What Is Altered Mental Status?

Medically Reviewed by Poonam Sachdev on October 07, 2022
5 min read

The brain is an amazing organ that influences how we think, move, and feel. Many things can affect the way the brain works, and when your brain is impaired, you may not think or act the way you normally would. You may hear this condition referred to as an altered mental status.

Altered mental status (AMS) is a general term referring to a change to your average mental function. Altered mental status isn’t a specific diagnosis; it’s a symptom of a broader problem. It is a broad term for a range of neurological symptoms. 

Medical providers divide altered mental status into three types: delirium, dementia, and psychosis:

Delirium.  Delirium is a change in mental function that often results in confusion and lack of awareness of the environment. Symptoms of delirium often set in rapidly.

Dementia. Dementia is a decline in mental function that results in difficulty remembering things and trouble thinking or making decisions. The CDC estimates that there are about five million adults over the age of 65 with dementia. Though dementia is commonly the result of aging, other factors can cause it to occur in younger individuals.

Dementia is a slower-progressing type of altered mental status, often caused by conditions within the brain like Alzheimer’s disease. Vascular problems, which may be caused by diabetes, high blood pressure, high cholesterol, and stroke, may also cause dementia. Other causes may include:

  • Medications
  • Pressure on the brain
  • Thyroid hormone imbalance
  • Vitamin deficiency

Psychosis. The term "psychosis” is used when people lose touch with reality. Psychosis usually involves hallucinations in which a person sees, hears, or otherwise senses something that is not there. Alternatively, it may cause delusions: The affected person has strong beliefs that are at odds with reality. Some people experience both. Psychosis can be caused by an underlying mental health condition.

Psychosis may be caused by mental health conditions such as trauma, stress, severe depression, bipolar disorder, and schizophrenia.

Some medical providers also consider changes in consciousness, such as a coma or stupor, to be types of altered mental status.

There are many, many things that can result in someone experiencing an AMS medical condition. Different types of altered mental status may have different causes. 

For rapid-onset altered mental statuses, such as in psychosis or delirium, causes may include:

Central nervous system problems. The central nervous system is made up of the nerves in the brain and spinal cord. Issues with the central nervous system that may lead to psychosis or delirium include:

  • Brain hemorrhage. A brain hemorrhage means bleeding of the brain. Many things can cause brain bleeding including bleeding disorders, clots, head trauma, complications in a pregnancy, and overuse of alcohol or recreational drugs.
  • Brain tumor. A brain tumor is a growth of abnormal cells in the brain. There are many types of brain tumors. Some are cancerous, but not all.
  • Hepatic encephalopathy. Hepatic encephalopathy is a nervous system condition caused by liver disease. If your liver doesn’t work properly, toxins build up within your blood and can make their way to your brain.
  • Obstructive hydrocephalus. Obstructive hydrocephalus is a condition in which a blockage causes a buildup of cerebrospinal fluid, resulting in increased pressure on the brain.
  • Seizure. A seizure is caused by a sudden, uncontrolled electrical disturbance within your brain. There are many types of seizures with many different causes.
  • Stroke. A stroke occurs when blood supply and nutrients to the brain are cut off, either by a clot or burst blood vessel. There are a few different types of strokes, and these strokes can cause a variety of symptoms and effects.

Drug overdose or withdrawal. Drug overdoses happen when someone takes more of a medicine or drug than their body can handle. Withdrawal occurs when someone who is physically dependent on a medication or drug stops taking the drug or cuts back. Either may lead to an altered mental state.

Infections. Infections happen when germs invade and spread throughout the body. Many types of infections (like meningitis, pneumonia, and even urinary tract infections) can lead to altered mental statuses.

Metabolic disorders. Metabolic disorders disrupt your body’s metabolic process, the process of breaking down food for energy. These may include:

  • Dehydration. Dehydration happens when you don’t have enough fluids, like water, for your body to work properly.
  • Hypoglycemia. Hypoglycemia is also called low blood sugar. Common causes include improper diet and too much insulin, a hormone your body needs to balance blood sugar.
  • Hyponatremia. Hyponatremia is a condition in which your body is low on sodium.
  • Hypothermia. When you’re hypothermic, your body temperature drops too low to sustain normal functions.
  • Hypothyroidism. Hypothyroidism is the result of an underactive thyroid.
  • Hypoxemia. Hypoxemia occurs when there is not enough oxygen in your blood.

Reactions to prescription medications. Some prescription medications may have adverse reactions that lead to altered mental status. Medications like corticosteroids, antiseizure medications, sedatives, and sleeping pills are all known to have altered mental status as an adverse side effect.

Shock. Shock happens when your body doesn’t have enough blood flow. This could be caused by heart problems, infection, an allergic reaction, or severe bleeding.

Traumatic brain injuries. Traumatic brain injuries (TBIs) occur when the brain is injured, often due to a violent blow to the head. Some TBIs are mild and heal well, but others can cause long-term problems and even death. 

The symptoms of altered mental status will vary depending on the type of altered mental status and what’s causing it.

Symptoms of delirium may include:

  • Behavioral changes. These may include hallucinations, agitation, and trouble sleeping
  • Cognitive impairment. Cognitive impairment (poor thinking skills) may manifest as disorientation, poor memory, rambling or difficulty with speech, and difficulty reading or writing.
  • Emotional disturbances. Emotional disturbances can range from feeling depressed to manic. Possible disturbances include anxiety, apathy, depression, elation, irritability, and anger, and these may all shift rapidly.
  • Reduced awareness of the environment. Reduced awareness may include a struggle to stay focused or a state of being withdrawn.

Symptoms of dementia may include: 

  • Trouble with memory, such as forgetting the name of a family member or getting lost in a familiar neighborhood
  • Attention problems, including not being able to complete tasks
  • Problems with communication
  • Improper problem-solving or bad judgment

The two major symptoms of psychosis are hallucinations and delusions.

  • Hallucinations. When someone experiences hallucinations, they sense something that is not there. This often means they see or hear something that isn’t real, but they may also feel, taste, or smell something that doesn’t exist. 
  • Delusions. Delusions happen when a person has a strong belief in something that most other people don’t believe or that doesn’t make sense.

Diagnosis for altered mental status will often begin with a physical assessment. Your doctor will check your airway and breathing, check for injury or exposure, and assess your mental status. They may also talk to loved ones who are familiar with how you usually act.

If you’re diagnosed with altered mental status, the next step is to determine what is causing it. To do this, your doctor may utilize a range of tests, including blood tests, urine tests, and imaging scans. 

Treatment for altered mental status means treating the cause of your altered mental status. This could mean administering or changing medication, administering oxygen or fluids, or surgery. 

Some causes of altered mental status, like Alzheimer’s disease, do not have a cure and instead require supportive care.