Altered mental status classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]


Altered mental status is a common chief complaint among older emergency department (ED) patients. Despite the frequency of this complaint, the term “altered mental status” is vague and has several synonyms such as confusion, not acting right, altered behavior, generalized weakness, lethargy, agitation, psychosis, disorientation, inappropriate behavior, inattention, and hallucination. Such lack of standardized terminology not only hinders the assessment and appropriate management of patients with altered mental status.


Scales and terms to classify the levels of consciousness differ, but in general, reduction in response to stimuli indicates an altered level of consciousness:

Levels of consciousness
Level Summary Description
Conscious Normal Assessment of LOC involves checking orientation: people who are able promptly and spontaneously to state their name, location, and the date or time are said to be oriented to self, place, and time, or "oriented X3".[1] A normal sleep stage from which a person is easily awakened is also considered a normal level of consciousness. "Clouding of consciousness" is a term for a mild alteration of consciousness with alterations in attention and wakefulness.
Hyperalert Increased arousal and hypersensitivity Heightened arousal with hypersensitivity to immediate surroundings. Verbally and physically threatening, restless, aggressive[2]
Confusion Disoriented; impaired thinking and responses People who do not respond quickly with information about their name, location, and the time are considered "obtuse" or "confused".[1] A confused person may be bewildered, disoriented, and have difficulty following instructions. The person may have slow thinking and possible memory time loss. This could be caused by sleep deprivation, malnutrition, allergies, environmental pollution, drugs (prescription and nonprescription), and infection.
Delirious Disoriented; restlessness, hallucinations, sometimes delusions Some scales have "delirious" below this level, in which a person may be restless or agitated and exhibit a marked deficit in attention.
Lethargy Reduced activity Reduced alertness with minimum interest in the surrounding.[3]
Somnolent Sleepy A somnolent person shows excessive drowsiness and responds to stimuli only with incoherent mumbles or disorganized movements.[1]
obtundation Decreased alertness; slowed psychomotor responses In obtundation, a person has a decreased interest in their surroundings, slowed responses, and sleepiness.
Stupor Sleep-like state (not unconscious); little/no spontaneous activity People with an even lower level of consciousness, stupor, only respond by grimacing or drawing away from painful stimuli.[1] Stupors person can only be aroused by repeated and forceful stimuli, however they never attain their baseline level.[4]
Coma Cannot be aroused; no response to stimuli Comatose people do not have response to stimuli, have no corneal or gag reflex, and they may have no pupillary response to light.[1]


  1. 1.0 1.1 1.2 1.3 1.4 Kruse MJ (1986). Nursing the Neurological and Neurotrauma Patient. Totowa, N.J: Rowman & Allanheld. pp. 57&ndash, 58. ISBN 0-8476-7451-7.
  2. "Clinical Review: Delirium in older people".
  3. "". External link in |title= (help)
  4. "Clinical policy for the initial approach to pa... [Ann Emerg Med. 1999] - PubMed - NCBI".