Acute changes in mental status are usually secondary to delirium, stupor, and coma, which are forms of acute brain dysfunction. These changes occur over a period of hours or days and are usually precipitated by an underlying medical illness that is potentially life threatening.
Other causes of altered mental status
Differential Diagnosis The most common causes of abnormal behavior, especially in elderly patients, are infectious, such as UTI and pneumonia. Medication overdoses, withdrawals, and drug-to-drug interactions also are among the most common causes of acute altered mental status and confusion in the ED.
Acute altered mental status is a very broad topic, and can encompass any number of states, from mild agitation to delirium, or from sleepy to coma. In many patients, particularly the elderly, there may exist some degree of chronic, ongoing, cognitive impairment, psychiatric illness, or dementia.
The commonest factors significantly associated with delirium were dementia, older age, co-morbid illness, severity of medical illness, infection, ‘high-risk’ medication use, diminished activities of daily living, immobility, sensory impairment, urinary catheterisation, urea and electrolyte imbalance and malnutrition.
Within the brain, severe hypertension can overwhelm protective autoregulation mechanisms leading to diffuse vasogenic edema with vasospasm and arterial ischemia; when persistent, the syndrome recognized as hypertensive encephalopathy may develop resulting in altered mental status, headache, and vomiting and may
Background. Urinary tract infection (UTI) is considered a common cause of mental status changes, particularly in elderly patients and patients with a psychiatric condition.
the essential diagnostic tests to differentiate among possible causes of altered mental status with their indications and contraindications including:
Confusion in the elderly patient is usually a symptom of delirium or dementia, but it may also occur in major depression and psychoses. Until another cause is identified, the confused patient should be assumed to have delirium, which is often reversible with treatment of the underlying disorder.
Brain dysfunction during sepsis is frequently entwined with others factors that have to be screened systematically, including withdrawal syndrome, drugs overdose, and severe metabolic disturbances.
In infants and children, the most common causes of altered mental status include infection, trauma, metabolic changes, and toxic ingestion. Young adults most often present with altered mental status secondary to toxic ingestion or trauma.
What Causes It?
There is a huge range of potential causes including head injury, interruption of blood circulation, impaired oxygenation or carbon dioxide toxicity (hypercapnia), central nervous system (CNS) infections, drug intoxication or withdrawal, post-seizure state, hypothermia, and metabolic derangements such as hypoglycemia,
The start of delirium is usually rapid — within hours or a few days. Delirium can often be traced to one or more contributing factors, such as a severe or chronic illness, changes in metabolic balance (such as low sodium), medication, infection, surgery, or alcohol or drug intoxication or withdrawal.
Delirium is most commonly due to a medical cause including severe illness, constipation, dehydration, infection, pain, drug effect or withdrawal (especially alcohol and sedative drugs).
Delirium can be triggered by a serious medical illness such as an infection, certain medications, and other causes, such as drug withdrawal or intoxication. Older patients, over 65 years, are at highest risk for developing delirium. People with previous brain disease or brain damage are also at risk.