Dementia, diabetes and UTIs can create a challenging puzzle when caring for seniors. It can be difficult for a caregiver to know where one stops and the next starts. It is important to understand the interaction between the three and to recognize what are sometimes non-traditional signs of a UTI in order to get prompt care.

Diabetes <-> Dementia

The link between diabetes and dementia is not completely understood, but there is no doubt that there is a link. According to one study, people with diabetes are 93% more likely to develop dementia. 

Medically, diabetes damages blood vessels, which can lead to cognitive impairment. The brain depends on many different chemicals to function. Too much insulin can cause these chemicals to be out of balance. Too much blood sugar increases inflammation; this may damage brain cells and cause dementia.

Behaviorally, dementia can make diabetes more challenging to manage. A person may forget that they have eaten and eat a meal several times. They may also completely forget to eat. Dementia can also cause lethargy, making a person less willing to exercise.

High blood sugar can also look like dementia. The side effects of diabetes can worsen confusion and cognitive impairment in people with dementia.

Diabetes <-> UTIs

So what does all this have to do with Urinary Tract Infections (UTIs)?

Increased blood sugar causes frequent urination. For someone who is incontinent, this can cause hygiene challenges. If garments are not changed frequently, the moist environment gives a place for bacteria to grow, causing frequent UTIs. People with type 2 diabetes experience more frequent and more severe UTIs. UTIs in diabetes patients can also be harder to treat, as they are frequently caused by resistant pathogens.

On the flip side, any infection tends to cause increased blood sugar for someone with diabetes. 

Dementia <-> UTIs

About 60-70% of people with dementia will develop incontinence. As mentioned before, incontinence without proper hygiene leads to UTIs. However, someone with dementia may not recognize the symptoms or be able to communicate them. When we think of UTIs, common symptoms are a strong need to urinate and a burning sensation. Between the neuropathy associated with diabetes and lack of awareness from dementia, your patients may not recognize these symptoms. 

As a caregiver, your first sign of a UTI may be a change in behavior. Perhaps the person is suddenly less willing to participate in group activities. Shame and embarrassment related to incontinence may be behind this change. If the person has a sudden and unexplained change in their behavior, such as increased confusion, agitation, or withdrawal, this may be because of a UTI.

You may also notice a change in the color or smell of urine. Strong smelling urine, cloudy urine or urine that is red, pink or cola colored are all signs of a UTI.

The Vicious Cycle

So, what we’ve learned is that dementia can increase high blood sugar. High blood sugar can increase the risk of UTIs. UTIs can cause symptoms that look like dementia. Going in the opposite direction, dementia also increases the risk of UTIs. UTIs increase blood sugar levels and high blood sugar can look like dementia. This vicious cycle can be life-threatening for a senior with diabetes and dementia.

Recognizing UTIs

According to The Alzheimer’s Society, the symptoms of a lower urinary tract infection include at least one of the following:

• pain, or a burning sensation when passing urine (called dysuria)
• the need to pass urine immediately (called urgency)
• the feeling of not being able to urinate fully
• cloudy, bloody, or bad-smelling urine
• lower abdominal pain
• urinary incontinence – the involuntary leakage of urine
• mild fever (a temperature between 98.6–101.0°F)
• delirium/acute confusion (sudden onset confusion developing within one to two days) – this is more common in the elderly.

Prompt treatment is critical. As the person who sees a resident on a daily basis, caregivers in senior living communities should be on the lookout for changes in behavior or urine and report these immediately to a health care professional or the hospice team.