Recent-Onset Altered Mental Status: Evaluation and Management

Area of Science:

• Neurology
• Internal Medicine
• Geriatrics

Background:

• Altered mental status (AMS) is a common clinical presentation, particularly in hospitalized older adults, often manifesting as delirium.
• Identifying and addressing precipitating factors is critical for managing AMS and preventing adverse outcomes.

Purpose of the Study:

• To outline the diagnostic approach and management strategies for patients presenting with altered mental status.
• To emphasize the importance of identifying and treating reversible causes of AMS to minimize morbidity and mortality.

Main Methods:

• Clinical evaluation including history and physical examination.
• Diagnostic testing such as laboratory workups, radiography, electrocardiography, neuroimaging (CT/MRI), lumbar puncture, and electroencephalography.
• Assessment of potential precipitating factors including CNS insults, infections, metabolic disturbances, toxins, medications, chronic diseases, and psychiatric conditions.

Main Results:

• A systematic approach combining clinical assessment and targeted investigations aids in identifying the etiology of AMS.
• Reversible causes are common and require prompt intervention.
• Nonpharmacologic interventions and judicious use of medications are recommended for behavioral management.

Conclusions:

• Early recognition and management of reversible causes of AMS are essential for improving patient prognosis.
• A comprehensive diagnostic workup is necessary to determine the underlying etiology of AMS.
• Preventive measures are beneficial for at-risk populations.