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    Confusion, Memory Loss, and Altered Alertness

    Confusion, Memory Loss, and Altered Alertness

    Topic Overview

    It is not unusual to occasionally forget where you put your keys or glasses, where you parked your car, or the name of an acquaintance. As you age, it may take you longer to remember things. Not all older adults have memory changes, but they can be a normal part of aging. This type of memory problem is more often annoying than serious.

    Memory loss that begins suddenly or that significantly interferes with your ability to function in daily life may mean a more serious problem is present.

    • Dementia is a slow decline in memory, problem-solving ability, learning ability, and judgment that may occur over several weeks to several months. Many health conditions can cause dementia or symptoms similar to dementia. In some cases dementia may be reversible. Alzheimer's disease is the most common cause of dementia in people older than age 65.
    • Delirium is a sudden change in how well a person's brain is working (mental status). Delirium can cause confusion, change the sleep-wake cycles, and cause unusual behavior. Delirium can have many causes, such as withdrawal from alcohol or drugs or medicines, or the development or worsening of an infection or other health problem.
    • Amnesia is memory loss that may be caused by a head injury, a stroke, substance abuse, or a severe emotional event, such as from combat or a motor vehicle accident. Depending upon the cause, amnesia may be either temporary or permanent.

    Confusion or decreased alertness may be the first symptom of a serious illness, particularly in older adults. Health problems that can cause confusion or decreased alertness include:

    Alcohol and many prescription and nonprescription medicines can cause confusion or decreased alertness. These problems may develop from:

    • Taking too much of a medicine (overmedicating) or taking medicines that may interact with each other. Overuse of medicines may be the single biggest cause of memory loss or confusion in older adults.
    • Alcohol and medicine interactions. This is a problem, especially for older adults, who may take many medicines at the same time.
    • Misusing or abusing a medicine or alcohol.
    • Drug intoxication or the effects of withdrawal.

    Other causes of confusion or decreased alertness can include:

    Conditions in the environment that can cause changes in the level of consciousness include:

    • Cold temperature exposure, leading to hypothermia.
    • High temperature exposure, leading to heatstroke .
    • Hospitalization. This especially affects older adults when their environment and routines are changed.
    • Decreased oxygen in the blood (hypoxia) from high altitude.
    • Exposure to toxins (poisons), such as carbon monoxide .

    Many times other symptoms are present, such as a fever, chest pain, or the inability to walk or stand. It is important to look for and tell your doctor about other symptoms you experience when confusion or decreased alertness occurs. This can help your doctor determine the cause of your symptoms.

    A decrease in alertness may progress to loss of consciousness . A person who loses consciousness is not awake and is not aware of his or her surroundings. Fainting ( syncope ) is a form of brief unconsciousness. Coma is a deep, prolonged state of unconsciousness.

    Check your symptoms to decide if and when you should see a doctor.

