![]() EpidemiologyĪn observational study conducted in the emergency department found that an acutely AMS was the primary reason for the visit for about 1% of all adult patients and 2.4% of older adults. However, more frequently patients exhibit altered levels of consciousness plus cognition: for example, with delirium, a relatively common and sometimes fatal cause of AMS. 2016 Aug 34(3):649-65.įor example, patients with meningitis may have impaired consciousness (i.e., altered sensorium, decreased attentiveness) with intact cognition, whereas patients with dementia may have a normal level of consciousness with impaired cognition. Fundamentally, mental status is a combination of the patient's level of consciousness (i.e., attentiveness) and cognition (i.e., mental processes or thoughts) patients may have disorders of one or both. Given the vagueness of the term, it is imperative to understand its key components before considering a differential diagnosis. Altered mental status in older patients in the emergency department. ![]() An MRI uses nuclear magnetic resonance imaging to make high-resolution images of the brain.Altered mental status (AMS) is a general term used to describe various disorders of mental functioning ranging from slight confusion to coma. Doctors use these images to find abnormalities. A CT scan uses computers and rotating X-rays to make high-resolution images of the brain. Doctors use this imaging test to evaluate the heart and lungs. This exam measures your heart’s electrical activity (such as heart rate and rhythm). This exam uses scalp electrodes to evaluate brain activity. These tests determine the health of your liver by measuring levels of proteins, liver enzymes, or bilirubin in your blood. These blood tests measures levels of sodium, potassium, chloride, and bicarbonate. This test uses a blood or urine sample to detect the presence and levels of medications, illegal drugs, and poisons in your system. An elevated white blood cell (WBC) count indicates infections, such as meningitis or pneumonia. This blood test reveals whether you have a low hemoglobin level, which indicates anemia. In addition to your complete history and physical, the doctor may order the following tests: They’ll also ask if you have a history of abusing illegal drugs, prescription drugs, or alcohol. They’ll ask about any medications you’re taking, such as insulin or anticonvulsants. Your doctor will want to know about any medical problems you have, such as diabetes, epilepsy, or depression. If you’re in a coma, you can’t respond to any stimulus, not even pain.ĭiagnosis and treatment of decreased consciousness begins with a complete medical history and physical examination, which includes a detailed neurological evaluation. ComaĬoma is the deepest level of impaired consciousness. ![]() Stupor is a deeper level of impaired consciousness in which it’s very difficult for you to respond to any stimuli, except for pain. If you’re lethargic, you may not respond to stimulants such as the sound of an alarm clock or the presence of fire. Lethargy is a state of decreased consciousness that resembles drowsiness. People who are delirious are often highly agitated as well. Their emotional responses range from fear to anger. People who are delirious are often disoriented. If you’re delirious, your thoughts are confused and illogical. The most extreme form of disorientation is when you lose the memory of who you are. Loss of short-term memory follows disorientation with respect to place. This is followed by disorientation with respect to place, which means you may not know where you are. The next stage is being disoriented with respect to time (years, months, days). The first stage of disorientation is usually around awareness of your current surroundings Disorientationĭisorientation is the inability to understand how you relate to people, places, objects, and time. Levels of impaired consciousness include:Ĭonfusion is marked by the absence of clear thinking and may result in poor decision-making.
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