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. 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 use, 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 can cause confusion or decreased alertness include:

Infections, such as a urinary tract infection, respiratory infection, or sepsis.
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 health problems, such as alcohol use disorder (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 non-prescription medicines can cause confusion or decreased alertness. These problems may develop from:

Taking too much of a medicine (overmedicating) or taking medicines that may interact with each other. 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 a medicine or alcohol use disorder.
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.
Sexually transmitted infections, such as syphilis (late-stage) and human immunodeficiency virus (HIV).
A seizure disorder (epilepsy).
Brain tumours.

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

Do you have a problem with memory loss, confusion, or changes in how alert you feel?

Yes

Confusion, memory loss, or altered alertness

How old are you?

3 years or younger

4 to 11 years

12 years or older

Are you male or female?

Male

Female

The medical assessment of symptoms is based on the body parts you have.

If you are transgender or non-binary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

Have you had a recent head injury?

Yes

Recent head injury

Did you pass out completely (lose consciousness)?

Yes

Lost consciousness

If you are answering for someone else: Is the person unconscious now?

(If you are answering this question for yourself, say no.)

Yes

Unconscious now

Are you back to your normal level of alertness?

After passing out, it's normal to feel a little confused, weak, or light-headed when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do.

Yes

Has returned to normal after loss of consciousness

Did the loss of consciousness occur during the past 24 hours?

Yes

Loss of consciousness in past 24 hours

Could you be having symptoms of a stroke?

Yes

Symptoms of stroke

Could you be having symptoms of a heart attack?

If you're having a heart attack, there are several areas where you may feel pain or other symptoms.

Yes

Symptoms of heart attack

Has there been a decrease in how alert or aware you are or how well you can think and respond?

Yes

Decreased level of consciousness

Is this something that is part of a medical problem you already have or that you have discussed with a doctor before?

Yes

Decreased level of consciousness is typical

Is the problem:

Quickly getting worse (over minutes to hours)?

Decreased level of consciousness is quickly getting worse

Slowly getting worse (over days)?

Decreased level of consciousness is slowly getting worse

Staying about the same (not better or worse)?

Decreased level of consciousness is unchanged

Getting better?

Decreased level of consciousness is improving

Is the problem:

Getting worse?

Decreased level of consciousness is getting worse

Staying the same (not better or worse)?

Decreased level of consciousness is unchanged

Getting better?

Decreased level of consciousness is improving

Do you feel or have you recently felt confused in a way that is not normal for you?

Yes

Recent episode of confusion

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

Would you describe the problem as severe, moderate, or mild?

Severe

Severe difficulty breathing

Moderate

Moderate difficulty breathing

Mild

Mild difficulty breathing

Do you think that the confusion may be caused by poisoning or by an alcohol or drug overdose?

Yes

Possible overdose or poisoning

Have you had muscle movements that you can't control, like twitching, shaking, or other repeated motions?

Yes

One or more episodes of unexplained, purposeless, repeated body movement

Do you have epilepsy or a history of seizures?

Yes

Epilepsy or history of seizures

Are the symptoms you're having now different than your usual seizure symptoms?

Yes

Seizure symptoms not typical

Are you back to normal now and not feeling confused?

Yes

Confusion is no longer present

Confusion is still present

Have you had problems with memory loss?

Yes

Problem with memory loss

Have you had a sudden and complete loss of memory?

Yes

Sudden, complete loss of memory

Do you think that a medicine may be affecting your memory?

Think about whether the memory problems started when you began using a new medicine or a higher dose of a medicine.

Yes

Memory problems may be caused by medicine

Are you having problems with judgment or problem solving?

Yes

Problem with judgment or problem solving

Are these symptoms new?

Yes

New problem with judgment or problem solving

Are these symptoms causing problems in your daily life?

Yes

Problems with judgment or problem solving affect daily life

Have you had problems with memory loss, confusion, or alertness for more than 2 weeks?

Yes

Memory loss, confusion, or changes in alertness for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, or natural health products can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

HomeTreatment

RelatedInformation

Symptoms of a heart attack may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Light-headedness or sudden weakness.
A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Problems with memory, judgment, or problem solving include things like:

Frequently misplacing items you use often (unless you have always done this).
Getting lost while walking or driving in a place you know well.
Having more trouble with tasks you used to be able to do without difficulty, like balancing your chequebook or preparing a meal.

Confusion may range from mild to severe. A person who is confused may:

Be unable to express his or her thoughts clearly.
Have trouble solving problems and performing simple tasks.
Express firmly held but false beliefs (delusions).
See, hear, feel, smell, or taste things that are not really there (hallucinations or illusions).
Believe that others want to harm him or her (paranoia).

Symptoms of a stroke may include:

Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
Sudden vision changes.
Sudden trouble speaking.
Sudden confusion or trouble understanding simple statements.
Sudden problems with walking or balance.
A sudden, severe headache that is different from past headaches.

Many prescription and non-prescription medicines can affect your memory. A few examples are:

Antidepressants.
Antihistamines.
Medicines for bladder control problems (anticholinergics).

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you're at rest (severe difficulty breathing).

Severe trouble breathing means:

You cannot talk at all.
You have to work very hard to breathe.
You feel like you can't get enough air.
You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It's hard to talk in full sentences.
It's hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.
It's becoming hard to breathe with activity.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don't have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

HomeTreatment

RelatedInformation

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Head Injury, Age 3 and Younger

Head Injury, Age 4 and Older

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." Be sure to write down all your important numbers and keep them in a safe place.
- 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. 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:

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

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 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.
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 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?

Credits

Current as of:
July 1, 2021

Author: Healthwise Staff
Medical Review:
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Anne C. Poinier MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
E. Gregory Thompson MD - Internal Medicine
David Messenger MD

Alzheimer Society of British Columbia: First Link Dementia Helpline

The First Link® Dementia Helpline is for anyone affected by dementia, whether professionally or personally. If you have questions about Alzheimer's disease or other dementias, call the Alzheimer Society of B.C.'s First Link® Dementia Helpline for information and support (toll-free):