ACUTE

RAPIUDDIN CONFUSION
WASIS UDAYA AL STATE
Department of Internal
Medicine
Medical Faculty
Hasanuddin University
Makassar 2010
 INTRODUCTION
 Acute & fluctuative
Acute cognitive changes
Confusional  Decreased
State concentration
 Decreased awareness
 Speech impairment
 Sleep disturbance
 Hallucination and
delusion
 INTRODUCTION

Acute Confusional Hipocrates  2000

State years ago

“Geriatric
Giant”
Fig 1. Hipocrates
 INTRODUCTION

Acute Confusional State

 1-2% of general population

 14% in age > 85 years old
 32-67% undiagnosed
 23% of Cipto Mangunkusumo
Hospital acute care (2004)
 17% of Cipto Mangunkusumo
Hospital inpatients (2004)
 ETIOLOGY
Toxin Prescribed medicine
Drugs abused
Toxins
Metabolic Electrolyte imbalance
Hypothermia and
hyperthermia
Lungs failure
Renal failure
Liver failure
Heart failure
Vit. Deficiency
Anemia
Dehydration and
 ETIOLOGY (cont’d)
Infection Systemic
Central nervous system
Hormonal Hypothyroid and
hyperthyroid
Hyperparathyroid
Adrenal insufficiency
Cerebrovascular General hypoperfusion
impairment
Hypertensive
encephalopathy
Ischemic and hemorrhagic
stroke
Autoimmune CNS vasculitis
Lupus cerebral
 ETIOLOGY (cont’d)
Malignancy Brain metastasis
Cerebral glimatosis

Meningitis
carcinomatous

Hospital inpatient care

 PATHOGENESIS

ACS
Pathophysiolo
Uncle
gy ar

Acetylcholine
deficiency
Brain oxidative
metabolic ACS
impairment
Increased brain
cytokine on acute
illness
Fig 2. Pathogenesis of ACS
Table 1.
 CLINICAL SYMPTOMS

 Memory impairment
Global
 Perception disturbance
Cognitive
Impairment  Mind process disturbance
 Psychomotor activities
impairment

Early • Irrelevant
Sympto communication
ms • Autoanamnesis
difficult to
understand
CLINICAL SYMPTOMS
DIAGNOSIS

Acute
confusional
state

70% were
difficult to
diagnose
DIAGNOSIS
PROGNOSIS
PROGNOSIS
 RESUME
ACS is an acute conscious
impairment which is one of
the “Geriatric Giant”

70% of ACS were missed

diagnose or given wrong
treatment
 RESUME
ACS is caused by toxins, metabolic
disease, hormonal, cerebrovascular
impairment, autoimmune, seizures
and malignancy
ACS treatment includes treating
underlying disease, supportive,
education and medicine
Mortality rates for ACS is as high
as sepsis or myocardial infarction