Altered mental status

This page is for adult patients. For pediatric patients, see: altered mental status (peds)


  • Acute alteration in brain function
    • May include alteration of arousal or awareness, thought content, memory, or attention
  • Both cerebral cortices or brainstem must be affected
  • Delirium vs dementia vs other organic pathology vs functional (psychiatric)
  • Must quickly determine if coma is from diffuse or focal impairment

Clinical Features

  • Depends on cause
    • Diffuse brain dysfunction - lack of focal findings
    • Focal brain dysfunction - hemiparesis, loss of motor tone, loss of ocular reflexes
  • Important to differentiate diffuse brain dysfunction from localized lesion as a patient may appear confused due to visual deficit, dysphasia, etc.

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma



AMS Workup

Common Orders

Consider Based on Clinical Situation


  • Patients with focal findings may have surgically treatable cause
  • Coma cocktail
  • Treat underlying cause


  • Most frequently admission, unless of a chronic and known etiology

See Also