Post by norbert1 on Sept 18, 2009 9:33:15 GMT -5
Added to misc dementia topics pt 2
What's the connection between UTI's and AD decline?
Q - I see all over the message board when a patient has a downward turn or "episode" of any kind, many many people refer to UTI's as being a possible underlying cause. What is the connection? And why don't we see this kind of connection being made with the common cold or the flu which seems to be a more frequent occurrence.
A - The elderly in general and especially those with dementia (because of lowered level of cognitive reserve) are susceptible to delirium. In dementia, UTIs cause a mild form of delirium that produces a decline in function and increase in confusion.
de•lir•i•um. A temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.
Google - dementia UTI delirium
Inflammatory Response To Infection And Injury May Worsen Dementia
www.medicalnewstoday.com/articles/121816.php
Systemic inflammation - inflammation in the body as a whole - is already known to have direct effects on brain function. Episodes of delirium, in which elderly and demented patients become extremely disoriented and confused, are frequently caused by infections, injury or surgery in these patients. For example, urinary tract infections, which are typically bacterial, appear to be particularly potent inducers of psychiatric symptoms.
Double trouble: When delirium complicates dementia
www.nursingcenter.com/prodev/ce_article.asp?tid=812348
Dementia Versus Delirium
www.selfhelpmagazine.com/article/dementia-delirium
“Delirium can be caused by virtually any medical condition. A urinary tract infection, reaction to drugs, low blood pressure, dehydration, even sensory deprivation for hospitalized patient.”
A comment on one line in this article. -- “Delirium is a true medical emergency.” -- The level of delirium caused by a UTI is not as severe as when caused by a more major illness and would not rise to the level of a “medical emergency”, but would produce a change of behavior. . . . However, a bladder infection can move up to the kidneys, where it can get into the blood stream creating sepsis. That IS a life threatening medical emergency.
Look at it another way, anything that produces stress on the body of a person with dementia will cause an increase in confusion and possible behavior issues. UTI, pain, dehydration or exhaustion will produce such results.
The complicating issue in dementia is that we can tell when they have a fever (from flu) or a cold, but they cannot or do not tell the caregiver that they have a UTI. And in dementia, they can have a silent UTI which does not exhibit the traditional symptoms.
Treating UTIs
Silent UTIs usually don't have any symptoms; no pain, burning, frequency or odor, but they are there. The only symptoms for many of our loved ones are abrupt changes in behavior, cognition or funcition.
One caregiver reported, in later stages, "my mother got these silent UTIs about five or so times a year. Her only symptom was that abrupt change in behavior or cognition. Once treated with the appropriate antibiotic, she was back to her usual level of function."
The facility is the one that should test the urine. A dipstick will be done first to check for bacteria. You can also test at home. The AZO test strip has two windows and is most accurate if the urine is held for 12 hours. Even if not held for 12 hours, the first window will still work properly to test for infection. If a UTI is present, then a lab culture will be done to check for the most effective antibiotic. The laboratory culture takes about three days to come back.
In the meantime, the MD usually treats the patient empirically with a broad spectrum antibiotic. If that antibiotic turns out not to be effective by culture, the antibiotic will be changed.
What's the connection between UTI's and AD decline?
Q - I see all over the message board when a patient has a downward turn or "episode" of any kind, many many people refer to UTI's as being a possible underlying cause. What is the connection? And why don't we see this kind of connection being made with the common cold or the flu which seems to be a more frequent occurrence.
A - The elderly in general and especially those with dementia (because of lowered level of cognitive reserve) are susceptible to delirium. In dementia, UTIs cause a mild form of delirium that produces a decline in function and increase in confusion.
de•lir•i•um. A temporary state of mental confusion and fluctuating consciousness resulting from high fever, intoxication, shock, or other causes. It is characterized by anxiety, disorientation, hallucinations, delusions, and incoherent speech.
Google - dementia UTI delirium
Inflammatory Response To Infection And Injury May Worsen Dementia
www.medicalnewstoday.com/articles/121816.php
Systemic inflammation - inflammation in the body as a whole - is already known to have direct effects on brain function. Episodes of delirium, in which elderly and demented patients become extremely disoriented and confused, are frequently caused by infections, injury or surgery in these patients. For example, urinary tract infections, which are typically bacterial, appear to be particularly potent inducers of psychiatric symptoms.
Double trouble: When delirium complicates dementia
www.nursingcenter.com/prodev/ce_article.asp?tid=812348
Dementia Versus Delirium
www.selfhelpmagazine.com/article/dementia-delirium
“Delirium can be caused by virtually any medical condition. A urinary tract infection, reaction to drugs, low blood pressure, dehydration, even sensory deprivation for hospitalized patient.”
A comment on one line in this article. -- “Delirium is a true medical emergency.” -- The level of delirium caused by a UTI is not as severe as when caused by a more major illness and would not rise to the level of a “medical emergency”, but would produce a change of behavior. . . . However, a bladder infection can move up to the kidneys, where it can get into the blood stream creating sepsis. That IS a life threatening medical emergency.
Look at it another way, anything that produces stress on the body of a person with dementia will cause an increase in confusion and possible behavior issues. UTI, pain, dehydration or exhaustion will produce such results.
The complicating issue in dementia is that we can tell when they have a fever (from flu) or a cold, but they cannot or do not tell the caregiver that they have a UTI. And in dementia, they can have a silent UTI which does not exhibit the traditional symptoms.
Treating UTIs
Silent UTIs usually don't have any symptoms; no pain, burning, frequency or odor, but they are there. The only symptoms for many of our loved ones are abrupt changes in behavior, cognition or funcition.
One caregiver reported, in later stages, "my mother got these silent UTIs about five or so times a year. Her only symptom was that abrupt change in behavior or cognition. Once treated with the appropriate antibiotic, she was back to her usual level of function."
The facility is the one that should test the urine. A dipstick will be done first to check for bacteria. You can also test at home. The AZO test strip has two windows and is most accurate if the urine is held for 12 hours. Even if not held for 12 hours, the first window will still work properly to test for infection. If a UTI is present, then a lab culture will be done to check for the most effective antibiotic. The laboratory culture takes about three days to come back.
In the meantime, the MD usually treats the patient empirically with a broad spectrum antibiotic. If that antibiotic turns out not to be effective by culture, the antibiotic will be changed.