Agitation and confusion are commonly used as rather imprecise descriptors of patients' behaviors. However, they commonly co-occur and they denote specific behaviors associated with several different underlying conditions, some of whom are treatable. In most situations they represent behavioral emergencies. Confusion is defined as disturbed orientation in respect to time, place or person. Orientation is a complex phenomenon reflecting short-term memory, consciousness and perceptual abilities. Agitation represents excessive motor activity which is most commonly fluctuating. Observed behaviours are motor restlessness, irritability and heightened responsivity to stimuli, inappropriate verbal and/or motor activity and decreased sleep.
The distinction towards other terms such as hyperactivity, restlessness and fidgetiness is unclear. Several different conditions may present with confusion and agitation. Most commonly is confusion associated with dementia, delirium (hyperactive, hypoactive and mixed types) or other medical conditions involving/effecting upon the CNS. Agitation can be associated with a primary psychiatric disorder (anxiety (panic), depression, psychosis (mania) or personality disorders), neuropsychiatric disorders (dementia and hyperactive delirium), substance abuse (intoxication or substance withdrawal) and several medical conditions (e.g. hyperthyroidism). In palliative patients the behaviours commonly co-occur as part of a delirium. The epidemiology of confused and/or agitated behaviour in palliative patients is uncertain but the behaviours are probably common. At the end of life most of the patients are confused, and 30-40% of delirious patients display agitation. Delirious patients commonly display both behaviours. While doctors and nurses easily recognize agitated behaviour, confusion without agitation is probably commonly overlooked. Non-detection rates as high as 60% have been reported. This is of great concern because delirium is deadly but also treatable in nearly 50% of the cases.
Treatment depends on the underlying condition. The diagnosis of the behaviour, associated symptoms and underlying conditions is therefore of great importance. Symptomatic treatment of delirium includes medication as well as supportive interventions (control stimuli, follow circadian rhythm, introduction of "signposts" and physical exercise). By focusing on some risk factors, the development of delirium can probably be prevented in a large group of patients at risk.