Mental confusion has a variety of causes and is more common in the elderly.

Mental confusion has a variety of causes and is more common in the elderly.

To understand what a confusional state is, it is first necessary to remember the meaning of the word to confuse, that is, to mix everything in a disorderly way, to lose clarity, to get confused with words. Thus, any change related to attention, awareness, understanding, response to stimuli and disorientation regarding time and space is considered mental confusion, which doctors call delirium.

The symptom can manifest in anyone, but it is more frequent among the elderly, especially those hospitalized, and can result from any type of organic imbalance such as fever or urinary infection, and even more serious situations such as a stroke (Cerebral Vascular Accident).

To date, there is no specific treatment for mental confusion and, generally, strategies to control its manifestation are summarized in the adoption of preventive measures – such as monitoring vulnerable patients and controlling chronic diseases.

In specific cases, when the symptom is associated with agitation and puts the life of the patient and other people at risk, calming medications may be indicated.

Understand what mental confusion is

It is a change in the states of attention, consciousness and cognition in which there is a reduction in the ability to maintain focus, think, understand, remember, respond to some type of stimulus, which also leads to a disorientation in terms of time and space.

Why does it happen?

This symptom is related to any type of stress that can alter the organic balance of vulnerable people, such as the elderly, people with chronic diseases or people who practice self-medication. Thus, the confusional state can be the result of different situations, such as the ones you see below:

  • Alcohol or drug intoxication
  • Using multiple drugs at the same time (polypharmacy)
  • Chronic use of medications (sedatives, anxiolytics, opioids)
  • Brain tumour
  • Head injuries or injuries
  • Fever
  • Imbalance in the levels of sodium, potassium, calcium, etc. (electrolyte imbalance)
  • Dehydration
  • Loss of brain function (among the elderly)
  • stroke
  • Infections (urinary or respiratory, for example)
  • Lack of quality sleep
  • Low or high blood sugar (hypoglycemia and hyperglycemia)
  • low level of oxygenation
  • Rapid drop in body temperature
  • convulsion
  • Kidney, liver or cardiorespiratory failure
  • bad nutrition
  • loss of vision
  • Depression
  • Surgery
  • septicemia

Could it be related to covid?

Yup. In addition to its intense inflammatory effect, which involves the CNS (Central Nervous System), covid can lead to low oxygenation and changes in pressure. All these factors together have the potential to result in mental confusion, especially among elderly patients. The explanation is provided by Raphael Ribeiro Spera, a neurologist and assistant physician in the emergency department of the neurological clinic division at HC-FMUSP.

The condition is even more frequent when there is a need for intensive care.

Learn how to recognize symptoms

Most of the time, the confusion appears suddenly (it is acute) and evolves within a few days. It can present itself more slowly or change throughout the day, which can lead to the perception that there has been an improvement.

Health problems such as stroke, epilepsy, seizures, changes in kidney function, Alzheimer’s and other forms of dementia are related to the symptom. In these cases, however, the confusion tends to last over time.

The most common manifestations of mental confusion are:

  • Difficulty thinking clearly
  • Lack of understanding of what is going on around them
  • Uncertainty as to current date and time
  • Frustration
  • Aggressiveness
  • Quick mood swings
  • atypical behaviors
  • Anxiety

Who needs to watch out?

The symptom can manifest in anyone, but it is more common in the extremes of life. In addition, some conditions can facilitate its appearance. Check out some of them:

  • Be over 70 years of age
  • Insanity
  • be male
  • Have vision or hearing difficulties
  • Moderate cognitive loss
  • alcohol abuse
  • Use of certain medications (psychoactive, antiallergic)
  • Drug side effect
  • Hospitalization
  • Anesthesia
  • Surgery
  • Exacerbation of chronic disease
  • infections

When is the time to seek medical help?

According to psychiatrist Alcion Svôlz Junior, assistant physician at HCFMRP-USP, at first, the confusional state is already a warning sign, since it is a condition that does not express the cause itself, but results from some disorder that affects brain functioning or the organism as a whole.

“Thus, whenever a state of mental confusion is identified, a medical evaluation is necessary”, adds the specialist.

Most of the time, people who present this symptom are seen in the emergency department by a general practitioner (general practitioner) who will later make referrals to specialists such as geriatricians, neurologists and psychiatrists.

