Is Infectious Meningitis/Encephalitis a Notable Problem in Older Adults Admitted to Emergency Department with Altered Mental Status?

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European journal of geriatrics and gerontology (Online), vol.5, no.1, pp.36-45, 2023 (Scopus) identifier identifier


Objective: Altered mental status (AMS) is challenging diagnosis. It was aimed to evaluate the underlying causes, reveal laboratory, microbiological and imaging findings, and determine the infectious process in older patients who presented with AMS. Materials and Methods: This retrospective study was conducted at a training and research hospital. Sixty-five year and older patients who presented with AMS and underwent lumbar puncture, were included. Results: Among 98 older patients with AMS, the median age was 75.0 years (interquartile range: 69.0-75.0) and 58.2% of patients were female. Of the patients, 26.5% meningitis/encephalitis, 33.6% other infection sources, and 39.8% other disorders were found, respectively. Cerebrospinal fluid (CSF) white blood cell and protein levels were found higher; CSF chloride levels were detected lower in meningitis/encephalitis group. In brain, magnetic resonance imaging (p<0.001) and electroencephalogram (p=0.009) were found more pathologies suggesting infection in meningitis/ encephalitis patients, while brain computed tomography revealed no differences between meningitis/encephalitis and other diagnoses group. The need for intensive care was higher in the other disorder group (p=0.02) while admission to service was higher in the meningitis/encephalitis group (p=0.03). Conclusion: Clinical characteristics failed to differentiate between meningitis/encephalitis and other diagnoses in older patients with AMS, and CSF analysis, cranial imaging methods were required for the final diagnosis.