ABSTRACT
This chapter presents a case study of John, who is a 54-year-old man who had surgery for a carcinoma of the colon. Acute confusional states are the commonest form of confusion in advanced disease. It is present if there are four or more typical features. Six are highly specific: acute onset, fluctuating course, disorganised thinking, inattention, memory impairment, and disorientation. Chronic confusional states are seen in the dementias. They can have similar features to acute states, but the history is longer, the symptoms fluctuate less, and the patient's alertness is unlikely to have changed. Confusional states can be frightening for all involved: the patients fear they are 'losing their mind', while carers feel uneasy at the unpredictability of the patient's words and actions. Features of confusions are memory failure; alteration in alertness; impaired concentration; and abnormal experiences.
