Health Library Confusion, Memory Loss, and Altered AlertnessFrom Healthwise

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 it 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 cause confusion or decreased alertness can include:

• Alzheimer's disease.
• Asthma or COPD, which cause a decrease in the amount of oxygen or an increase in the amount of carbon dioxide in the blood.
• Cardiac problems, such as heart failure, coronary artery disease, or irregular heartbeats (arrhythmias), that reduce blood flow.
• Problems from diabetes.
• Kidney or liver failure, which causes high levels of toxins to build up in the blood.
• Malnutrition and vitamin deficiencies caused by problems, such as long-term alcoholism (Wernicke-Korsakoff syndrome).
• Mental health problems, such as depression or schizophrenia.
• Thyroid problems, such as hypothyroidism, myxedema coma, or 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). 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:

• 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.
• Reye's syndrome (in people age 20 or younger).
• 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, 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 unaware of his or her surroundings. Fainting ( syncope) is a form of brief unconsciousness. Coma is a deep, prolonged state of unconsciousness.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Unconsciousness or inability to respond to touch or voice (unresponsive)
• Sudden decreased level of consciousness lasting longer than 1 minute
• Signs of shock
• Moderate to severe difficulty breathing
• Sudden memory loss, confusion, or decreased alertness with any of the following symptoms:
  • Signs of a stroke
  • Chest pain, particularly if it is crushing or squeezing, that feels like a heavy weight on the chest, or occurs with any other symptoms of a heart attack
  • Heart rate changes and irregular heartbeats (arrhythmia), particularly if your pulse rate is less than 50 beats per minute or more than 150 beats per minute. To check your heart rate, see taking a pulse.
  • Skin changes such as hot, dry, red or flushed skin, even under the armpits.
  • Tiny purple or red spots (petechiae) or small bruises ( purpura) on the skin.
  • Fear of dying or a sense of impending doom
• Confusion or decreased alertness after swallowing, breathing, or injecting an illegal drug or any other potentially poisonous substance

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• A head injury: Go to the topic Head Injury, Age 4 and Older.
• Cold temperature exposure: Go to the topic Cold Temperature Exposure.
• A headache: Go to the topic Headaches.
• Heat exposure: Go to the topic Heat-Related Illness.
• Seizure: Go to the topic Seizures.
• Symptom of poisoning: Go to the topic Poisoning.

