As Alzheimer’s disease progresses, the resulting cognitive impairments can make some medical conditions more common. While common, these conditions can be sneaky — signs and symptoms can appear suddenly, and they may be mistaken for another condition or even dismissed or misdiagnosed as signs of dementia. If caregivers don’t know what to look for, they may not recognize when something arises that could risk their loved one’s health and longevity.
As the owner of Be Light Care Consulting, Adria Thompson personalizes therapy care and provides resources to help those helping others with dementia. The Certified Dementia Practitioner ®and Dementia Consultant weighs in with her expertise.
“Caregivers also are often in the thick of providing the daily needed care for basic survival, so it may be easy to overlook the beginning signs of medical conditions,” she adds. “Doctors and other medical providers can be a much-needed outside perspective that may pick up on signs and symptoms of an illness or disease.”
Here are four medical conditions commonly associated with Alzheimer’s disease that every caregiver should be aware of:
Incontinence
Incontinence is the lack of voluntary control of urine and, eventually, feces. Thompson says it’s common for incontinence of the bladder and bowels to occur as Alzheimer’s disease progresses.
“Incontinence can occur as a result of the changes in a person’s physical ability to ‘hold it,’ but it also can be caused by difficulty in getting to a bathroom in time. This is called ‘functional’ incontinence. A person with dementia may feel the sensation to urinate and be able to hold it, but be cognitively unable to navigate their environment to find an appropriate place to relieve themselves.”
Signs of incontinence:
- Leaking urine when laughing, coughing, sneezing, or lifting things
- Problems emptying the bladder
- Soiled clothes and bed sheets
- Trouble making it to the bathroom in time
- Urinating or defecating in places other than the bathroom
If you notice any of these signs or behaviors, tell your loved one’s doctor so you can identify and treat the underlying issue. The solution may be as simple as some lifestyle changes. Or, these symptoms could be pointing to a more serious condition that requires medical intervention.
Tips for dealing with incontinence:
- Offer frequent bathroom reminders (every 2-3 hours and immediately before bed).
- Be understanding when accidents occur — because they will. Stay calm and reassure your loved one if they are upset.
- Use incontinence supplies like adult disposable briefs or underwear, bed protectors, and waterproof mattress covers.
- Limit fluid intake (especially caffeine) after 6 p.m.
- Put signs on the bathroom doors and near the toilet so your loved one remembers where to go.
Pressure ulcers or bedsores
Sitting or lying in the same position for too long can cause pressure ulcers, also known as bed sores. They typically develop in bony areas of the body like elbows, heels, tailbone, spine, and the back of the head from sitting or lying in a position for a long time. The skin in places that come in contact with another surface begins to break down and can become infected. When skin is moist and warm, this breakdown can happen quicker.
The Mayo Clinic lists warning signs of bedsores or pressure ulcers as follows:
- Unusual changes in skin color or texture
- Swelling
- Pus-like draining
- An area of skin that feels cooler or warmer to the touch than other areas
- Tender areas
“Individuals with dementia can sometimes be unaware of painful places developing, be unable to change positions independently, and be unable to effectively communicate with caregivers to request assistance,” Thompson explains.
Caregivers can help their loved one avoid or treat pressure ulcers by regularly checking the areas pressure ulcers may appear. Make sure to reduce the pressure and friction that causes them by helping them reposition and use support sources (like special cushions) to protect vulnerable skin. If they have wounds, clean and dress them properly to prevent infection.
If the bedsores don’t improve in 24 to 48 hours, contact your loved one’s health care provider. Seek immediate medical care if they show signs of infection, such as a fever, drainage from a sore, a sore that smells bad, changes in skin color, warmth, or swelling around a sore.
