Urinary Tract Infection and Dementia

If you are a regular reader of my blog, I suspect you noticed that the past couple entries were me ranting and being upset. It was a carry over from the way I was feeling for the past 1-2 weeks. I was angry, agitated and pretty darned tough to live with. I was lashing out at things and people, but had no idea why I was feeling that way.

Two days ago, the light bulb went on. For the past couple years, when anyone would describe feeling that way or their caregiver would describe a sudden worsening of dementia symptoms, the first thing I would say was "Have you checked for a urinary tract infections (UTI)?" I did not understand why, but from listening to others, it was quite common for a UTI to cause worsening of symptoms and I would share that information. I pulled out a test strip and, sure enough, I had a UTI! The doctor insisted on seeing me and testing it herself before prescribing.

While with the doctor, she asked me what my symptoms were. I told her that, looking back, I was experiencing more frequent urination, but certainly not enough to really notice. She asked me what caused me to check it. I told her that she would probably think I am crazy but it seems that with FTD, urinary tract infections can make our symptoms worse.

She explained that I am not crazy (though some may dispute this) that it is not just with FTD. She went on to explain that even patients, who have no diagnosed dementia, are brought in because they are showing symptoms of extreme dementia that came on suddenly. It can sometimes as bad as not knowing where they are. All this time, I was mistakenly thinking it was a fluke thing with FTD. An undiagnosed UTI can present with agitation, lethargy, decreased mobility and more Having dementia makes the problems even worse. By the way, I should have suggested she explain this to her staff since the nursing assistant who did my intake did indeed look at me like I was crazy when I explained why I checked. Then again, my paranoia had also been stronger for the same time period.

Urinary Tract Infections are more common in older adults. They can be caused by incontinence or bladder leakage leading to prolonged exposure to urine. Interestingly enough, constipation can aggravate the problem as well because it often prevents the bladder from completely emptying. Some ways to prevent them is to urinate more frequently, perhaps on a regular schedule, keeping the genital area clean after going to the bathroom, and drinking plenty of water. All of these advised precautions can be very difficult for someone with FTD and a real challenge for caregivers.

My familiarity with UTI's is more from when I was younger. Younger people develop more distinctive symptoms such as frequency, pain or burning during urination, pain in the abdomen or back and even fevers. Unfortunately, in older adults, the body begins to react differently to infection. A frequent theory is that it is due to the fact that our immune system is different when we are older. Because the symptoms are not those commonly associated with UTI's, the infection can be not be recognized and and can go untreated for a long period of time. It is possible for the infection to then enter the blood stream, making it life-threatening.

The Alzheimer's Society explains that UTI's can cause behavior changes including confusion, agitation, restlessness, delirium, mobility including falls and general worsening of dementia symptoms. The sooner treatment begins, the better. If the UTI goes untreated for an extended length of time, the worsening of the dementia may become permanent. That raises the question as to how can there be a connection between urinary infections and the brain? It seems that a UTI can be a serious strain on the body, a physical strain and a mental strain. This can also be said about any illness but, in the case of UTI's, that illness can go unrecognized.

Urinary tract infections do indeed play favorites. Women are three times more likely to get them. This is explained by the shortness of the urethra in women compared to men. On the other hand, prostate issues can cause more frequent UTI's in men due to the difficulty in completely emptying the bladder.

I had been complaining for nearly two weeks that I was exhausted. One night, I slept for 16 hours. I had no energy to do much of anything at all. Low and behold, another symptom of a UTI in those with dementia is often fatigue and general malaise. That sure described me. I didn't want to, or have energy to, do anything. My husband and I normally set recurring appointments (B12 shots, chiropractor, hair cuts etc.) on Thursdays. We call it our errand day and it limits the number of times we have to drive to town. After we are done for the day, we usually stop somewhere for lunch, usually at our favorite diner-type restaurant. This past Thursday, he asked me where I would like to eat. He mentioned a few places and I started to panic. He tried to think of quiet, uncrowded places, but I became more and more agitated and insisted he take me home. It took several hours to calm myself down. I usually enjoy these days out and that is how I knew that there must be something was going on and that is what triggered that light bulb coming on.

Now that I have researched this subject, the next time I ask "Have you checked for a UTI?", I will better understand why I am asking. A couple final notes... If the person with FTD begins to get URI's more often that 3 times a year, their doctor may suggest putting them on a prophylactic antibiotic treatment. This usually means taking an antibiotic every day. Test strips for urinary tract infections can now be purchased in most all drug stores. They are pricey, about $12 - $15 for a box of three. When you compare that to three co-pays and the inconvenience of going to the doctor's office every time you think "Could it be a UTI," in my mind is a good value.

Oh, and please go drink some water... and do it often!