By Austin McKee, LMSW
Ellie’s Story
Joan, a retired teacher in the middle stages of Alzheimer’s, was known for her gentle disposition and love of puzzles. One evening, her daughter, Ellie, noticed a change in Joan’s behavior. Joan refused to work on their puzzle, paced the room anxiously and accused Ellie of taking her favorite coffee mug. Her typically calm voice grew loud and accusatory, a sharp contrast to her usual behavior.
Ellie brushed it off as a “bad day,” but the next morning, Joan became disoriented and began hallucinating, insisting there was a dog in her bedroom. Alarmed by the sudden changes, Ellie contacted Joan’s doctor, who diagnosed a urinary tract infection (UTI). He explained that UTIs can trigger confusion, agitation, and hallucinations in individuals with Alzheimer’s, often appearing as abrupt behavioral changes.
With treatment, Joan’s symptoms improved, reminding Ellie how physical health issues can dramatically impact cognitive symptoms in those living with Alzheimer’s.
Ellie’s story is all too familiar for those caring for a loved one with Alzheimer’s. Alzheimer’s is often associated with symptoms like agitation, confusion, unpredictability, and even hallucinations, along with its gradual progression. So, when faced with abrupt changes in behavior—like Joan’s sudden agitation and accusations—it’s easy to assume it’s just another difficult stage of the disease.
However, when changes occur suddenly, seemingly overnight, it’s a red flag that something else may be happening. In many cases, these abrupt shifts in behavior are signs of a urinary tract infection (UTI). UTIs in older adults, particularly those with Alzheimer's or other dementias, often present differently than in younger individuals and can lead to delirium—a sudden and severe change in mental state, resulting in heightened confusion, aggression, behavior changes, or even hallucinations.[1]
Recognizing UTI symptoms in a person with Alzheimer’s is crucial for those involved in their care, including family, friends, and caregivers, as early detection and treatment can help prevent unnecessary suffering and serious complications.
In this article, we’ll explore:
- Definition of a UTI
- Impacts on the brain
- Recognizing symptoms at different stages of Alzheimer’s
- The importance of prompt intervention
- The role of treatment and prevention in managing these infections
By being informed, individuals can better support their loved ones and ensure that a treatable issue like a UTI doesn’t lead to unnecessary suffering or further decline.
What Is a UTI?
A urinary tract infection (UTI) occurs when bacteria enter the urinary tract, leading to infection. While both men and women can develop UTIs, they are far more common in women.[2] Often dismissed as minor and easily treatable, UTIs can take on a very different trajectory as a person ages. For older adults, particularly those with conditions like Alzheimer’s disease, a UTI can cause sudden and significant changes in behavior and health, underscoring the importance of recognizing and addressing these infections promptly.[3]
Impacts on the Brain
When an older adult with Alzheimer’s develops a UTI, the body responds by releasing chemicals to fight the infection. While this reaction is usually contained, it can sometimes affect brain function, especially in those with dementia.[4] This may be due in part to age-related changes, including a weakened ability to keep harmful substances out of the brain. As a result, the infection can trigger sudden confusion, agitation, or even hallucinations.[5] Because these symptoms can resemble Alzheimer’s progression, they are often overlooked. However, they may actually be signs of delirium—a serious but treatable condition that requires quick medical attention.[6]
Alzheimer’s Stages and UTI Symptoms
Below is a comparison chart of some of the most common UTI symptoms found in a person with Alzheimer’s. UTI symptoms can closely mirror Alzheimer’s disease’s existing challenges, making it essential to focus not just on their presence, but on how suddenly and severely they emerge.[7] Alzheimer’s is a progressive disease, meaning symptoms gradually worsen over time. If sudden changes occur—such as increased confusion, agitation, or incontinence seemingly overnight—it may signal an underlying issue, like a UTI. Recognizing these abrupt shifts can help ensure timely medical intervention, preventing further complications.
| Symptom | Early Stage Alzheimer’s | Middle Stage Alzheimer’s | Late Stage Alzheimer’s |
|---|---|---|---|
| Confusion/ Disorientation | Mild forgetfulness and occasional disorientation, but still compensates | Growing trouble with conversations, memory, and recognition | Severe disorientation; may not recognize family or surroundings, causing distress |
| Agitation/ Behavioral Changes | Mild irritability or frustration, still able to express emotions | Heightened mood swings, restlessness, aggression, or resistance to care | Severe agitation, withdrawal, or unpredictable aggression, including possible outbursts |
| Urinary Changes | May have increased urgency/frequency but recognizes the need to urinate | May forget to use the bathroom, have more accidents, and resist toileting | Frequent incontinence, with changes in urine color, odor, and concentration |
| Fatigue/ Weakness | May experience occasional fatigue but remains generally active | Increased daytime drowsiness and napping, along with lower energy levels | Severe lethargy, difficulty swallowing, and trouble staying awake |
| Hallucinations/ Delusions | Rare, but possible in some individuals | More frequent hallucinations or delusions, such as seeing or hearing things | Persistent hallucinations and delusions; trouble distinguishing reality. |
Importance of Prompt Intervention and Treatment
Delaying the diagnosis and treatment of a UTI in someone with Alzheimer’s can lead to serious complications such as delirium, kidney infections, and sepsis, all of which can result in irreversible decline or even be life-threatening. Early detection and prompt treatment are crucial, as they significantly improve the chances of full recovery or at least reduce lasting damage.[8] Given that Alzheimer’s already affects cognitive function, any sudden changes in behavior or mental alertness should be carefully monitored, as they could indicate an underlying infection that requires immediate attention.