	Yes	Have you had a recent episode of confusion, decreased alertness, or extreme sleepiness?
When to See a Doctor See significance of temporary confusion or decreased alertness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had a change in your mental state, such as a period of confusion? Yes Have you had a brief (2 seconds to 1 minute) unexplained episode of decreased alertness? Yes Have you had one or more episodes of unexplained, purposeless, repeated body movement? Yes Do you feel depressed, and you have not moved, talked, or responded normally to touch or voice for hours or days? Yes Do you have decreased alertness and diabetes? Yes Do you have decreased alertness and a severe headache? Yes Do you have decreased alertness and a stiff neck? Yes Do you have decreased alertness and shaking chills? Yes Do you have decreased alertness and new, tiny purple or red spots on your skin (petechiae)? Yes Do you have decreased alertness and a sudden increase in bruises (purpura)? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a seizure disorder and have you had one or more episodes of unexplained, purposeless, repeated body movement that is different than your usual seizure symptoms? Yes Are you very sleepy or hard to wake up but do not have any other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you fainted (temporary loss of consciousness)?
When to See a Doctor See significance of fainting (temporary loss of consciousness) if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you fainted more than 1 time when trying to stand up? Yes Do you also have coronary artery disease, heart failure, or a history of an irregular heartbeat (arrhythmia)? Yes Do you also have high blood pressure or a history of stroke or transient ischemic attack (TIA)? Yes Do you continue to feel lightheaded after fainting? Call your health professional today if you answer "Yes" to the following question. Yes Did you faint, but you are now fully alert without other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your symptoms may be caused by alcohol or drugs?
When to See a Doctor See the significance of alcohol or drugs if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Are you having severe withdrawal symptoms? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you recognize your need for help and are you willing to be evaluated for possible treatment? Yes Do you continue to use alcohol or drugs after completing a treatment program (relapsed)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your symptoms may be caused by a medicine?
When to See a Doctor See significance of a medicine if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If your answer to any of the questions below is "yes": Call the health professional who prescribed the medicine today. He or she can determine whether you should stop taking the medicine or take a different one. An appointment may or may not be needed. If you are taking nonprescription medicine, stop taking the medicine. Call your health professional if you feel you need to continue taking the medicine or if you need help to control your symptoms after you stop taking the medicine. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you think that a medicine is causing you to feel confused? Yes Do you think that a medicine is causing decreased alertness? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you think that a medicine is causing memory loss? Yes Did you experience confusion or decreased alertness after you began taking a new medicine, but you feel fine now? Yes Did confusion or decreased alertness start after you stopped taking a medicine? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you having problems with memory, judgment, or problem solving?
When to See a Doctor See significance of problems with memory, judgment, or problem solving if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Have you had a sudden complete loss of memory (amnesia)? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Are you having ongoing or a gradually increasing difficulty with daily tasks, such as getting dressed, preparing a meal, or shopping? Yes Do you find that it is increasingly difficult to learn and remember new information? Yes Do you frequently forget recent events or appointments or have difficulty remembering familiar information? Yes Do you frequently get lost when walking or driving to familiar places? Yes Do you frequently misplace things? Yes Are you having an ongoing or a gradually increasing difficulty handling complex but familiar tasks, such as balancing your checkbook? Yes Are you having an ongoing or a gradually increasing difficulty knowing what to do when problems occur, such as knowing what to do if the bathroom floods? Yes Do you often show poor judgment, such as unsafe or rude behavior or conversation? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Dizziness, lightheadedness, or vertigo: Go to the topic Dizziness: Lightheadedness and Vertigo.
• Fever: Go to the topic Fever, Age 4 and Older.
• Weakness or fatigue: Go to the topic Weakness and Fatigue.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

As you age, it is normal to experience some memory lapses. Usually, an occasional memory lapse does not mean you have a serious problem. The following are some steps you can take to 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.” Use the same PIN number for all of your accounts, if possible.
  • 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 health professional 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 health professionals, make sure that they all know what other medicines you are taking. Have all of your prescriptions filled at the same pharmacy. Ask your health professional or pharmacist whether the combination of your medicines could cause problems.

Ginkgo biloba is a popular herbal treatment for memory problems. Before using any treatment for a memory problem, discuss the potential risks and benefits of the treatment with your health professional.

Living with a family member who has a decline in memory, problem-solving ability, learning ability, or judgment (dementia) is difficult. 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

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment.

• Loss of function, confusion, or decreasing alertness develops.
• A memory problem develops.
• Symptoms become more frequent or severe.

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 Tobacco Use.
• 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 (Hypertension).
• 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.

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

You can help your health professional 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?

• Alcohol Abuse and Dependence
• Alcohol and Drug Problems
• Alzheimer's Disease
• Carbon Monoxide Poisoning
• Caregiver Tips
• Change in Heartbeat
• Cold Temperature Exposure
• Dealing With Emergencies
• Dehydration
• Depression
• Dizziness: Lightheadedness and Vertigo
• Encephalitis
• Fever, Age 4 and Older
• Head Injury, Age 4 and Older
• Headaches
• Heat-Related Illnesses
• Multiple Sclerosis (MS)
• Nervous System Problems
• Parkinson's Disease
• Reye's Syndrome
• Seizures
• Stroke
• Transient Ischemic Attack (TIA)

Author:	Jan Nissl, RN, BS	Last Updated: February 27, 2007
Medical Review:	William M. Green, MD - Emergency Medicine Colin Chalk, MD, CM, FRCPC - Neurology
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