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Confusion, Memory Loss, and Altered Alertness

Topic Overview

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 they 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 behaviour. 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 car crash. 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:

Alcohol and many prescription and non-prescription 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:

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 not aware of his or her surroundings. Fainting (syncope) is a form of brief unconsciousness. Coma is a deep, prolonged state of unconsciousness.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Home Treatment

As you age, it is normal to experience some memory lapses. Usually, an occasional memory lapse does not mean 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 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 non-prescription medicines and dosages with your doctor 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 doctors, make sure that they all know what other medicines you are taking. Have all of your prescriptions filled at the same pharmacy. Ask your doctor or pharmacist whether the combination of your medicines could cause problems.

Ginkgo biloba is a popular herbal treatment for memory problems. But studies have not shown that ginkgo biloba helps improve memory or prevent dementia.1 Before you use any treatment for a memory problem, discuss the potential risks and benefits of the treatment with your doctor.

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

Call your doctor if any of the following occur during home treatment:

Prevention

You can sometimes reduce the impact of age-related memory problems. The saying "use it or lose it" applies to your memory. Your best defence 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 Smoking.
  • 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 non-prescription 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 millimetres 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.
  • 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 travelling 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.

Preparing For Your Appointment

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

You can help your doctor 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 non-prescription 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 travelled outside of Canada?
  • 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?

References

Citations

  1. Birks J, Grimley Evans J (2009). Ginkgo biloba for cognitive impairment and dementia. Cochrane Database of Systematic Reviews (1).

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer H. Michael O'Connor, MD - Emergency Medicine
Last Revised March 18, 2011

Last Revised: March 18, 2011

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & H. Michael O'Connor, MD - Emergency Medicine

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