Confusion pathophysiology

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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]


Confusion results from global impairment of brain functions. Some areas of the brain are identified for various presentations of confusion. Drugs, poisons, and chemicals interact with the neurotransmitters and can cause confusion. Inflammatory agents are involved in conditions such as a fever.


Confusion is a commonly used term for any kind of altered mental status, inability to pay attention or to making decisions. Confusion is seen in various conditions and caused by many drugs, poisons, and chemicals. Various theories are postulated for the development of confusion.

  • Lesions involving the ascending reticular activating system causes disturbances in arousal.
  • Lesions of the cortex will cause disturbances in the insight and judgement capacity of the individual.

Delirium is a type of confusional state which develops suddenly and causes rapid changes in brain function.

  • Disturbances in the global function of the brain leads to delirium.
  • Certain diseases and strokes cause confusion. There is evidence to support a sub cortical mechanism for confusion.[1]
  • Certain drugs have anticholinergic properties which can impair brain function in elderly people and when used in high doses.[2]
  • In certain conditions, post surgical recovery states can induce cytokine activation, which may be the cause for confusion.
  • Certain metabolic states like hypoglycemia, electrolyte abnormalities, and hypoxia cause global brain dysfunction leading to confusion.


  1. Trzepacz PT (1994). "The neuropathogenesis of delirium. A need to focus our research". Psychosomatics. 35 (4): 374–91. doi:10.1016/S0033-3182(94)71759-X. PMID 7916159.
  2. Mach JR, Dysken MW, Kuskowski M, Richelson E, Holden L, Jilk KM (1995). "Serum anticholinergic activity in hospitalized older persons with delirium: a preliminary study". J Am Geriatr Soc. 43 (5): 491–5. PMID 7730529. Unknown parameter |month= ignored (help)

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