Consciousness has long been a perplexing subject for philosophers and physicians, and it may be argued that human consciousness is still poorly understood. However, emergency physicians need an operational definition for the disorders of consciousness that are frequently encountered in emergency departments. Dementia is a chronic state of reduced cognitive ability. The individual once was able to function but has lost intellectual skills and memory so that normal functioning has become impaired. The onset of dementia is typically difficult to pinpoint. Delirium or acute confusional state is typically of brief duration, and the degree of intellectual impairment often fluctuates rapidly. Thinking is disorganized and the ability to sustain attention is diminished. Psychosis indicates impairment of reality testing with delusions, hallucinations, disorganized behavior, or loosened associations ( Table.221-,1).
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