How is the diagnosis made?

At the time of the appointment, the doctor will ask for information about the patient’s complaint, his health history and will perform a physical examination. “An important data that must be raised by the professional is related to the use of medication. Therefore, it is necessary to have in hand the names of any drugs used”, explains geriatrician Arnaldo Aires Peixoto Junior, from HUWC-UFC.

The doctor explains that there is no specific test to diagnose mental confusion and, to investigate the possible causes of the symptom, laboratory and imaging tests (such as chest X-ray, cranial tomography, etc.) causes of this picture.

Find out how the treatment is done

As there is no medication for the treatment of the symptom, the therapeutic strategies for its control are based —mainly— on non-pharmacological initiatives, such as prevention practices. These include paying more attention to patients whose risk factors facilitate mental confusion, especially hospitalized and elderly patients who have chronic illnesses or infections — which must be treated and controlled.

Another preventive measure is to be aware of the effects of changing medications for continuous use, or even medications that have mental confusion on the list of side effects. In addition, measures are recommended that reduce all types of environmental disturbance, as well as the promotion of sleep hygiene.

In some specific circumstances, the doctor may consider using medication. This is the case for people whose mental confusion can lead to behaviors that endanger the patient’s own life or those around him.

Can it be prevented?

Yes, especially if you are not old enough. To avoid feeling confused, take the following preventive measures:

  • Avoid alcohol or drug abuse
  • Adopt a balanced diet to ensure you get the nutrients your body needs.
  • Keep chronic diseases like diabetes under control
  • Organize time for rest and invest in quality sleep
  • Avoid self-medication
  • Be aware of the doses of medication indicated by the doctor, as well as the suggested time of treatment.

Tips for those who care for people with this symptom

Some individuals may experience mental confusion for a long time. It is recommended that those in charge of their care adopt some practices to guarantee their dignity and also facilitate communication and guidance. Check out:

  • Introduce yourself to the person every time you talk to them if they can’t remember who you are
  • Talk to her about everyday matters
  • Explain who the other people in the house or environment are
  • Help her orient herself over time. You can say that a certain situation will happen after breakfast, lunch or dinner.
  • Encourage her to watch TV, paint, play memory games
  • Walking and exercising gently should be encouraged as long as there is space for relaxation and rest afterwards.
  • Help her with personal care such as going to the bathroom, bathing and dressing
  • Prefer to offer nutritious foods, reducing the supply of sodium, sugar and processed products. The swallowing condition, food culture and nutritional needs should be considered. Some people will need to be assisted at the time of feeding to ensure adequate food intake.
  • Ensure adequate hydration
  • Keep the environment comfortable, if possible with temperature control, and light enough to prevent falls
  • Keep a clock and calendar in view to help them orient time and space
  • Make sure eyeglasses and hearing aids are available
  • Ensure that some personal items such as photographs, blanket and pillow can be taken to the place where the person is transferred for care. These familiar items bring her comfort.

Sources: Alcion Sponsolz Juniorpsychiatrist and assistant physician at HCFMRP-USP (Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo); Arnaldo Aires Peixoto Juniorgeriatrician at HUWC-UFC (Walter Cantídio University Hospital, Federal University of Ceará), linked to the Ebserh network (Brazilian Hospital Services Company), adjunct professor at the Department of Clinical Medicine at the Faculty of Medicine of the same institution; Raphael Ribeiro Spera, neurologist and assistant physician in the emergency department of the neurological clinic division of the HC-FMUSP (Hospital das Clínicas, Faculdade de Medicina da USP), collaborating member of the GNCC (Group of Cognitive and Behavior Neurology) of the same institution; He is also a member of the ABN (Brazilian Academy of Neurology). Medical reviewers: Alcion Sponsolz Junior and Arnaldo Peixoto Junior.

References: Ramírez Echeverría MdL, Schoo C, Paul M. Delirium. [Atualizado em 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available at https://www.ncbi.nlm.nih.gov/books/NBK470399/; Bates, D., & Bates, C. (2013). Confusion and delirium. Medicine, 41(3), 151-154. doi:10.1016/j.mpmed.2013.01.002. Available at https://bit.ly/3dvLXlg.

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