    Check Your Symptoms

    Do you have a problem with memory loss, confusion, or changes in how alert you feel?
    Yes
    Confusion, memory loss, or altered alertness
    No
    Confusion, memory loss, or altered alertness
    How old are you?
    3 years or younger
    3 years or younger
    4 to 11 years
    4 to 11 years
    12 years or older
    12 years or older
    Are you male or female?
    Male
    Male
    Female
    Female
    Have you had a recent head injury?
    Yes
    Recent head injury
    No
    Recent head injury
    Did you pass out completely (lose consciousness)?
    Yes
    Lost consciousness
    No
    Lost consciousness
    If you are answering for someone else: Is the person unconscious now?
    (If you are answering this question for yourself, say no.)
    Yes
    Unconscious now
    No
    Unconscious now
    Are you back to your normal level of alertness?
    After passing out, it's normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.
    Yes
    Has returned to normal after loss of consciousness
    No
    Has returned to normal after loss of consciousness
    Did the loss of consciousness occur during the past 24 hours?
    Yes
    Loss of consciousness in past 24 hours
    No
    Loss of consciousness in past 24 hours
    Could you be having symptoms of a stroke?
    Yes
    Symptoms of stroke
    No
    Symptoms of stroke
    Could you be having symptoms of a heart attack?
    If you're having a heart attack, there are several areas where you may feel pain or other symptoms.
    Yes
    Symptoms of heart attack
    No
    Symptoms of heart attack
    Has there been a decrease in how alert or aware you are or how well you can think and respond?
    Yes
    Decreased level of consciousness
    No
    Decreased level of consciousness
    Is this something that is part of a medical problem you already have or that you have discussed with a doctor before?
    Yes
    Decreased level of consciousness is typical
    No
    Decreased level of consciousness is typical
    Is the problem:
    Quickly getting worse (over minutes to hours)?
    Decreased level of consciousness is quickly getting worse
    Slowly getting worse (over days)?
    Decreased level of consciousness is slowly getting worse
    Staying about the same (not better or worse)?
    Decreased level of consciousness is unchanged
    Getting better?
    Decreased level of consciousness is improving
    Is the problem:
    Getting worse?
    Decreased level of consciousness is getting worse
    Staying the same (not better or worse)?
    Decreased level of consciousness is unchanged
    Getting better?
    Decreased level of consciousness is improving
    Do you feel or have you recently felt confused in a way that is not normal for you?
    Yes
    Recent episode of confusion
    No
    Recent episode of confusion
    Are you having trouble breathing (more than a stuffy nose)?
    Yes
    Difficulty breathing more than a stuffy nose
    No
    Difficulty breathing more than a stuffy nose
    Would you describe the problem as severe, moderate, or mild?
    Severe
    Severe difficulty breathing
    Moderate
    Moderate difficulty breathing
    Mild
    Mild difficulty breathing
    Do you think that the confusion may be caused by poisoning or by an alcohol or drug overdose?
    Yes
    Possible overdose or poisoning
    No
    Possible overdose or poisoning
    Have you had muscle movements that you can't control, like twitching, shaking, or other repeated motions?
    Yes
    One or more episodes of unexplained, purposeless, repeated body movement
    No
    One or more episodes of unexplained, purposeless, repeated body movement
    Do you have epilepsy or a history of seizures?
    Yes
    Epilepsy or history of seizures
    No
    Epilepsy or history of seizures
    Are the symptoms you're having now different than your usual seizure symptoms?
    Yes
    Seizure symptoms not typical
    No
    Seizure symptoms not typical
    Are you back to normal now and not feeling confused?
    Yes
    Confusion is no longer present
    No
    Confusion is still present
    Yes
    Problem with memory loss
    No
    Problem with memory loss
    Have you had a sudden and complete loss of memory?
    Yes
    Sudden, complete loss of memory
    No
    Sudden, complete loss of memory
    Do you think that a medicine may be affecting your memory?
    Think about whether the memory problems started when you began using a new medicine or a higher dose of a medicine.
    Yes
    Memory problems may be caused by medicine
    No
    Memory problems may be caused by medicine
    Yes
    Problem with judgment or problem solving
    No
    Problem with judgment or problem solving
    Are these symptoms new?
    Yes
    New problem with judgment or problem solving
    No
    New problem with judgment or problem solving
    Arethesesymptomscausingproblems inyourdailylife?
    Yes
    Problems with judgment or problem solving affect daily life
    No
    Problems with judgment or problem solving affect daily life
    Have you had problems with memory loss, confusion, or alertness for more than 2 weeks?
    Yes
    Memory loss, confusion, or changes in alertness for more than 2 weeks
    No
    Memory loss, confusion, or changes in alertness for more than 2 weeks

    Try Home Treatment

    You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

    • Try home treatment to relieve the symptoms.
    • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
    Head Injury, Age 4 and Older

    Many prescription and nonprescription medicines can affect your memory. A few examples are:

    • Antidepressants.
    • Antihistamines.
    • Medicines for bladder control problems (anticholinergics).
    Head Injury, Age 3 and Younger

    Make an Appointment

    Based on your answers, the problem may not improve without medical care.

    • Make an appointment to see your doctor in the next 1 to 2 weeks.
    • If appropriate, try home treatment while you are waiting for the appointment.
    • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

    Seek Care Now

    Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

    • Call your doctor now to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care in the next hour.
    • You do not need to call an ambulance unless:
      • You cannot travel safely either by driving yourself or by having someone else drive you.
      • You are in an area where heavy traffic or other problems may slow you down.

