Altered Mental Status

What is altered mental status?

Altered mental status (AMS) is a disruption in how your brain works that causes a change in behavior. This change can happen suddenly or over days. AMS ranges from slight confusion to total disorientation and increased sleepiness to coma.

What causes AMS?

AMS can be caused by physical, psychological, and environmental factors. In older adults, AMS may be caused by a combination of these factors. The following are some of the most common causes of AMS:

  • Diseases or conditions in the body that can affect your brain and nervous system:

    • Hypoxia (low oxygen levels)

    • Low or high blood sugar levels, or diabetic ketoacidosis

    • Heart attack

    • Dehydration, low or high blood sodium levels

    • Thyroid or adrenal gland disease

    • Urinary tract infection or renal failure

  • Diseases or conditions within your skull:

    • Seizures

    • Head traumas, concussions

    • Brain tumors or strokes

    • Brain disease, such as encephalopathy

    • High altitude cerebral edema (brain tissue swelling at high altitude)

  • Other factors:

    • Burns

    • Hypothermia (low body temperature), hyperthermia (high body temperature), or heat stroke

    • Toxic plants, such as mushrooms

    • Carbon monoxide

    • Drug or alcohol withdrawal

    • Psychiatric problems

What factors increase the risk for AMS?

  • Older adults may have AMS after changes in their medicines, heart attacks, or hip fractures. Infections, such as urinary tract infections or pneumonia, can also increase the risk for AMS.

  • A medical history of high blood pressure, heart problems, diabetes, or psychiatric illness increases the risk for AMS.

What are the signs and symptoms of AMS?

You, or those close to you, will notice changes in how you think and in your awareness, movements, and routines. Some of the more common signs are:

  • Lack of concentration or forgetfulness

  • Slow responses

  • Hallucinations and changes in sleep patterns

  • Decreased or increased movement

  • Agitation or rambling speech

  • Cannot or will not follow reasonable requests

  • Cannot be aroused from sleep

How is AMS diagnosed?

Your caregiver will ask you and your family about your usual mental status. He will want know if the changes happened suddenly or over time. He will want to know about recent events, such as falls or other traumas or illnesses. He may ask witnesses about your behavior. Your caregiver will ask about the medicines you take and any problems with substance abuse. He will do a physical exam. You may also need the following tests to learn the cause of your AMS:

  • A neurological exam tells caregivers if you are having problems with your brain or nerves. During the exam, your reflexes will be tested.

  • Vital signs give caregivers information about your current health. Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. They will measure the amount of oxygen in your blood with a device called a pulse oximeter.

  • Blood tests are done to check the function of your liver, kidneys, and lungs. They will also show if you have an infection or other toxins in your body. Your blood glucose level will also be checked.

  • A chest x-ray is a picture of your lungs and heart. Caregivers use the x-ray to look for signs of infection, such as pneumonia, that could be causing your AMS.

  • A CT scan is also called a CAT scan. An x-ray machine uses a computer to take pictures of your head. The pictures may show a tumor, swelling, or bleeding on the brain.

  • A lumbar puncture is also called a spinal tap. During a lumbar puncture, you will need to lie still. Caregivers may give you medicine to numb a small area of your back. A needle will be put in and fluid will be removed from around your spinal cord. The fluid will be sent to a lab for tests. The tests check for infection, bleeding around your brain and spinal cord, or other problems.

How is AMS treated?

Treatment will depend on the cause of your AMS. Treatments with oxygen and medicines may be needed to improve your symptoms. You may be placed in the hospital if your symptoms are severe.

When should you or someone close to you contact your caregiver?

Contact your caregiver if:

  • You have sudden changes in behavior.

  • You are more sleepy or confused than usual.

  • You have questions or concerns about your condition or care.

When should you or someone close to you seek immediate care?

Seek care immediately or call 911 if:

  • Your speech is slurred or you are rambling.

  • You have a seizure.

  • You are not able to move any part of your body freely.

  • You cannot be woken up.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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