Age related illnesses | November 16, 2014 | Author: The Super Pharmacist
Dementia, or neurocognitive disorder, is a term referring to a spectrum of conditions typically characterised by cognitive defects and functional disability.
Dementia and dementia-like conditions include:
Of these, Alzheimer's disease is the most common type of dementia. These disorders are associated with widespread death of cells in certain areas of the brain. This may be a result of the aggregation of certain proteins within and without the cells (Lewy bodies or beta-amyloid plaques).
Cases of dementia are often thought of as an effect on the memory and cognition of its patients, but it may have other symptoms and signs, based on the brain regions affected.
These may include:
Therefore, adequate treatment and care of patients with these disorders ideally extends beyond problems posed by reduced capacities of cognition and recall.
Many patients with dementia are found to be dehydrated on admission to hospital. Up to 95% of residential care patients with dementia have problems feeding themselves or being fed.
This may be associated with reduced fluid intake and malnutrition, a consequence of either the loss of independence in feeding or functional impairment when trying to eat or drink independently - for example, a patient may 'forget' how, or be otherwise unable, to open a container or package. Malnutrition or dehydration may also result from the loss of interest or attention while taking a meal.
Dementia tends to be associated with other conditions, which may or may not be related to the reduced capacity of the patient to report the problem or address it themselves, thus leaving the problem untreated and able to escalate progressively.
These disorders include:
Delirium is commonly associated with dehydration, and may be difficult to distinguish from dementia in acute medical facilities. It is strongly associated with dementia, possibly due to the issues of nutrition as discussed above, and may also be related to the drugs used to treat dementia. In a study of 504 elderly women, Alzheimer's disease was significantly associated with delirium, which was also associated with a diagnosis of urinary tract infection.
A similar study of 395 older women found that approximately 30% suffered from cystitis or urinary tract infections in the preceding year, which was also associated with dementia.
A study of 407 patients discharged from a psychogeriatric facility over two years found that 3.4% of these were diagnosed with delirium and urinary tract infection. 71% of these had dementia. Therefore, a link between dementia, delerium and urinary tract infections is eminently possible.
Urinary tract infections are associated with many bacterial species, including the common species E. coli. They may present differently in seniors, compared to younger individuals. Therefore, urinary tract infections may be associated with different symptoms in this population, including:
Therefore, dementia patients living independently or not in receipt of care are at a higher risk of having these infections go undiagnosed and unchecked. In these cases, the infection may spread further into the urinary tract or beyond into tissues such as the vascular system. The risk of urinary tract infections in the elderly is also influenced by:
Elderly patients with dementia may have more trouble with some of these factors, due to the cognitive and functional deficits associated with these disorders (as outlined previously). Those concerned with the care of such individuals may contribute to preventing infections by promoting or assisting with hygiene or laundry.
When urinary tract infections are diagnosed, they may be inadequately treated, leading to the increased risk of mortality. Mortality related to urinary tract infection may also be associated with dementia. Treatment for urinary tract infections often takes the form of antimicrobial therapy, such as antibiotic medications. Inadequate treatment of these infections in the elderly is also associated with other factors, including:
Residential care patients are also often diagnosed with urinary tract infections. This may be due to antibiotic-resistant bacterial strains abounding in community-type facilities.
This may also be a result of the administration of antibiotics as a prophylactic measure against the same, thus decreasing their efficacy when an infection is contracted. Reduced mobility is also associated with the increased risk of urinary tract infections. A study of over 400,000 residential care home patients found that the ability to walk was associated with a 69% reduction in hospital admissions for urinary tract infection.
Due to the intersection of risk factors and symptoms of urinary tract infections, dementia and dehydration, diagnosis of one of these occurring in a patient with another is understandably difficult. However, failing to do so may have severe repercussions for the patient. Strategies to diagnose these infections include bacterial cultures and bladder ultrasound. The latter may reduce the need for bladder catherisation (typically used to assess bladder volume and function) which is in itself associated with the increased prevalence of urinary tract infections. Avoiding catherisation may reduce infections by up to 72%.
Gross RG, McMillan CT, Chandrasekaran K, et al. Sentence processing in Lewy body spectrum disorder: the role of working memory. Brain Cogn.2012;78(2):85-93.
Glover A, Bradshaw LE, Watson N, et al. Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study. BMC Geriatr. 2014;14:43. Accessed 2014.
Vandervoort A, Van den Block L, van der Steen JT, et al. Nursing home residents dying with dementia in Flanders, Belgium: a nationwide postmortem study on clinical characteristics and quality of dying. J Am Med Dir Assoc.2013;14(7):485-492.
Edahiro A, Hirano H, Yamada R, Chiba Y, Watanabe Y. [Comparative study of eating behavior in elderly patients with Alzheimer's disease and vascular dementia: a first report. - Comparison of disturbed eating behavior - ]. Nihon Ronen Igakkai Zasshi.2013;50(5):651-660.
Zuliani G, Galvani M, Sioulis F, et al. Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia. Int J Geriatr Psychiatry.2012;27(3):313-320.
Breil D. [Delirium or behavioral and psychological symptoms of dementia in the elderly patient: diagnosis and treatment]. Praxis (Bern 1994).2010;99(18):1079-1088.
Eriksson I, Gustafson Y, Fagerström L, Olofsson B. Urinary tract infection in very old women is associated with delirium. Int Psychogeriatr.2011;23(3):496-502.
Eriksson I, Gustafson Y, Fagerström L, Olofsson B. Prevalence and factors associated with urinary tract infections (UTIs) in very old women. Arch Gerontol Geriatr.2010;50(2):132-135.
Manepalli J, Grossberg GT, Mueller C. Prevalence of delirium and urinary tract infection in a psychogeriatric unit. J Geriatr Psychiatry Neurol.1990;3(4):198-202.
Colodner R, Kometiani I, Chazan B, Raz R. Risk factors for community-acquired urinary tract infection due to quinolone-resistant E. coli. Infection.2008;36(1):41-45.
D'Agata E, Loeb MB, Mitchell SL. Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc.2013;61(1):62-66.
Rhoads J, Clayman A, Nelson S. The relationship of urinary tract infections and falls in a nursing home. Director.2007;15(1):22-26.
Rogers MAM, Fries BE, Kaufman SR, Mody L, McMahon LF, Saint S. Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study. BMC Geriatr. 2008;8:31. Accessed 2008.
Esparcia A, Artero A, Eiros JM, et al. Influence of inadequate antimicrobial therapy on prognosis in elderly patients with severe urinary tract infections. Eur J Intern Med.2014;25(6):523-527.
Rummukainen M-L, Jakobsson A, Matsinen M, et al. Reduction in inappropriate prevention of urinary tract infections in long-term care facilities. Am J Infect Control.2012;40(8):711-714.
Health Quality O. Portable bladder ultrasound: an evidence-based analysis. Ont Health Technol Assess Ser.2006;6(11):1-51.