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.

In order to understand what a state of confusion is, it is first necessary to remember the meaning of the word confusion, that is, to mix everything in a disorganized way, loss of clarity, confusion with words. Thus, any change in attention, awareness, understanding, response to stimuli, and confusion with respect to time and place is considered mental confusion, which is what clinicians call delirium.

Symptoms can occur in anyone, but they are more common among the elderly, especially those who are hospitalized, and can result from any kind of organic imbalance such as fever or urinary tract infection, and even more serious conditions such as stroke (cerebral vascular accident ) .

To date, there is no specific treatment for mental confusion, and in general, strategies for controlling its manifestations are the adoption of preventive measures – such as monitoring of patients at risk and control of chronic diseases.

In specific cases, when symptoms are associated with agitation and endanger the life of the patient and other persons, sedative medications may be indicated.

Understand what mental confusion is

It is a change in states of attention, awareness and perception in which there is a decrease in the ability to maintain focus, think, understand, remember and respond to some kind of stimulus, which also leads to confusion in terms of time and space.

Why does this happen?

This symptom is associated with any kind of stress that can alter the organic balance of people at risk, such as the elderly, people with chronic diseases or those who practice self-medication. Thus, the state of confusion can be the result of various situations, such as the ones you see below:

  • Alcohol or drug intoxication
  • Using several medicines at the same time (multi-drugs)
  • Chronic use of medications (sedatives, anxiolytics, opioids)
  • brain tumor
  • Head injury or injury
  • Fever
  • An imbalance in the levels of sodium, potassium, calcium and others. (electrolyte imbalance, electrolyte imbalance)
  • drying
  • Loss of brain function (among the elderly)
  • brain attack
  • Infections (urinary or respiratory tract, for example)
  • lack of good sleep
  • Low or high blood sugar (hypoglycemia and hyperglycemia)
  • low oxygen level
  • Rapid drop in body temperature
  • spasm
  • Kidney and liver failure or heart and respiratory failure
  • poor nutrition
  • loss of sight
  • depression
  • surgery
  • Blood poisoning

Could it be related to the covid virus?

yes. In addition to its severe inflammatory effect, which includes the central nervous system (CNS), Covid disease can lead to decreased oxygen and changes in pressure. All of these factors combined have the potential to cause mental confusion, especially among elderly patients. Annotation was provided by Rafael Ribeiro Spira, a neurologist and assistant physician in the emergency department of the Department of Neurological Clinic at HC-FMUSP.

The condition is more frequent when intensive care is needed.

Learn to recognize the symptoms

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

Symptoms are associated with health problems such as stroke, epilepsy, seizures, changes in kidney function, Alzheimer’s disease, and other forms of dementia. However, in these cases, the confusion tends to persist over time.

The most common manifestations of mental confusion are:

  • Difficulty thinking clearly
  • Not understanding what is going on around them
  • Uncertainty regarding the current date and time
  • frustration
  • aggression
  • rapid mood swings
  • atypical behaviors
  • Worry

Who needs to be careful?

Symptoms can appear in anyone, but they are most common in the roughest stages of life. In addition, certain conditions can facilitate its appearance. Check out some of them:

  • You must be over 70 years old
  • mad
  • be a male
  • You have difficulty seeing or hearing
  • Mild cognitive loss
  • alcoholic
  • Use of certain medications (psychoactive, antiallergic)
  • Drug side effects
  • Hospital treatment
  • Anesthesia
  • surgery
  • exacerbation of chronic disease
  • infections

What is the right time to seek medical help?

According to psychiatrist Alcion Svôlz Junior, Physician Assistant at HCFMRP-USP, at first, a state of confusion is really a warning sign, because it is a condition that does not express the cause itself, but is caused by some disorder that affects the functions of the brain or the organism as a whole.

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

Most of the time, people with these symptoms are seen in the emergency department by a general practitioner (general practitioner) who subsequently makes 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 and health history and will perform a physical examination. “Important data that the specialist must raise relate to the use of medications. Therefore, it is essential to have on hand the names of any drugs used,” explains geriatrician Arnaldo Aires Peixoto Junior, of HUWC-UFC.

The doctor explains that there is no specific test to diagnose mental confusion, to check possible causes of symptoms, and to check laboratory and imaging tests (such as chest X-ray, cranial CT scan, etc.) for the reasons for this picture.

Find out how the treatment works

Since there is no medication to treat symptoms, therapeutic strategies to control it are based primarily on non-pharmacological initiatives, such as prevention practices. This includes paying more attention to patients whose risk factors facilitate mental confusion, especially those who are hospitalized and are of advanced age and who have chronic illnesses or infections – which must be treated and controlled.

Another precaution is to be aware of the effects of changing medications for continued use, or even mental confusion medications on the list of side effects. In addition, it is recommended to take measures to reduce all kinds of environmental disturbances, as well as promote sleep hygiene.

In some specific cases, the doctor may consider the use of medications. This is the case for people whose mental confusion can lead to behaviors that put the life of the patient or those around him at risk.

Can it be prevented?

Yes, especially if you are not old enough. To avoid feeling overwhelmed, take the following precautions:

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

Tips for caring for people with these symptoms

Some people may experience mental confusion for a long time. It is recommended that those responsible for their care adopt certain practices to ensure their dignity and also facilitate communication and counselling. paying off:

  • Introduce yourself to the person every time you talk to them if they can’t remember who you are
  • Talk to her about everyday things
  • Explain who the other people in the home 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, draw and play memory games
  • Gentle walking and exercise should be encouraged as long as there is room to relax and rest afterward.
  • Help her with personal care like going to the bathroom, showering and getting dressed
  • It is preferable to introduce nutritious foods, reduce the supply of sodium, sugar and processed products. Swallowing status, food culture and nutritional needs should be considered. Some people will need help at feeding time to ensure they are eating enough.
  • Make sure you drink enough fluids
  • Maintain a comfortable environment, if possible with temperature control, and adequate lighting to prevent falls
  • Keep the clock and calendar on display to help them orientate the time and place
  • Make sure you have glasses and hearing aids available
  • Make sure that some personal items such as photographs, a blanket and a pillow can be taken to where the person is taken for care. These familiar items bring her comfort.

Sources: Alcion Sponsolz Juniora psychiatrist and assistant physician at HCFMRP-USP (Hospital das Clinicas, Ribeirão Preto School of Medicine, University of São Paulo); Arnaldo Ayres Peixoto Jr.geriatrician at HUWC-UFC (Walter Cantídio University Hospital, Federal University of Ceará), associated with the network Ebserh (Brazilian Hospital Services Company), Assistant Professor in the Department of Clinical Medicine at the Faculty of Medicine of the same institution; Rafael Ribeiro Spira, a neurologist and assistant physician in the emergency department of the Department of Neurology Clinic of HC-FMUSP (Hospital das Clínicas, Faculdade de Medicina da USP), collaborating member of the GNCC (Cognitive and Behavioral Neuroscience Group) from the same institution; He is also a member of the ABN (Brazilian Academy of Neurology). Medical reviewers: Alcyon Brulls Jr and Arnaldo Peixoto Jr.

References: Ramirez Echeverria MdL, Schoo C, Paul M. Delirium. [Atualizado em 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (Florida): StatPearls Publishing; January 2022 Available at https://www.ncbi.nlm.nih.gov/books/NBK470399/; Bates, Dr.; and Betts, 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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