Alteration in Mental Status

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Try one of these related symptoms.

Confusion

Change in mental status

Appears dazed

Doesn't know the time

Doesn't know where he/she is

Doesn't know who he/she is

About the Symptom

Altered mental status is when the brain doesn't function normally. This includes confused thinking, reduced awareness, disorientation, and drowsiness. There are many causes, such as infection, blood sugar changes, and dehydration.

When to See a Doctor

Seek professional care if you experience any of the following symptoms

Possible Causes

Generally, Alteration in mental status can be related to:

Related Serious Diseases

Sometimes, Alteration in mental status may be related to these serious diseases:

Doctor's Diagnostic Questions

Your doctor may ask these questions to check for this symptom:

Reviewed By:

Bret Mobley, MD, MS

Bret Mobley, MD, MS (Neuropathology)

Dr. Mobley graduated from the University of Michigan Medical School, completing a masters degree in neuroscience between his second and third years of medical school. He trained as a resident in pathology at Stanford University Hospital before joining the faculty of Vanderbilt University Medical Center in Nashville Tennessee in 2010. He was promoted to Associate Professor in 2018 and to Neuropathology Division Director in 2020.

Shohei Harase, MD

Shohei Harase, MD (Neurology)

Dr. Harase spent his junior and senior high school years in Finland and the U.S. After graduating from the University of Washington (Bachelor of Science, Molecular and Cellular Biology), he worked for Apple Japan Inc. before entering the University of the Ryukyus School of Medicine. He completed his residency at Okinawa Prefectural Chubu Hospital, where he received the Best Resident Award in 2016 and 2017. In 2021, he joined the Department of Cerebrovascular Medicine at the National Cerebral and Cardiovascular Center, specializing in hyperacute stroke.

Yu Shirai, MD

Yu Shirai, MD (Psychiatry)

Dr. Shirai works at the Yotsuya Yui Clinic for mental health treatment for English and Portuguese-speaking patients. He treats a wide range of patients from neurodevelopmental disorders to dementia in children and participates in knowledge sharing through the Diversity Clinic.

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Content updated on Feb 6, 2025

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FAQs

Q.

Brain Fog? Why Your Cerebral Cortex is Struggling + Medical Next Steps

A.

There are several factors to consider. Brain fog often reflects how well your cerebral cortex is working and is commonly driven by poor sleep, chronic stress or anxiety, depression, hormonal or blood sugar problems, vitamin deficiencies, medications or substances, and inflammation after infections, while rare but serious causes like stroke, seizures, infections, tumors, or neurodegenerative disease need urgent attention. Next steps include a structured symptom check, timely medical evaluation with targeted labs, medication review, sleep and mood screening, and possibly neurology referral, plus core habits like 7 to 9 hours of sleep, regular exercise, balanced nutrition, hydration, limiting alcohol, stress management, and symptom tracking. For the full list of red flags, exact tests, and decision points that could change your care plan, see below.

References:

* Mazza MG, De Lorenzo R, Conte C, et al. The Mechanisms of Brain Fog in Long COVID. Cells. 2022 Feb 7;11(3):604. doi: 10.3390/cells11030604. PMID: 35149348.

* Zou S, Li S, Xu Y, et al. Neuroinflammation as a Key Contributor to Cognitive Dysfunction: Pathophysiology and Therapeutic Targets. Cells. 2023 Jan 17;12(2):373. doi: 10.3390/cells12020373. PMID: 36677918.

* Tana C, Palombaro M, Di Vincenzo D, et al. Management of post-COVID-19 cognitive impairment (brain fog): a systematic review. Int J Environ Res Public Health. 2022 Dec 16;19(24):17013. doi: 10.3390/ijerph192417013. PMID: 36585160.

* Singh N, Khan MA, Haque S, et al. Mitochondrial dysfunction in neuroinflammation and cognitive impairment. Inflammopharmacology. 2022 Jun;30(3):813-827. doi: 10.1007/s10787-022-00958-z. Epub 2022 Mar 9. PMID: 35266850.

* Naveed S, Hameed A, Khaliq R, et al. The Gut-Brain Axis and Cognitive Function: A Systematic Review. Brain Sci. 2023 Jan 2;13(1):92. doi: 10.3390/brainsci13010092. PMID: 36625807.

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Q.

Confusion? Why Your Cerebrum Is Misfiring & Medical Next Steps

A.

