Neuropsychological findings in toxicometabolic confusional states

Patients with acute confusional states display impaired attention and memory with difficulty following complex verbal commands. In addition to these deficits, we have observed a selective impairment in spatial thinking similar to that present following right-hemisphere lesions. Consequently, we compared patients with acute confusional states (CS) to patients with focal right-hemisphere disease (RHD) and controls on a standard neuropsychological battery. Although impaired relative to controls, both CS and RHD groups did not differ from each other on those tests typically associated with right-hemisphere lesions. These included performance IQ, constructional praxis, spatial judgment, and cancellation tasks. In light of these findings, the neurological correlates of selective deficits in spatial processes include not only unilateral right-hemisphere lesions, but also diffuse disorders such as CS. Thus, there is the potential to misinterpret the neuropsychological test results of patients with diffuse cerebral disorders as indicating focal abnormalities when none exist.