Urinary tract infections and other types of infections are closely associated with delirium, a short-term state of confusion.about 30 percent Percentage of older adults with urinary tract infections develop delirium, which is caused by infection About half of delirium cases.
“We don’t know about patients, but the general public knows how a UTI can do this,” he said. Shori Lahiri, associate professor of neurology, biomedical science, and neurosurgery at Cedars-Sinai Medical Center. “If you have an episode of confusion, this is an opportunity to seek medical advice and assess your symptoms. An underlying urinary tract infection. Doing so would preserve not only short-term cognition but also perhaps long-term cognitive function. ”
How delirium contributes to dementia
Delirium is an acute, disorganized mental state characterized by inattention, executive dysfunction, and short-term memory deficits that vary in severity. Triggers for delirium include infections and certain medical procedures and medications.
Delirium is usually thought to be a temporary cognitive condition, but if its cause “remains unresolved or untreated, delirium can accelerate and become increasingly severe.” Lahiri said. “It can leave a permanent mark.”
It’s also surprisingly common, especially among hospitalized patients.Some studies have estimated that 15-30% number of patients in the ward 70 percent of patients Seriously ill people develop delirium. Every year, Over 2.6 million Americans over 65 develop delirium.
Some people mistakenly think that delirium is normal for older people.
“People think delirium is safe,” he said. Wes Ealy, professor of medicine and co-director of the Center for Critical Illness, Brain Dysfunction, and Survivorship at Vanderbilt University Medical Center. “It’s very, very dangerous. It’s extremely dangerous for someone to go into a state of delirium.”
In the short term, “delirium increases length of hospital stay and is associated with increased mortality,” Lahiri said. “It is associated with unimaginable human suffering.”
Older people are more susceptible to delirium, likely because of age-related changes in the blood-brain barrier that reduce their “brain reserve” to compensate for the additional challenges to the brain.
However, delirium can also be costly in the long term if not properly managed.
“This accelerates chronic brain dysfunction,” Lahiri says. “I think of it like this. Modifiable risk factors Mitigating Alzheimer’s disease and related dementias can slow the progression of these diseases. ”
Research shows that people who are diagnosed with dementia and subsequently develop delirium; Cognitive decline doubles the rate Compared to people who don’t. There is also. Dose response effect Degree of delirium in long-term cognition: The more severe the delirium, the higher the risk of dementia.
Infectious diseases increase risk of dementia
Emerging evidence is emerging that infections themselves, including urinary tract infections, are associated with an increased risk of dementia.a 2021 survey The electronic health records of 989,800 adults aged 65 and over with no history of dementia or cognitive impairment in the UK were followed.
After adjusting for a variety of other factors, including gender, ethnicity, smoking, and alcohol consumption, the researchers found that overall, people with some infections were more likely to develop dementia than those without infections. They found that the risk of developing the disease was 1.53 times greater.
The more severe the infection, such as sepsis or pneumonia, the more likely a person is to develop dementia later in life. Those admitted to hospital fared worst, with their risk of dementia almost doubling. However, even mild infections such as urinary tract infections increased the risk of subsequent dementia by 1.73 times.
Because this study is associational, it cannot prove causation. People with dementia also more likely to develop an infection, for example. However, the risk remained elevated more than nine years after infection.
“What we really need now is to truly understand the mechanisms behind the link between infectious diseases and dementia,” he said. Rutendo Mzambi, a research fellow at the London School of Hygiene and Tropical Medicine and author of the study. Clinical trials are also needed to test whether strategies to reduce infections lower the risk of dementia, she says. Said.
One common factor may be inflammation caused by the immune response to infection. It is initially an infection of the body and can then spread to the brain.
The brain’s frontal lobes, important for executive function, and the hippocampus, important for memory, are particularly affected during delirium, said Ely, a co-author of the study. review About delirium in 2020.
in 2021 survey, Lahiri et al. reported that mice with urinary tract infections exhibited delirium-like behavior, meaning they became more anxious in the maze compared to mice without urinary tract infections. These behavioral changes were correlated with increases in inflammatory cytokines and neuronal changes in the mice’s frontal cortex and hippocampus.
“These cells are damaged and not working properly, which can confuse patients,” Ely says. “And if that process continues and the cells die, that’s when dementia develops.”
How to reduce your risk of urinary tract infections, delirium, and dementia
Stay hydrated and urinate frequently to reduce the risk of urinary tract infections. Pay attention to whether your urination becomes painful, difficult, or frequent, or if you start to have a fever, chills, or fatigue.
If a urinary tract infection occurs, seek immediate medical attention. This reduces the risk of known serious complications such as delirium and sepsis, but more evidence is needed to see if it also prevents the risk of dementia, Mzambi said.
Caregivers should reorient their loved one who is suffering from delirium. Ely, who is the author of “Every Deep-Drawn Breath,” a book about emergency medicine and delirium, said patients need to be constantly mobilized to ensure they are sleeping well at night and awake during the day.
Addresses other common but preventable risk factors for dementia, such as hearing loss, excessive alcohol consumption, and smoking.
Have questions about human behavior or neuroscience? Email BrainMatters@washpost.com I may answer that in a future column.