DIAGNOSTIC-APPROACH TO THE CONFUSED ELDERLY PATIENT

Confusion in the elderly patient is usually a symptom of delirium or d ementia, but it may also occur in major depression and psychoses. Unti l another cause is identified the confused patient should be assumed t o have delirium, which is often reversible with treatment of the under lying disorder. Causes of delirium include metabolic disorders, infect ions and medications. Thyroid dysfunction, vitamin deficiencies and no rmal-pressure hydrocephalus are some potentially reversible causes of dementia. Major irreversible causes include Alzheimer's disease, centr al nervous system damage and human immunodeficiency virus infection. A ll but the rarest causes of confusion can usually be identified based on the complete history, medication review, physical examination, ment al status evaluation and laboratory evaluation with longitudinal reeva luation.