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 problems, 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.
• Sexually transmitted infections, such as syphilis (late-stage) and 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 his or her surroundings. Fainting (syncope) is a form of brief unconsciousness. Coma is a deep, prolonged state of unconsciousness.

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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Preparing For Your Appointment