Altered Mental Status (AMS)

What is an altered mental status?

An altered mental status (AMS) isn’t a specific disease. It’s a change in mental function that stems from illnesses, disorders and injuries affecting your brain. It leads to changes in awareness, movement and behaviors.

What are the types of altered mental status?

There are three types:

• Delirium occurs suddenly and is a medical emergency. A person with delirium may act disoriented, be distracted and exhibit unusual behaviors. This type of AMS is reversible.
• Dementia is a progressive disorder causing a decline in mental function that affects daily life. It primarily affects older adults. In advanced stages, a person loses awareness of their identity and surroundings.
• Psychosis, due to a medical condition or medication, is a temporary condition in which a person loses touch with reality. They may experience disturbing thoughts, as well as sights and sounds that aren’t real.

What are the causes of altered mental status?

In people with dementia, progressive mental decline is the natural course of the disease.

A sudden altered mental status, such as delirium and psychosis, can be due to issues with nearly any organ system. Potential causes include:

Central nervous system issues

• Brain bleed (hemorrhage).
• Brain tumor.
• Hepatic encephalopathy.
• Obstructive hydrocephalus, fluid build-up in your brain that increases pressure in your skull.
• Seizure.
• Stroke.

Metabolic disorders

• Dehydration.
• Hypothermia.
• Low blood oxygen (hypoxemia).
• Low blood sugar (hypoglycemia).
• Low sodium levels in the blood (hyponatremia).
• Low calcium levels in the blood (hypocalcemia).
• Underactive thyroid (hypothyroidism).

Adverse reactions to prescription drugs

• Antiseizure medications.
• Anticholinergics, a group of drugs that control involuntary muscle movements.
• Corticosteroids.
• Sedatives, which help you relax.
• Sleeping pills.

Infections

• Urinary tract infections.
• Encephalitis.
• Meningitis.
• Pneumonia.

Other causes

• Cardiogenic and other types of shock.
• Overdose or withdrawal from opioids, alcohol and other controlled substances.
• Traumatic brain injury.

What are altered mental status signs and symptoms?

You may experience a broad range of altered mental status symptoms. They include:

Changes in cognitive function and awareness

• Altered consciousness, which may include coma.
• Confusion.
• Disorientation.
• Forgetfulness (amnesia) and other memory problems.
• Hallucinations, seeing or hearing things that aren’t there.
• Delusions.
• Incoherent or nonsensical speech.
• Slow responses to questions or stimuli.

Mood and mental health issues

• Agitation and irritability.
• Anxiety.
• Depression.
• Emotional outbursts.
• Euphoria, a feeling of intense happiness.
• Social withdrawal, avoiding interactions with other people.
• Unusual behavior.

Additional altered mental status symptoms

• Fatigue.
• Hyperactivity.
• Respiratory distress, including shortness of breath.

How is AMS diagnosed?

Diagnosing an altered mental status involves a thorough evaluation to determine the cause. In many cases, this takes place in a hospital emergency department.

Emergency care providers tailor your assessment based on altered mental status symptoms and how severe they are. They start by asking you (or a loved one if you can’t communicate) about your medical history. The initial physical exam often involves:

• Airway: Examining your airway to make sure it’s open.
• Breathing: Listening to your lungs with a stethoscope.
• Circulation: Checking your pulse, blood pressure and heart rhythm.
• Neurological deficits: Determining the level of consciousness and screening for neurologic injury, such as paralysis on one side of your body.
• Exposure: Performing a head-to-toe physical exam to look for signs of injury or medicated transdermal patches.

What else might an altered mental status evaluation involve?

The initial assessment helps emergency care providers quickly determine the severity of your symptoms and start lifesaving treatment, if necessary. To pinpoint the cause, you may need additional testing, such as:

• Blood tests.
• CT scan.
• Chest X-ray.
• Electrocardiogram (EKG).
• Electroencephalogram (EEG).
• Urinalysis.
• Blood sugar tests.

What treatments might I need for AMS?

The best treatments for you depend on the medical or neurological cause and type of AMS.

Care may include:

• Antibiotics for infection.
• Change of medications for AMS due to prescription drug reactions.
• Glucagon injection for hypoglycemia.
• Intravenous fluids for dehydration.
• Naloxone for narcotic overdose.
• Rescue medications for seizures.
• Anxiolytics, or antipsychotics.
• Surgery to repair a hemorrhage or relieve pressure on your brain.
• Supplemental oxygen for hypoxia.

What can I do to prevent an altered mental status?

Some causes of altered mental status, such as dementia, can’t be prevented. Others may be possible to avoid.

You can lower your risk of AMS by:

• Following care instructions for chronic conditions such as epilepsy, diabetes and thyroid disease.
• Taking prescription medications at the correct time and in the prescribed dose.
• Avoiding nonmedical drug or substance use.

What is the prognosis for people with AMS?

For altered mental status due to delirium or psychosis, the outlook is good. Symptoms typically fade away once you receive treatment. If AMS is due to dementia, treatments can stabilize life-threatening issues, but mental decline will continue to progress.

What is living with an altered mental status like?

For delirium or psychosis, once you receive treatment, life will likely return to normal after a short recovery. It’s possible to experience AMS in the future, so it’s essential to follow care recommendations. For example, AMS due to hypoglycemia may require more frequent glucose monitoring to keep blood sugar levels within a healthy range.

A note from Cleveland Clinic

Altered mental status is a change in mental function. It stems from certain illnesses, disorders and injuries affecting your brain. The change is often temporary, but can quickly become life-threatening. It’s essential to seek emergency medical care if you, or a loved one, show signs of this condition.