elderly. West J Emerg Med. 2012;13(2):194–201. doi:10.5811/westjem.2011.10.6654
Inouye SK, Van dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941-8. doi:10.7326/0003-4819-113-12-941
Grover S, Kate N. Assessment scales for delirium: A review. World J Psychiatry. 2012;2(4):58–70. doi:10.5498/wjp.v2.i4.58
Hegde S, Ellajosyula R. Capacity issues and decision-making in dementia. Ann Indian Acad Neurol. 2016;19(Suppl 1):S34–S39. doi:10.4103/0972-2327.192890
Sanello A, Gausche-Hill M, Mulkerin W, et al. Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care. West J Emerg Med. 2018;19(3):527–541. doi:10.5811/westjem.2018.1.36559
Cooper JS, Shah N. Oxygen Toxicity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
Meyer TW, Hostetter TH. Approaches to uremia. J Am Soc Nephrol. 2014;25(10):2151–2158. doi:10.1681/ASN.2013121264
Portacolone E, Johnson JK, Covinsky KE, Halpern J, Rubinstein RL. The Effects and Meanings of Receiving a Diagnosis of Mild Cognitive Impairment or Alzheimer’s Disease When One Lives Alone. J Alzheimers Dis. 2018;61(4):1517–1529. doi:10.3233/JAD-170723
Gray A, Threlkeld RJ. Nutritional Recommendations for Individuals with Diabetes. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.
Mukherjee E, Carroll R, Matfin G. Endocrine and metabolic emergencies: hypoglycaemia. Ther Adv Endocrinol Metab. 2011;2(2):81–93. doi:10.1177/2042018811401644
Lorenzl S, Füsgen I, Noachtar S. Acute confusional States in the elderly–diagnosis and treatment. Dtsch Arztebl Int. 2012;109(21):391–400. doi:10.3238/arztebl.2012.0391
Gueguen B, Raynaud P, Guedj MJ. [Indications for EEG in mental confusion and behavior problems]. Neurophysiol Clin. 1998;28(2):134-43. doi:10.1016/s0987-7053(98)80024-5
Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5(4):210–220. doi:10.1038/nrneurol.2009.24