Urinary tract infections (UTI)
UTIs are caused by bacteria entering the urethra and infecting the urinary tract. Typical UTI symptoms like burning and frequent urination often do not appear in older adults or may be too subtle for caregivers to notice. Instead, UTIs may present in older adults as behavioral changes, appearing as symptoms typically associated with cognitive issues, such as:
- Frequent falls
- Confusion
- Dizziness
- Agitation or aggression
- Fatigue and lethargy
- Decreased appetite
UTIs in older adults are commonly caused by factors and conditions like diabetes, catheter usage, immobility, kidney stones, and even dehydration. But Thompson reminds caregivers that UTIs are frequently related to incontinence, especially for people who wear incontinence products. “If they are unable to clean themselves and put on a new product or reliably and effectively communicate to their caregivers that they need assistance, they may wear a dirty incontinence product for a long time.”
Your loved one may not feel comfortable sharing their symptoms or discomfort, or it’s possible they aren’t experiencing any urinary symptoms at all. Caregivers must be aware of these symptoms so they can carefully monitor for any early signs. A UTI can be misdiagnosed as symptoms of dementia or aging. If untreated, it can spread to the kidneys and cause an even more severe infection that could become life-threatening.
If you suspect your loved one has a UTI, immediately contact their healthcare provider, who can perform urinalysis or other tests to confirm the diagnosis and prescribe antibiotics if needed.
Tips for preventing or cutting down the frequency of UTIs:
- Women should always wipe from front to back, moving any bacteria away from the urethral opening. Caregivers should also follow these protocols.
- Urinary catheters should be inserted in the cleanest possible environment and protected from contamination.
- Hydration and drinking plenty of water helps flush bacteria from the urethra.
Dysphagia
Dysphagia is a swallowing disorder caused by changes in strength and coordination of the muscles and body parts responsible for chewing and swallowing. Thompson, also a speech-language pathologist, says individuals with late-stage dementia are more prone to developing dysphagia and may no longer be able to chew and swallow easily.
Signs and symptoms of dysphagia commonly include:
- Coughing or choking when eating or drinking
- Bringing food back up, sometimes through the nose
- A sensation that food is stuck in your throat or chest
- Persistent drooling of saliva
Thompson warns that dysphagia often results in serious — even deadly — health consequences. Difficulty swallowing may lead to choking or inadvertently inhaling food particles, liquids, or even gastric fluid into the lungs. This is known as aspiration, which can lead to pneumonia.
“An aspiration is anything that enters the airways or lungs other than air, such as food or drink. We often describe this as things ‘going down the wrong way.’ The body responds to these foreign objects by mounting an immune response, resulting in pneumonia.”
Because people with Alzheimer’s disease have impaired immune systems, pneumonia is often fatal; in fact, research shows that the most common cause of death among Alzheimer’s patients is aspiration pneumonia. Caregivers can help prevent aspiration in a loved one or patient with dysphagia with these practices:
- Minimize distractions when drinking and eating
- Make sure they are sitting with good posture and propped up to at least a 45-degree angle
- Cut food into small, bite-sized pieces and encourage slow and thorough chewing after each bite
- Practice good oral health and get dental treatment (such as dentures) when needed
It’s important to prevent and treat these medical conditions before they become life-threatening.
Thompson reminds caregivers that medical issues can quickly become dangerous if they are misdiagnosed or left untreated for too long. Infections related to UTIs, pneumonia, and bedsores can spread to the bloodstream and develop into sepsis, a life-threatening medical condition that can be hard to treat, even fatal. Research shows that UTIs cause more than half the cases of urosepsis among older adults.
“Many of these medical conditions are complicated by the individual with dementia’s inability to communicate their discomfort, pain, and needs. They are difficult to predict and see coming. This means that caregivers may have to look for nonverbal signs of disease and illness, which may not always be reliable,” Thompson says. “Objective tests like blood work or urine testing will take the guesswork out of figuring out whether there is a problem. Regular medical care can prevent complications and allow caregivers to treat issues before they get out of hand.”
Thompson adds that caregivers must explore available resources to help them prevent medical conditions. She says services like physical, occupational, and speech therapy are often available and completely covered by Medicare; they can maintain physical and cognitive abilities for longer, but they are often under-referred.
