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Confusion, Memory Loss, and Altered Alertness
Overview
It's not unusual to sometimes forget where you put your keys or glasses. Or maybe you forget 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 these changes can be a normal part of aging. This type of memory problem is more often annoying than serious.
Memory loss that starts suddenly or that clearly interferes with how well you can function in daily life may be a sign of a more serious problem.
- Dementia is a slow decline in memory, problem-solving ability, learning ability, and judgment. It may occur over several weeks to several months. Many health conditions can cause dementia or symptoms like it. Alzheimer's disease is the most common cause of dementia in people older than 65.
- Delirium is a sudden change in how well a person's brain is working (mental status). It can cause confusion, changes in the sleep-wake cycles, and unusual behavior. It can have many causes. One cause is withdrawal from alcohol or drugs or medicines. It can also be caused by an infection or other health problem that starts or gets worse.
- Amnesia is memory loss that may be caused by a head injury, a stroke, or substance abuse. It can also be caused by a severe emotional event, such as from combat or a car crash. Amnesia may be either short-term or permanent. It depends on what caused it.
Confusion or decreased alertness may be the first symptom of a serious illness. This happens most in older adults. Health problems that can cause it include:
- Infections. Examples are urinary tract infections, respiratory infections, and sepsis.
- Alzheimer's disease.
- Asthma or COPD. They cause a decrease in the amount of oxygen or an increase in the amount of carbon dioxide in the blood.
- Cardiac problems that reduce blood flow. Examples are heart failure, coronary artery disease, and irregular heartbeats (arrhythmias).
- Problems from diabetes.
- Kidney or liver failure. They cause high levels of toxins to build up in the blood.
- Malnutrition and vitamin deficiencies caused by health problems. One example is alcohol use disorder (Wernicke-Korsakoff syndrome).
- Mental health conditions, such as depression or schizophrenia.
- Thyroid problems. These include hypothyroidism, myxedema coma, and hyperthyroidism.
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 that often affects older adults, who may take many medicines at the same time.
- Misusing a medicine or alcohol use disorder.
- Drug intoxication or the effects of withdrawal.
Other causes of confusion or decreased alertness can include:
- A head injury.
- Decreased or blocked blood flow to the brain. This may occur during a transient ischemic attack (TIA) or a stroke.
- Infection, such as a brain abscess, encephalitis, meningitis, or sepsis. It can also include sexually transmitted infections (STIs), such as syphilis (late-stage).
- Human immunodeficiency virus (HIV).
- A seizure disorder (epilepsy).
- Brain tumors.
Conditions in the environment that can cause changes in the level of consciousness include:
- Cold temperature exposure. It can lead to hypothermia.
- High temperature exposure. It can lead to heatstroke.
- Hospitalization. This often 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 there are other symptoms, such as a fever, chest pain, or not being able to walk or stand. It's important to look for and tell your doctor about other symptoms you have when confusion or decreased alertness occurs. This can help your doctor find the cause of your symptoms.
A decrease in alertness may progress to loss of consciousness. A person who loses consciousness isn't awake or aware of their surroundings. Fainting (syncope) is a form of brief unconsciousness. Coma is a deep, prolonged state of unconsciousness.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
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, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or 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.
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.
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.
For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.
Problems with memory, judgment, or problem solving include things like:
- Frequently misplacing items you use often (unless you have always done this).
- Getting lost while walking or driving in a place you know well.
- Having more trouble with tasks you used to be able to do without difficulty, like balancing your checkbook or preparing a meal.
Confusion may range from mild to severe. A person who is confused may:
- Be unable to express his or her thoughts clearly.
- Have trouble solving problems and performing simple tasks.
- Express firmly held but false beliefs (delusions).
- See, hear, feel, smell, or taste things that are not really there (hallucinations or illusions).
- Believe that others want to harm him or her (paranoia).
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.
Many prescription and nonprescription medicines can affect your memory. A few examples are:
- Antidepressants.
- Antihistamines.
- Medicines for bladder control problems (anticholinergics).
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).
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.
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.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
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.
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.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Self-Care
Caring for yourself when you have memory loss
As you age, it's normal to have some memory lapses. In most cases, having a memory lapse now and then doesn't mean that 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, clocks, or a phone app.
- Use lists, notes, and other helpful devices as reminders.
- Write your daily activities on a calendar, a planner, or in your phone. 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. Hang your keys from it every time you come in.
- Try memory tricks.
- To remember a person's name, repeat it several times after you are 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 passwords. Keep them in a safe place or use a password manager app in your phone.
- Retrace your steps if you can't remember why you went into a room.
- Find ways to reduce your stress. Being stressed can impair your memory.
- Review all of your medicines and dosages with your doctor or pharmacist.
- Ask about medicines that by themselves or in combination with other medicines can cause mental confusion.
- Be aware that confusion may occur when medicines interact in your body.
- Make sure that all of your doctors know what other medicines you take.
- Have all of your prescriptions filled at the same pharmacy.
- Ask your doctor or pharmacist if the combination of your medicines could cause problems.
- Talk to your doctor before you use any treatment for a memory problem.
Caring for someone who has memory loss
Caring for someone who has dementia or who has a decline in memory, problem-solving ability, learning ability, or judgment is hard. Use these tips to help with their health and safety.
- Give the person short instructions when teaching a new task.
- Break tasks down into simple steps.
- Give the person written instructions, if you think it helps.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- New or worse loss of function or confusion.
- Decreasing alertness.
- New or worse memory loss.
- Symptoms occur more often or are more severe.
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Credits
Current as of: September 25, 2023
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.