Confusion

What is confusion?

Confusion is a term that describes symptoms that involve disruptions in your memory, ability to think and focus, awareness and more. People often use “confusion” to describe small missteps, errors or inaccuracies. From a medical perspective, confusion has a very different meaning. It’s a form of altered mental status, which indicates a problem with how your brain works.

Different abilities rely on different parts of your brain. Some abilities — like spoken language — rely on different areas working together. Confusion happens when these areas aren’t working as they should.

What confusion ISN’T:

• Mix-ups, like calling someone by the wrong name or misunderstanding what someone is saying.
• Stumbles or recall delays, like needing a moment to remember something or having trouble retrieving a word or idea (“What was I saying?” or “Now, where were we?”).
• “Almost-but-not-quite” instances. For example, you might have trouble remembering the name of a specific color (like maroon or crimson) but say a related one instead (like red).
• Minor mistakes. You might make fact-recall errors (like saying the state capital of New York is New York City instead of Albany). Or you might do simple arithmetic wrong in your head.

What confusion IS:

• Diminished alertness. This means you’re less aware of what’s going on around you.
• Disorientation. This involves not knowing when and where you are or other current or relevant facts (like who’s your nation’s leader).
• Memory disruptions. These can involve trouble recalling simple phrases from a few minutes earlier or “crossing” memories. It might look like mistaking a person for someone else (thinking someone is a friend, relative or other loved one from earlier in your life).
• Impaired thinking. This means you have trouble using mental skills and abilities. Examples include being unable to count backward from seven or say the months of the year in reverse.
• Malfunctions in awareness and thinking. This can include hallucinations. Hallucinations can occur when your brain feels like it’s experiencing stimulation in one of the five senses, but that stimulation isn’t there (like hearing voices, but no one’s around). Illusions can also occur. Illusions are when your brain misinterprets stimulation that’s there (for example, thinking you see a black cat but it’s a black sock). Another example is delusions. Those are beliefs you hold strongly even when there’s overwhelming evidence your belief is incorrect.

What are the most common causes of confusion?

Any condition, circumstance or event that disrupts your brain function can cause confusion. That means there are dozens of potential causes. Many times, confusion involves multiple causes and factors happening at the same time. In some cases, there’s no cause that healthcare providers can find.

Conditions that can cause confusion include:

• Alcohol intoxication and alcohol poisoning.
• Blood sugar level extremes, including very low blood sugar (hypoglycemia) and very high blood sugar (hyperglycemia).
• Brain bleeds.
• Brain cancer.
• Brain lesions (damaged areas in the brain).
• Dehydration.
• Delirium.
• Electrolyte imbalances, like very low sodium (hyponatremia) or very high calcium (hypercalcemia).
• Endocrine disorders, like hypothyroidism and hyperthyroidism.
• Extreme body temperatures, including very low body temperature (hypothermia) and very high body temperature (hyperthermia).
• Head injuries, including concussions and traumatic brain injuries (TBI).
• Hydrocephalus and normal pressure hydrocephalus.
• Infections — especially encephalitis and meningitis — as well as life-threatening, infection-related conditions like sepsis.
• Lack of blood flow, such as from any kind of stroke, especially ischemic stroke.
• Lack of oxygen (cerebral hypoxia).
• Medical and nonmedical drug use, especially with certain drugs like hallucinogens.
• Mental health conditions or states that involve disrupted or disorganized brain activity, like schizophrenia or psychosis.
• Migraines.
• Neurodegenerative diseases like Alzheimer’s disease or dementia.
• Organ failure, especially when it affects your kidneys or liver.
• Seizures, especially right after a seizure, or status epilepticus, which is a medical emergency.
• Toxins and poisons, like carbon monoxide, heavy metals, certain pesticides or inhalants.

How is confusion treated?

Confusion itself isn’t treated. Instead, healthcare providers treat the conditions that can cause confusion. You shouldn’t attempt to self-treat confusion unless it’s related to a condition your healthcare provider has already diagnosed. If it’s a diagnosed condition, following your healthcare provider’s guidance is the best way to manage it.

Treatments vary, so look to your healthcare provider for information. They can tailor the options and their recommendations to your (or your loved one’s) needs and preferences.

What are the possible complications or risks of not treating confusion?

Confusion is a symptom that disrupts your ability to control what you think, do and say. Because of that, you can’t recognize that you have it, and it affects your ability to make decisions about your medical care.

Certain conditions related to confusion — especially delirium — increase the risk of later complications. Confusion may increase the risk of having the following complications:

• Agitated or aggressive behavior that’s out of character for you, possibly leading to injuries.
• Falls and related traumatic injuries.
• Inability to care for yourself, leading to a loss of independence.
• Increased risk of later brain-related conditions like dementia, especially when you have a confusion-related condition after age 65.
• Depression, post-traumatic stress disorder (PTSD) and other mental health conditions.

Confusion affects everyone differently, so it can be difficult to predict its complications. Your healthcare provider (or your loved one’s provider) is the best source of information about possible complications.

Can confusion be prevented?

Confusion isn’t preventable. It happens unpredictably and often for reasons that experts still don’t understand. But you can reduce the risk of developing some conditions that can cause it. Some things you can do include:

• Managing your chronic conditions. Follow your healthcare provider’s guidance on managing chronic conditions like diabetes, high blood pressure and epilepsy.
• Wearing safety equipment as needed. Head injuries, especially concussions and traumatic brain injuries, are among the most common causes of confusion. Protect your brain from injury using safety equipment, like helmets and seat belts.
• Eating a balanced diet. Electrolyte imbalances and nutrient deficiencies are often avoidable (or you can reduce the risk of having them). Managing what you eat can also help avoid confusion related to many brain-related conditions, especially strokes.
• Staying physically active, and reach and maintain a weight that’s healthy for you. Your weight and how active you are can prevent or delay conditions that affect your brain. Healthcare providers can guide you on reaching and maintaining a weight that’s healthy for you.
• Avoiding substance and nonmedical drug use, and use alcohol in moderation. Substance use disorders greatly increase the risk of disruptions that can cause confusion. Remember also to take any prescription medications exactly as directed. Confusion is less likely to happen when you follow your healthcare provider’s instructions on using any medications you take.

When should a doctor or healthcare provider treat confusion?

Sudden-onset confusion is always a sign that someone needs medical attention. That’s because it’s a possible symptom of dangerous or life-threatening medical emergencies like a stroke.

Medical attention is also recommended when you first notice signs of confusion that develop gradually in yourself or a loved one. Once a healthcare provider diagnoses the cause (if it’s possible to find one), they can guide you on managing it.

Confusion vs. delirium — what’s the difference?

Delirium is a specific, more severe type of confusion. It can develop when injury, illness or other factors overwhelm your brain’s ability to keep working like it should. The disruptions in brain activity are so severe, they can cause or worsen dementia in people at risk because of age or other factors. Delirium develops quickly and it can shift and change from hour to hour. Delirium and confusion aren’t the same thing, and you can have confusion without having delirium.

A note from Cleveland Clinic

If you recognize or suspect a loved one has confusion — especially when it begins or worsens quickly — it’s important to get medical attention immediately. Confusion can affect memory, thinking and more. With medical care, many causes of confusion are temporary or reversible.

While it can be scary to see a loved one who has this symptom, your loved one’s healthcare provider can guide you on what you can do to help manage this symptom. Ongoing research offers hope of treating permanent or serious causes of confusion. It could also make it possible to delay how it worsens, offering renewed hope and opportunities in years to come.