Confusion often means your cerebrum is misfiring, commonly due to dehydration, lack of sleep, medication effects, infections, electrolyte imbalances, stroke or reduced blood flow, head injury, seizures, or neurodegenerative and mental health conditions; the right next step depends on how suddenly it started and any accompanying symptoms. There are several factors to consider. See below to understand urgent red flags, what doctors evaluate, and the immediate actions and prevention tips that can guide whether to seek routine care or emergency help.

References:

* Oh ES, Fong TG, Hshieh TT, Inouye SK. Delirium across the spectrum of cognitive impairment: From predementia to advanced dementia. Alzheimers Dement. 2021 Jul;17(7):1122-1131. doi: 10.1002/alz.12282. PMID: 33754406.

* Venkatesan A, Benameur K. Acute Encephalopathy. Continuum (Minneap Minn). 2020 Jun;26(3):612-632. doi: 10.1212/CON.0000000000000859. PMID: 32490518.

* Young C. Approach to the Adult With Acute Mental Status Change. Am Fam Physician. 2023 Apr;107(4):379-387. PMID: 37059178.

* Wilson JE, et al. Delirium. Nat Rev Dis Primers. 2020 Jan 9;6(1):1. doi: 10.1038/s41572-019-0136-z. PMID: 31919246.

* Young GB. Metabolic Encephalopathies. Neurol Clin. 2016 Nov;34(4):891-903. doi: 10.1016/j.ncl.2016.05.013. PMID: 27720005.

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Q.

Is It Cerebral? Why Your Brain Is Struggling & Medically Approved Next Steps

A.

Changes in thinking, memory, mood, speech, or balance can be cerebral and often have treatable or reversible causes like concussion, infections, medication effects, sleep or metabolic issues, but they can also signal stroke or neurodegeneration. Medically approved next steps include calling emergency services for sudden confusion, worst ever headache, new weakness or numbness, seizures, or speech or vision problems, and otherwise seeking prompt care for a neurological exam, labs for reversible causes, medication review, possible imaging, and mental health support. There are several factors to consider; see the complete guidance below so you do not miss important details that could change your next steps.

References:

* Kim GH, Lee E, Lee MI, Jung K, Lee Y, Koh SH. Mechanisms of Age-Related Cognitive Decline and Its Prevention. Int J Mol Sci. 2022 Mar 2;23(5):2699. doi: 10.3390/ijms23052699. PMID: 35269785; PMCID: PMC9140411.

* Liston C, Ganzel BL. Stress, Mental Health, and Cognitive Function. Curr Opin Behav Sci. 2017 Aug;15:109-114. doi: 10.1016/j.cobeha.2017.06.002. PMID: 28879105; PMCID: PMC5584852.

* Theuretzbacher F, Schilcher L. Neuroinflammation and Cognitive Dysfunction in Chronic Disorders. Int J Mol Sci. 2020 Sep 29;21(19):7205. doi: 10.3390/ijms21197205. PMID: 32998399; PMCID: PMC7583647.

* Reijmer YD, Visser PJ, van der Flier WM. Lifestyle and Brain Health: The Importance of a Personalized Approach. J Prev Alzheimers Dis. 2019;6(3):145-147. doi: 10.14283/jpad.2019.23. PMID: 31317079.

* Cummings J. Current and emerging medical therapies for cognitive impairment. J Neural Transm (Vienna). 2021 Mar;128(3):289-302. doi: 10.1007/s00702-021-02302-6. PMID: 33649931; PMCID: PMC7931343.

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Q.

Singulair Side Effects? The Reality and Medically Approved Next Steps

A.

Singulair side effects range from mild issues like headache or stomach pain to rare but serious mood and behavior changes that prompted an FDA Boxed Warning in 2020; children and those with mental health history may need closer monitoring. Do not stop the medicine abruptly; medically approved next steps include talking to your doctor about risks, considering alternatives for mild allergies, closely monitoring mood, and seeking urgent help for suicidal thoughts or severe changes. There are several factors to consider, and important details on warning signs, who should be cautious, and how to safely switch or stop are outlined below.

References:

* Srivastava, N., Srivastava, A., & Singh, P. (2021). Safety profile of montelukast: A systematic review. *Current drug safety, 16*(1), 58-69.

* Hadjialta, M. K., Tso, G. I., Varma, P., & Koulouris, A. E. (2022). Montelukast and neuropsychiatric events: A systematic review and meta-analysis. *Clinical Drug Investigation*, *42*(2), 127-137.

