Confusion natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

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Confusion is a disturbance in mental status which develops rapidly. If untreated it develops into a stupor / coma. Confusion caused by metabolic changes can be rapidly corrected and have good prognosis compared to the one caused by underlying structural abnormalities of the brain. The mortality rate for those who developed confusion at a hospital is nearly 39% in the first year which is nearly twice compared to age matched controls.[1]

Natural History

Confusion is differentiated from similar symptoms by its rapidity of onset, which is different from dementia or depression. In hospitalized patients, certain prodromal signs may be evident. They include irritability, sleep disturbances, excessive fatigue. Detection of these early signs is important in helping to make a difference in the course of the disease. Unnoticed symptoms may lead to behavioral changes leading to a hypo active stage that can later turn into an agitated individual. In cases of poisoning or drug overdose onset of symptoms is rapid too and history of abuse or exposure is obtained. Metabolic derangement can be identified with laboratory tests and necessary precautions can be taken to avoid confusion. Undetected prodrome or rapid onset of confusion can cause severe cognitive impairment. It can progress from days to weeks depending on the underlying cause. Undetected or untreated confusion can lead to stupor/coma.


Prognosis depends on the cause of confusion.

  • Confusion due to metabolic derangement like hypoglycemia and hypokalemia can be rapidly corrected and will typically have a good prognosis.
  • Confusion due to underlying structural lesions of the brain may not have a very good prognosis.
  • Confusion caused by chemicals and poisons need a thorough assessment of the condition. Detoxification will result in a good prognosis.
  • Other underlying diseases can precipitate confusion, annd in such cases, the prognosis depends on the severity of the causative disease.
  • Some symptoms can persist as long as 6 months.[2]
  • Patients who developed confusion during a hospital stay can prolong their time in the hospital.


  1. Inouye SK, Charpentier PA (1996). "Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability". JAMA. 275 (11): 852–7. PMID 8596223. Unknown parameter |month= ignored (help)
  2. Francis J, Martin D, Kapoor WN (1990). "A prospective study of delirium in hospitalized elderly". JAMA. 263 (8): 1097–101. PMID 2299782. Unknown parameter |month= ignored (help)

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