Delirium in Dementia Patients with Bladder Infections

Introduction

Urinary tract infections (UTIs) may pose a greater threat than the usual physical symptoms to people suffering from dementia. UTIs have been linked with delirium in older dementia patients, causing sudden, distressing changes in behaviour. When younger people get a UTI – also known as a bladder infection – they experience physical symptoms such as painful urination. Older adults respond differently to the infection because of changes in their body's immune system. Instead of pain, older people with a bladder infection may show signs of confusion. For older adults suffering from dementia, a UTI can aggravate the condition, and their altered state of mind may be mistakenly perceived as part of the dementia itself. If the UTI isn't diagnosed, it can spread to the bloodstream and become life-threatening. A dementia patient suffering from a urinary tract infection may be unable to communicate how they feel, so if you know someone with dementia, you need to be alert to delirium symptoms that may be the result of a bladder infection.

Symptoms of Delirium

Delirium is far more common among older people, particularly those with dementia. While dementia develops gradually over months or even years, symptoms of delirium happen within hours or a few days, plunging the sufferer into a disturbing state of distracted confusion. Delirium can result in an abrupt onset of significant and distressing changes in behaviour, such as perplexity, mood swings, aggression, hallucinations, agitation, dizziness, poor motor skills, and withdrawal.

Some symptoms of delirium – such as delusions, confusion, and agitation – can be similar to those of dementia. Hypoactive delirium, which induces withdrawal and excessive sleepiness, can also easily be mistaken for depression. Hyperactive delirium can cause hallucinations and make the person agitated or even aggressive. Unlike dementia, delirium starts suddenly, over hours or days, and the symptoms can vary greatly over the course of a day.

What is Dementia?

Dementia is a general term that refers to a progressive, severe decline in mental ability that impairs everyday functionality. Symptoms include memory loss, and the most common type of dementia is Alzheimer's, accounting for two-thirds of all cases. There is no way to halt or slow the progression of Alzheimer's, although drugs and other treatments may help ease symptoms. Someone can have both dementia and delirium, and it can be difficult to tell which is causing their symptoms.

What is a Urinary Tract Infection?

The urinary tract consists of a series of channels that enable the body to get rid of urine. A UTI typically occurs when bacteria get into the urinary tract via the urethra – the duct that carries urine out of the body from the bladder. The bacteria can then travel upwards through the urinary tract and infect the bladder (cystitis) and sometimes the kidneys (pyelonephritis). A lower urinary tract infection attacks the bladder and/or urethra, while an upper urinary tract infection can affect the kidneys as well. It's more serious than a lower UTI and can damage the kidneys.

Treatments for Dementia, Delirium and UTIs

Dementia, delirium, and urinary tract infections are particularly prevalent among older people. While a urinary tract infection can be uncomfortable and dementia distressing, a combination of the two can have devastating consequences for the patient and their loved ones alike if it leads to delirium. A UTI in a dementia patient needs particularly prompt treatment, as any infection can speed up the progression of dementia.

Treatment of dementia depends on its cause. There is no cure for most progressive dementia types, including Alzheimer's, and no treatment that can halt their further development, but medication may improve symptoms in the short term, and non-drug therapy can also ease some symptoms. Initial treatment for delirium focuses on underlying triggers, such as an infection, and then on creating the optimum environment for calming the brain and healing the body. Lower UTIs are generally treated with a three-day course of antibiotics, plus pain relief such as paracetamol. Upper UTI treatment usually includes a longer course of antibiotics, and more severe cases may require hospitalisation and intravenous antibiotics, given directly into a vein. Patients with recurring UTIs may be referred to a urology specialist for further investigation, and in some cases the problem can be managed with low-dosage antibiotics in the long term.

Heightened Dangers of UTIs in Dementia Patients

Left untreated, a urinary tract infection can cause sepsis (blood poisoning), a life-threatening condition that shuts down vital organs. A UTI may go unnoticed in an older person because none of the usual physical symptoms are present. In older dementia patients, symptoms of delirium produced by a UTI may be mistaken as part of the dementia itself, rather than an additional, separate, and serious issue. If you're a relative or carer of someone with dementia, it's crucial to be aware that signs of delirium may well be pointing to a bladder infection.