Acute confusion in the elderly as a presenting symptom in an accident and emergency department requires just the same energy devoted to diagnosis as does, say for example, acute coma, epilepsy or haematemesis. Doctors in accident and emergency departments are reminded not to succumb to the pitfalls of assuming that acute confusion is merely part of a progressive dementia in an elderly person and therefore incapable of treatment. In this paper a number of clinical examples are given where treatment of the cause of the acute confusion has led to restoration of the patient's independent existence. In passing, the abbreviated mental test score is commended to accident and emergency doctors as being just as useful in a different context as the worldwide acceptance has been of the Glasgow Coma Score. Currently the standard abbreviated mental test score seems confined to the United Kingdom as part of the generally accepted practice