Decreased alertness
Decreased alertness is a state of reduced awareness and is often a serious condition.
A coma is the most severe state of decreased alertness from which a person cannot be awakened. A long-term coma is called a vegetative state.
Causes
Many conditions can cause decreased alertness, including:
- Chronic kidney disease
- Extreme tiredness or lack of sleep
- High blood sugar or low blood sugar
- High or low blood sodium concentration
- Infection that is severe or involves the brain
- Liver failure
- Thyroid conditions that cause low thyroid hormone levels or very high thyroid hormone levels
Brain disorders or injury, such as:
- Dementia or Alzheimer disease (advanced cases)
Dementia
Dementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, j...
Read Article Now Book Mark ArticleAlzheimer disease
Dementia is a loss of brain function that occurs with certain diseases. Alzheimer disease (AD) is the most common form of dementia. It affects memo...
Read Article Now Book Mark Article - Head trauma (moderate to severe cases)
- Seizure
Seizure
A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...
Read Article Now Book Mark Article - Stroke (usually when the stroke is either massive or has destroyed certain areas of the brain such as the brainstem or thalamus)
Stroke
A stroke occurs when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack. " If blood flow is cut off for longer th...
Read Article Now Book Mark Article - Infections that affect the brain, such as meningitis or encephalitis
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
Read Article Now Book Mark ArticleEncephalitis
Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.
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Injury or accidents, such as:
- Diving accidents and near drowning
- Heat stroke
- Very low body temperature (hypothermia)
Heart or breathing problems, such as:
- Abnormal heart rhythm
- Lack of oxygen from any cause
- Low blood pressure
- Severe heart failure
- Severe lung diseases
- Very high blood pressure
High blood pressure
Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Hypertension is the ...
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Toxins and drugs, such as:
- Alcohol use (binge drinking or damage from long-term alcohol use)
- Exposure to heavy metals, hydrocarbons, or toxic gases
- Overuse of drugs such as opiates, narcotics, sedatives, and anti-anxiety or seizure medicines
- Side effect of almost any medicine, such as those used to treat seizures, depression, psychosis, and other illnesses
Home Care
Get medical help for any decrease in consciousness, even when it is due to alcohol intoxication, fainting, or a seizure disorder that has already been diagnosed.
People with epilepsy or other seizure disorders should wear a medical ID bracelet or necklace describing their condition. They should avoid situations that have triggered a seizure in the past.
When to Contact a Medical Professional
Get medical help if someone has decreased alertness that cannot be explained. Call 911 or the local emergency number if normal alertness does not return quickly.
What to Expect at Your Office Visit
Most often, a person with decreased consciousness will be evaluated in an emergency room.
The health care provider will perform a physical examination. The exam will include a detailed look at the heart, breathing, and nervous system.
The health care team will ask questions about the person's medical history and symptoms, including:
Time pattern
- When did the decreased alertness happen?
- How long did it last?
- Has it ever happened before? If so, how many times?
- Did the person behave the same way during past episodes?
Medical history
- Does the person have epilepsy or a seizure disorder?
- Does the person have diabetes?
Diabetes
Diabetes is a long-term (chronic) disease in which the body cannot regulate the amount of sugar in the blood.
Read Article Now Book Mark Article - Has the person been sleeping well?
- Has there been a recent head injury?
Other
- What medicines does the person take?
- Does the person use alcohol or drugs on a regular basis?
- What other symptoms are present?
Tests that may be done include:
- Chest x-ray
- Complete blood count (CBC) or blood differential
- CT scan or MRI of the head
CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark ArticleMRI
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark Article - Oxygen level (pulse oximetry or blood gas)
- Electrocardiogram (ECG)
- Electroencephalogram (EEG)
Electroencephalogram (EEG)
An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.
Read Article Now Book Mark Article - Metabolic panel and liver function tests
- Toxicology panel and alcohol level
- Urinalysis
Treatment depends on the cause of the decreased alertness. How well a person does depends on the cause of the condition.
The longer the person has had decreased alertness, the worse the outcome.
Reviewed By
Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Berger JR, Price R. Stupor and coma. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 5.
Lei C, Smith C. Depressed consciousness and coma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 12.