    Seek Care Today

    Based on your answers, you may need care soon. The problem probably will not get better without medical care.

    • Call your doctor today to discuss the symptoms and arrange for care.
    • If you cannot reach your doctor or you don't have one, seek care today.
    • If it is evening, watch the symptoms and seek care in the morning.
    • If the symptoms get worse, seek care sooner.

    Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

    • Your age. Babies and older adults tend to get sicker quicker.
    • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
    • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
    • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
    • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or other emergency services now.

    Symptoms of a stroke may include:

    • Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
    • Sudden vision changes.
    • Sudden trouble speaking.
    • Sudden confusion or trouble understanding simple statements.
    • Sudden problems with walking or balance.
    • A sudden, severe headache that is different from past headaches.

    Symptoms of a heart attack may include:

    • Chest pain or pressure, or a strange feeling in the chest.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
    • Lightheadedness or sudden weakness.
    • A fast or irregular heartbeat.

    The more of these symptoms you have, the more likely it is that you're having a heart attack. Chest pain or pressure is the most common symptom, but some people, especially women, may not notice it as much as other symptoms. You may not have chest pain at all but instead have shortness of breath, nausea, numbness, tingling, or a strange feeling in your chest or other areas.

    Severe trouble breathing means:

    • You cannot talk at all.
    • You have to work very hard to breathe.
    • You feel like you can't get enough air.
    • You do not feel alert or cannot think clearly.

    Moderate trouble breathing means:

    • It's hard to talk in full sentences.
    • It's hard to breathe with activity.

    Mild trouble breathing means:

    • You feel a little out of breath but can still talk.
    • It's becoming hard to breathe with activity.

    Symptoms of difficulty breathing can range from mild to severe. For example:

    • You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
    • It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you?re at rest (severe difficulty breathing).

    Call 911 Now

    Based on your answers, you need emergency care.

    Call 911 or other emergency services now.

    After you call 911 , the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

    Problems with memory, judgment, or problem solving include things like:

    • Frequently misplacing items you use often (unless you have always done this).
    • Gettinglostwhilewalkingordrivingina place you know well.
    • Havingmoretrouble with tasks you used to be able to do without difficulty, like balancing your checkbook or preparing a meal.

    Home Treatment

    As you age, it is normal to experience some memory lapses. Usually, an occasional memory lapse does not mean you have a serious problem. Try these steps to help improve your memory:

    • Focus your attention. Often forgetfulness may mean that you have too much on your mind. Slow down and pay full attention to the task you are doing now.
    • Stick to a routine. Complete common tasks in the same order each time you do them.
    • Structure your environment to help improve your memory.
      • Use calendars and clocks.
      • Use lists, notes, and other helpful devices as reminders.
      • Write your daily activities on a calendar or daily planner, and keep it in a place where you can see it easily.
      • Store easy-to-lose items in the same place each time after you use them. For example, install a hook by the door and hang your keys from it every time you come in.
    • Try memory tricks, such as the following:
      • To remember a person's name, repeat it several times after being introduced.
      • To recall numbers, group them and then relate them to a date or story. For example, if your personal identification number (PIN) is 2040, remember it with the phrase "20 plus 20 equals 40." Be sure to write down all your important numbers and keep them in a safe place.
      • Retrace your steps if you can't remember why you went into a room.
    • Reduce your stress. Being anxious can impair your memory. For more information, see the topic Stress Management.
    • Review all your prescription and nonprescription medicines and dosages with your doctor or pharmacist. Many medicines, by themselves or in combination with other medicines, can cause mental confusion. Also, confusion may occur when medicines interact in your body. If you see several doctors, make sure that they all know what other medicines you are taking. Have all of your prescriptions filled at the same pharmacy. Ask your doctor or pharmacist whether the combination of your medicines could cause problems.

    Ginkgo biloba is a popular herbal treatment for memory problems. But studies have not shown that ginkgo biloba helps improve memory or prevent dementia. 1 Before you use any treatment for a memory problem, discuss the potential risks and benefits of the treatment with your doctor.

    Living with a family member who has a decline in memory, problem-solving ability, learning ability, or judgment ( dementia ) is hard. To ensure your family member's health and safety, give him or her short instructions when teaching a new task. Break the task down into simple steps. You may find it helpful to give the person written instructions.