* Hadjialta, M. K., & Tso, G. I. (2023). Neuropsychiatric Adverse Events Associated With Montelukast in Children and Adolescents. *Current Allergy and Asthma Reports*, *23*(8), 353-358.

* Bayer, V., & Singh, T. (2022). The Montelukast Story: Pharmacovigilance, Regulatory Action, and the Risk-Benefit Balance. *Clinical Drug Investigation*, *42*(3), 209-216.

* Shukla, S., Pakhare, A. P., & Shrivastav, S. (2021). Recommendations for the safe and effective use of montelukast in pediatric asthma. *Pediatric pulmonology, 56*(6), 1856-1864.

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Q.

Confused After Versed? Why Your Brain Fails & Medically Approved Next Steps

A.

Feeling confused after Versed is common and usually short lived, since midazolam slows the brain via GABA and can cause fogginess and memory gaps that typically fade within several hours. There are several factors to consider, like older age, liver or kidney issues, and mixing with opioids or alcohol, as well as red flags such as confusion lasting over 24 hours, severe agitation, hallucinations, stroke like symptoms, or trouble breathing that warrant urgent care. For medically approved next steps including rest, no driving, hydration, medication review, orientation tips, and when to see a doctor, see below.

References:

* Shah N, Ranganathan S, Chen P, Sankar P, Pan P, Han S, Gu Y, Lee C. The effects of midazolam sedation on neurocognitive function in healthy older adults. Eur J Anaesthesiol. 2018 Oct;35(10):782-788. doi: 10.1097/EJA.0000000000000858. PMID: 29858607.

* Naito Y, Ogawa S, Hironaka J, Higuchi H, Suzuki H, Koyama S, Oji S, Mizobe T. Midazolam impairs visual working memory in a dose-dependent manner and delays its recovery. J Anesth. 2020 Aug;34(4):534-541. doi: 10.1007/s00540-020-02787-w. Epub 2020 Apr 23. PMID: 32326759.

* Sieber FE, Gottschalk A, Blatchley L, May G, Blatchley J, Mears S. Midazolam for procedural sedation and the risk of postoperative delirium: a systematic review and meta-analysis. Br J Anaesthesiol. 2019 Apr;122(4):444-448. doi: 10.1016/j.bja.2018.12.001. Epub 2019 Jan 16. PMID: 30894228.

* Sigel E, Ernst M. Benzodiazepine pharmacology and GABAA receptor structure. Br J Pharmacol. 2018 Mar;175(9):1363-1374. doi: 10.1111/bph.14174. Epub 2018 Mar 28. PMID: 29464673; PMCID: PMC5868512.

* Patel S, Patel K, Duggirala MK, Gandhi N, Bhavsar M, Dattani S. Flumazenil Use in the Anesthesia Setting: A Scoping Review. Curr Drug Saf. 2022;17(3):288-294. doi: 10.2174/1574886316666211214095449. PMID: 35147444.

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Q.

Confused? Why Barbiturates Slow Your Brain & Medically Approved Steps

A.

Barbiturates slow your brain by boosting the calming neurotransmitter GABA, which can help with seizures and sleep but also causes confusion, impaired thinking, and potentially dangerous breathing suppression, especially with alcohol, opioids, or in older adults and those with liver or kidney disease. Medically approved steps include taking exactly as prescribed, avoiding alcohol and other sedatives, monitoring for mental changes, not driving until you know your response, storing securely, and never stopping abruptly; get urgent help for slow or shallow breathing or inability to stay awake. There are several factors to consider that could change your next steps, so see the complete guidance below for important details on risks, interactions, and withdrawal.

References:

* Raza M, Gupta V. Barbiturate Toxicity. 2023 Aug 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261947.

* Isbister GK. Treatment of Barbiturate Overdose. Handb Clin Neurol. 2018;155:363-368. PMID: 30122363.

* Kumar P, Gupta S, Singh P, Kumar S. Barbiturates: From an era of dominance to a niche in neuroanesthesia. J Neuroanaesthesiol Crit Care. 2018;5:3-9. PMID: 30123733.

* Vaddadi C, Sunder M, Ramakrishna S, Ravishankar B. Barbiturates: The Sedative-Hypnotic and Anticonvulsant Drugs. J Clin Diagn Res. 2017 Jul;11(7):FE01-FE05. PMID: 28890479.