Effective UTI treatment depends on factors such as severity and overall health, including the individual's stage of Alzheimer’s. The most common approach is oral antibiotics, though IV antibiotics may be needed in severe cases. If a UTI triggers delirium, doctors may prescribe short-term antipsychotic medication, but only when non-drug approaches are ineffective and symptoms cause significant distress.[9]
Prevention and Helpful Tips
Preventing UTIs starts with staying hydrated, maintaining regular bathroom habits, and practicing good hygiene—but as any caregiver knows, these simple steps can be anything but easy when caring for someone with Alzheimer’s.[10] A well-intended reminder like “Do you need to use the bathroom?” or “Make sure to drink plenty of water today” can quickly turn into a struggle, leaving both the caregiver and their loved one feeling frustrated and exhausted. To help reduce resistance and make these habits feel more natural, try implementing some of the following strategies:
- Make hydration feel like their choice. Offer a variety of drinks and let them decide what they’d like to sip on.
- Play into their interests. Serve drinks in fun cups, like one that displays their favorite sports team or one tied to a fond memory. This can make hydration more appealing.
- Incorporate bathroom breaks into daily routines by linking them to natural transitions. Before activities like mealtimes, TV breaks, or afternoon walks, guide the person to the bathroom by saying, “Let’s freshen up” and then gently transition that into an opportunity to use the toilet.
- Use positive, non-accusatory language. Avoid statements like “You haven’t gone all morning—you need to at least try.” Instead, opt for softer phrases such as “It’s always nice to feel clean.” This helps prevent resistance and makes the experience feel more natural.
- Make the environment as comfortable and accessible as possible. Simple adjustments—like ensuring shoes and clothing are easy to slip on and off—can make dressing and undressing less of a struggle. Leaving the bathroom door open can also serve as a helpful visual cue.
The goal is to make hydration and bathroom breaks feel like a natural part of the daily routine by fostering a non-confrontational environment that respects the person's autonomy as much as possible.
Final Thoughts
UTIs may seem like a minor health issue, but for individuals with Alzheimer’s, they can have serious and even life-threatening consequences. Because these infections can mimic or worsen dementia symptoms, recognizing the signs and acting quickly is essential. By staying informed, implementing prevention strategies, and advocating for timely medical care, families and caregivers can help protect their loved ones from unnecessary suffering. While Alzheimer’s presents many challenges, understanding how infections impact cognitive health can empower those providing care to make a meaningful difference in their loved one’s well-being.
Dealing with the impact of a UTI in someone with Alzheimer’s can feel overwhelming. For further questions or support, we encourage you to visit Alzheimer’s Texas or call our 24/7 Helpline at (512) 241-0420. Our compassionate team is here to listen, provide resources, and help you manage the challenges of navigating both the infection and its effects on your loved one’s health.
Austin McKee, MSSW, is the Helpline Specialist and Content Creator at Alzheimer’s Texas. With a Master of Science in Social Work, Austin has extensive experience in geriatric care, including social support and engagement, end-of-life care, and caregiver support. She is passionate about bridging the gap between generations, fostering mutual understanding, and helping people recognize the inherent value and purpose in individuals of all ages, regardless of physical or cognitive changes.
Sources:
[1] Healthline, How Urinary Tract Infections (UTIs) Affect Older Adults and Those with Dementia., last reviewed May 13, 2024, https://www.healthline.com/health/dementia/uti-and-dementia (accessed January 25, 2025).
[2] Centers for Disease Control and Prevention, Urinary Tract Infections Basics., last reviewed January 22, 2024, https://www.cdc.gov/uti/about/index.html (accessed February 3, 2025).
[3] VeryWellHealth, Urinary Tract Infections and People with Dementia., last reviewed February 3, 2023, https://www.verywellhealth.com/urinary-tract-infections-in-people-with-dementia-3573873 (accessed January 23, 2025).
[4] National Institute of Health, The Nature of Immune Responses to Urinary Tract Infections., Last reviewed October 1, 2016. https://pmc.ncbi.nlm.nih.gov/articles/PMC4926313/# (accessed on January 15, 2025).
[5] GoodRx, Why Does a Urinary Tract Infection(UTI) Cause Confusion in Older Adults?, Last reviewed August 26th, 2024. https://www.goodrx.com/conditions/urinary-tract-infection/uti-and-confusion (accessed February 3, 2025).
[6] Alzheimer’s Association, Sudden Change in Behavior? Urinary Tract Infection Could be the Cause., March 2020, https://www.alz.org/blog/2011/sudden-change-in-behavior-urinary-tract-infection-could-be-the-cause (accessed January 23, 2025).
[7] Healthline, How Urinary Tract Infections (UTIs) Affect Older Adults and Those with Dementia., last reviewed May 13, 2024, https://www.healthline.com/health/dementia/uti-and-dementia (accessed January 27, 2025).
[8] Healthline, How Urinary Tract Infections (UTIs) Affect Older Adults and Those with Dementia., last reviewed May 13, 2024, https://www.healthline.com/health/dementia/uti-and-dementia (accessed January 25, 2025).
[9] Alzheimer Society, UTIs and Delirium., Last reviewed 2025, https://www.alzheimers.org.uk/get-support/daily-living/UTIs-and-delirium# (accessed January 28, 2025).
[10] VeryWellHealth, Urinary Tract Infections and People with Dementia., last reviewed February 3, 2023, https://www.verywellhealth.com/urinary-tract-infections-in-people-with-dementia-3573873 (accessed January 23, 2025).