Urinary tract infections (UTIs) commonly occur in people with dementia. Older adults with or without dementia may experience atypical UTI symptoms, such as delirium, changes in behavior, and hallucinations.

A UTI is a bacterial or fungal infection in the urinary system. This includes the urethra, bladder, kidneys, and ureters.

Dementia refers to symptoms of cognitive decline. Various brain disorders, such as Alzheimer’s disease, are types of dementia.

This article looks at symptoms, causes, treatment, and diagnosis of UTIs in people with dementia. It also looks at how to prevent UTIs.

A carer looking after an older adult with dementia and a UTI.Share on Pinterest
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Typical UTI symptoms include pain or discomfort during urination and feeling a more frequent and urgent need to urinate.

However, a 2020 review notes that older adults with and without dementia may not experience these common UTI symptoms and may instead experience atypical symptoms. These include:

Although UTIs do not always cause clear physical symptoms, some older adults with UTIs may also experience:

Delirium

Delirium is one of the most common symptoms of UTIs in older adults. Almost half of all cases of delirium occur due to infection, most often of the urinary tract or the lungs.

Delirium involves a sudden change in someone’s ability to think (cognitive function). This can include difficulty paying attention, slurring or incoherent speech, and uncharacteristic moods and behaviors.

Medical professionals do not know precisely how infection may lead to delirium. It may occur due to increased inflammation and stress on the brain, which may be more pronounced in older adults.

Although dementia and delirium have some symptoms in common, differences between the two include the following:

  • Dementia develops slowly, while delirium causes sudden symptoms.
  • Symptoms of dementia do not usually improve, while symptoms of delirium can worsen or improve.
  • Dementia does not cause hallucinations, while delirium may.
  • Dementia usually starts with memory loss, while delirium mainly involves difficulty paying attention.

Dementia is most common in older adults, and around half of all people ages 85 years and older have some form of the condition. Many of the risk factors of UTIs in people with dementia also apply to older adults without dementia.

Risk factors may include:

  • Catheterization: A doctor may insert a thin tube, called a urinary catheter, to help drain urine from the bladder. People with dementia can develop incontinence, which a health professional may address with catheterization. This may allow bacteria to enter the body, which can lead to UTIs.
  • Comorbidities: Many older adults and those with dementia have additional health conditions. Some common comorbidities in people with dementia, such as diabetes, may increase their risk of developing a UTI.
  • Functional impairments: People with dementia may have personal care and hygiene issues due to cognitive decline. This can increase the risk of developing a UTI.
  • Age-related changes in immune function: As people age, their immune systems may become less effective at fighting infections. Health professionals refer to this as immunosenescence.
  • Exposure to nosocomial infections: People with dementia may have a higher risk of developing nosocomial infections. These are infections that a person may acquire while receiving medical care and include UTIs.

Treatment for UTIs in people with dementia may differ according to the type and location of the infection.

Lower UTI

A lower UTI affects the bladder, the urethra, or both.

A doctor may treat a lower UTI with over-the-counter (OTC) pain-relieving medication, such as acetaminophen, and a short, 3-day course of antibiotics.

Upper UTI

An upper UTI affects the kidneys and ureters and often also involves the bladder, urethra, or both. The infection is typically more serious than a lower UTI. It may lead to complications such as bacteremia, a potentially severe condition that involves bacteria in the blood.

A doctor may treat an upper UTI with a 7- to 14-day course of antibiotics. In severe cases, a person may require hospitalization and intravenous antibiotics.

Catheter-related UTIs

Catheters, especially indwelling catheters that remain in the bladder, can increase a person’s risk of UTIs.

If a doctor suspects a person has developed a UTI as a result of catheterization, they may prescribe antibiotics.

Recurrent UTI

Doctors may describe a person as having recurrent UTIs if they develop more than two UTIs within 3 months.

A doctor may treat recurrent UTIs with low dose, long-term antibiotics. A doctor may refer a person with recurrent UTIs to a urologist for further testing and treatment.

A carer may have to assist a person with dementia in providing a doctor with information about their symptoms.

A doctor may require a urine sample to diagnose a UTI. Then, a healthcare professional may perform a dipstick test on the sample. This involves placing a thin strip containing various chemicals into the urine and observing how the strip reacts.

They may also send a urine sample to a laboratory to identify the types of bacteria it contains.

A doctor may refer a person to a urologist, who may perform further tests. These may include:

  • blood tests
  • cystoscopy, in which a urologist uses a small camera to view the inside of the urinary tract
  • a rectal examination to assess the prostate gland
  • an ultrasound to view the bladder and kidneys

Obtaining a urine sample

It may be difficult to obtain a urine sample in the usual way from a person with dementia.

If the person has incontinence, a healthcare professional may be able to draw a urine sample from an incontinence pad with a syringe.

People with dementia may require care to help maintain their personal hygiene.

Carers can help prevent UTIs in people with dementia by:

  • ensuring they are well-hydrated
  • helping them use the toilet regularly
  • wiping from front to back after using the toilet
  • helping them maintain hygiene by assisting with cleaning and promptly changing incontinence pads, underwear, and bedding, when wet
  • avoiding the use of catheters when possible
  • following good infection prevention measures if a person requires a catheter

Why do UTIs cause confusion in those with dementia?

Health professionals do not know the exact causes of atypical UTI symptoms, such as confusion, in those with dementia.

The infection may cause more inflammation and stress than usual in the brains of older adults and those with dementia, which may contribute to confusion.

Is there a connection between UTI and dementia?

People with dementia may have a higher risk of developing UTIs for various reasons. These include changes in the function of the immune system, catheterization, and comorbidities.

How does a UTI affect the brain?

A UTI can cause symptoms in older adults such as delirium, hallucinations, and paranoia. It may also cause changes in a person’s mood and behavior, such as anxiety and aggression.

Can UTI-related delirium be permanent?

Doctors can reverse delirium from a UTI with treatment.

UTIs commonly occur in people with dementia. This is due to various risk factors, such as catheterization, a high rate of comorbidities, and difficulties maintaining hygiene.

People with dementia and older adults may experience atypical UTI symptoms. These include delirium, hallucinations, and changes in moods and behaviors.

Doctors typically use urine samples to diagnose UTIs. They usually treat UTIs with antibiotics.

Carers may help prevent UTIs in people with dementia by helping them maintain good hygiene and hydration.