    Symptoms to watch for during home treatment

    Call your doctor if any of the following occur during home treatment:

    Prevention

    You can sometimes reduce the impact of age-related memory problems. The saying "use it or lose it" applies to your memory. Your best defense against a memory problem is to stay healthy and fit.

    • Eat a balanced diet . A balanced, low-fat diet with ample sources of vitamins B12 and folate will help protect your nervous system .
    • Drink plenty of water. This helps to prevent dehydration , which can cause confusion and memory problems. For more information, see the topic Dehydration.
    • Get plenty of rest. Being tired can impair your memory.
    • Do not smoke or use other tobacco products. Tobacco products decrease blood flow to the brain, raise blood pressure, and increase your risk of stroke. For more information, see the topic Quitting Smoking.
    • Exercise regularly. Regular exercise can improve the blood flow to your brain. For more information, see the topic Fitness.
    • Reduce your stress. Being anxious can impair your memory. For more information, see the topic Stress Management.
    • Socialize with family and friends. Research has shown that people who regularly get together with family or friends are less likely to lose mental function. Socializing also helps you stay connected with your community.
    • Try to learn new things. This may help increase your attention span and ability to focus.
    • Play stimulating mind games, such as Scrabble, or do a crossword puzzle or word jumble.
    • Limit your alcohol intake, and do not use illegal drugs such as cocaine, crack, or amphetamines. For more information, see the topic Alcohol and Drug Problems.
    • Decrease your use of nonprescription medicines. Overuse of medicines may be the single biggest cause of memory loss or confusion in older adults.
    • Keep your blood pressure at or below 130/85 millimeters of mercury (mm Hg). Untreated high blood pressure can cause memory problems and affect problem-solving abilities. If you have been diagnosed with high blood pressure, take your medicines as directed. For more information, see the topic High Blood Pressure.
    • Seek treatment for depression if you think that you may be depressed. Memory loss may be a symptom of depression. For more information, see the topic Feeling Depressed.

    Prevent accidents and injuries that might lead to memory problems.

    • Wear your seat belt when you are traveling in a motor vehicle.
    • Do not use alcohol or other drugs before participating in sports or when operating an automobile or other equipment.
    • Wear a helmet and other protective clothing whenever you are biking, motorcycling, skating, skate boarding, kayaking, horseback riding, skiing, snowboarding, or rock climbing.
    • Wear a hard hat if you work in a construction job or in an industrial area.
    • Do not dive into shallow or unfamiliar water.
    • Prevent falls in your home by removing hazards that might cause a fall.
    • Do not keep firearms in your home. If you must keep firearms, lock them up and store them unloaded and uncocked. Lock ammunition in a separate area.

    Preparing For Your Appointment

    To prepare for your appointment, see the topic Making the Most of Your Appointment.

    You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

    • What are your symptoms?
      • When did they begin?
      • Did they begin suddenly or come on gradually?
      • Do your symptoms fluctuate or come and go?
    • Do you have other symptoms with the confusion, memory loss, or decreased alertness?
    • Have you had these symptoms before? If so, what was the diagnosis? When and how were your symptoms treated?
    • Are you on a special diet? What do you eat for breakfast, lunch, and dinner?
    • Have you had any recent head injuries?
    • What prescription or nonprescription medicines do you take? Bring a complete list of all your medicines to your appointment.
    • Do you often feel extremely sleepy during the day?
    • Have you or another family member ever had a mental health problem, such as depression or an anxiety disorder ?
    • Have any of your family members been diagnosed with a disease that causes confusion or memory loss, such as Alzheimer's disease or Huntington's disease ?
    • Have you been ill or hospitalized recently?
    • Have you recently traveled outside of the United States?
    • How much alcohol do you drink? How often? When did you have your last drink?
    • Do you use any illegal drugs? If so, which ones? How often? When did you last use drugs? Do you swallow, inhale, or inject the drugs?
    • Do you have any health risks?

    References

    Citations

    1. Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).

    Credits

    By Healthwise Staff
    Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
    Specialist Medical Reviewer David Messenger, MD
    Last Revised July 31, 2013

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