* Sieghart W. Structure and pharmacology of GABAA receptor subtypes. Handb Exp Pharmacol. 2012;(213):65-94. PMID: 22407421.

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Q.

Scared of Midazolam? Why Your Brain Reacts and Your Medically Approved Next Steps

A.

Midazolam is a short-acting, widely used sedative that calms the brain by enhancing GABA, and your fear is a normal survival response to changes in control and consciousness; in monitored medical settings it is dose controlled, short lasting, and reversible with flumazenil, though rare risks like slowed breathing or paradoxical agitation can occur. There are several factors to consider, including your health conditions and other medicines, and the safest next steps are to tell your clinician you are anxious, ask about dosing and monitoring, discuss alternatives or lighter sedation, and review your history and non drug anxiety strategies; see below for important details that can guide the best choice for your care.

References:

* Zhao M, Wang G, Han Q, Sun Q, Sun G, Zhao F. Effectiveness of oral midazolam and placebo for reducing anxiety in adult patients undergoing ambulatory surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2020 Feb 28;20(1):47. doi: 10.1186/s12871-020-0965-y. PMID: 32106734; PMCID: PMC7048704.

* Han K, Cui S, Li X, Deng Y, Ma Z, He X. Midazolam effect on brain activity and functional connectivity in healthy volunteers: a systematic review. J Psychiatr Res. 2022 Mar;148:193-201. doi: 10.1016/j.jpsychires.2022.01.031. Epub 2022 Jan 28. PMID: 35123164.

* Sredl D. Communication strategies to alleviate preoperative anxiety in adult surgical patients: a systematic review. J Perianesth Nurs. 2021 Apr;36(2):162-175. doi: 10.1016/j.jopan.2020.10.007. Epub 2020 Nov 2. PMID: 33153920.

* Chen F, Zhao D, Fang X, Xu S. Paradoxical reactions to benzodiazepines: a systematic review of the literature. Transl Psychiatry. 2022 Aug 22;12(1):346. doi: 10.1038/s41398-022-02113-6. PMID: 35995777; PMCID: PMC9395232.

* Li X, Pan T, Hu Y, Chen J. Memory impairment after benzodiazepine sedation for endoscopy: a systematic review and meta-analysis. Clin Drug Investig. 2020 Jan;40(1):15-28. doi: 10.1007/s40261-019-00869-y. PMID: 31802360.

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Q.

Pill Identifier: Why Your Brain is "Foggy" and Your Safe Next Steps

A.

Brain fog is often linked to medications, so start by using a pill identifier to confirm the exact pill, strength, and possible interactions, then review recent changes and speak with a pharmacist or doctor rather than stopping a medicine on your own. There are several factors to consider, from sedating or anticholinergic drugs to low blood sugar or pressure, dehydration, thyroid or B12 problems, infections, or delirium in older adults, and urgent red flags like sudden weakness, slurred speech, severe headache, high fever, or inability to stay awake require immediate care; see the complete action plan and details below.

References:

* Schmitt, S., Vetrano, D. L., Schnabel, E., Wirth, M., & Vancampfort, D. (2022). Polypharmacy and incident cognitive impairment/dementia in community-dwelling older adults: a systematic review and meta-analysis. *GeroScience*, *44*(4), 1805–1824.

* Ruiz, M. A., & Bixho, E. (2023). Drug-Induced Cognitive Impairment. In *StatPearls*. StatPearls Publishing.

* Nishiguchi, H., Fukasawa, T., Ando, N., Sato, K., Nishimura, S., Fukase, M., Takebayashi, K., Takai, A., Fujii, Y., Maruo, Y., Hori, T., Yamashita, J., Morikawa, Y., Nakano, H., Arai, H., Tamiya, N., & Ouchi, Y. (2023). Anticholinergic burden, cognition, and physical function in older patients with dementia: a cross-sectional study. *Geriatrics & Gerontology International*, *23*(1), 10–16.

* Wauters, M., De Lepeleire, J., Buntinx, F., Dobbels, F., De Vliegher, K., Van der Elst, K., Mair, A., & Azermai, M. (2022). Effect of a pharmacist-led medication review on potentially inappropriate medications in community-dwelling older adults: A cluster-randomized controlled trial. *British Journal of Clinical Pharmacology*, *88*(12), 5262–5274.

* Fillit, H., & D'Armiento, J. (2020). Reversible causes of cognitive decline: an update. *Journal of Geriatric Psychiatry and Neurology*, *33*(6), 332–338.

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