altered mental status

I have had altered mental status for 2 years more frequently since quad bypass surgery in Dec 2008. There is no head trauma but  I am diabetic and have neuropathic degeneration that causes constant pain. I am on multiple meds for diabetes, heart and nerve pain. Is the nerve damage causing the AMS or is my brain shutting down because of the extreme pain?  Nothing shows on CAT scan or blood work ( not tested for Lyme disease yet).  The AMS started after my first surgery in2006  for nerve pain on my left shoulder.  Could the anesthesia have cause a malfunction in my brain?  Is there a treatment?    

[Bhupinder Kaur, MD]

Hello,

Certain risk factors predispose a person to develop altered mental state—most commonly, advanced age, dementia, polypharmacy, bacterial infection, surgery, chronic disease, and the use of eyeglasses or hearing aids. In your case multiple medications and a prior surgery are present.

AMS in young may be due to trauma and in elderly due to neurological insult. Certain conditions like diabetes, alcohol intake, thyroid disorders, heart disease, stroke, meningitis, space occupying lesions in brain, hepatic encephalopathy, UTI and uremia and psychiatric disorders like depression and schizophrenia can also cause AMS.

The cause is judged by physical examination and by lab investigations like ECG, CBC with differential coagulation studies, urinalysis, thyroid hormones, LFT’s, bld sugar evaluation and CT or MRI brain. Treatment will depend on the cause.

Hope it helped. Take care and regards.