ACUTE CONFUSIONAL STATE

INTRODUCTION
• Mental and behavioural state of reduced
comprehension,coherence and capacity to
reason
• Early signs,disorientation and inattention
• Late signs,global cognitive impairment
• Apparent confusion:aphasia,amnesia,agnosia
• Impaired consciousness over hours or days
• Reversal of sleep:wake cycle
 Epidemiology
• 50% of inpatients over 65 years
• Longer admission,more
complications,increased mortality
• Risk factors:elderly,dementia/cognitive
impairment,hip fractures,acute illness,
 Aetiology
• Disorder of nervous system
• Surgery/post GA
• Systemic infections
• Intracranial infection or injury
• Drugs/drug withdrawal
• Alcohol withdrawal
• Metabolic:Na,hypo/hyperglycaemia,
 Aetiology
• Hypoxia
• Vascular
• Nutritional
 Clinical features
• Hypoactive:slow,withdrawn,physically inactive,not
inclined to speak
• Hyperactive :restless,mood lability,agitation or
aggression
• Mixed
• Delirium
tremens:agitation,illusions,hallucinations,tremors
• Compare current behaviour with pre-morbid state
 Clinical features
• EVALUATION
• Orientation/Memory:place,time,person
• Specific information:address,telephone no,p.o
box etc
• Attention/coherence:accuracy and speed of
responses
• Repeat string of numbers
• Spell world backwards,serial 3s or 7s
 Clinical features
• Other features:hemiparesis,hemianopia etc
• Disorganised,rambling language
• Paraphasic words
• Asterixis :metabolic encephalopathy
• Myoclonic jerks/tremors:uraemia,drugs
• Drugs :anticholinergics,alcohol,benzodiazepines
• Differenciate dementia from delirium,both can
coexist
 Treatment
Stop medications
Rectify metabolic alterations
Treat infection
Skilled nursing
Quiet room
Take measures to lessen risk factors in elderly
Low dose typical/atypical antipsychotics
Benzodiazepiness