Depression and urinary tract infections

[Lilygilly]

My sister and I have cared for our mother who has Alzheimer's since 2005. It would have helped HUGELY had it been suggested to us that some of the symptoms thought to be Alzheimer's can be due to depression. When we researched the disease we requested anti-depressants for Mum, starting at a very low dose. Her GP was initially reluctant to prescribe them, saying it might make her more confused, however they really improved her general wellbeing and she bcame much more like the Mum she used to be and we realised that the disease didn't have such a big grip on her as had first appeared.

The second big thing is urinary tract infections which can be difficult to recognise. Mum has now had a few, but the two most recent sent her quite "mad", as she hallucinated and became verbally aggressive, symptoms that distress and terrify her, and us. Unfortunately by the time you realise that she may have an infection, get a water sample, have the GP test it and obtain and administer antibiotics, things can be quite desperate.

If Alzheimer information sources were to red flag these 2 things for carers to consider, we might have thought about them when father-in-law had dementia, and questioned whether anti-depressants might have helped him (and therefore my mother-in-law who was the object of his rage)and it is likely that some of his more bizarre behaviour may well have been due to urinary tract infections. Not all carers ask for help from GPs, assuming it to be just the disease, and not all GPs automatically suggest either things might be the problem.

The only way we found out about the potential seriousness of urinary infections in the dementia patient was by Googling "urine infections". Perhaps something could be flagged at the top of this website suggesting that depression or urinary infections can sometimes make Alzheimer's symptoms worse?

Barbara

 

[Lynne]

Hello Barbara, and welcome to TP.

I agree Dementia vs. Depression is a frequent mis-diagnosis, in both directions.
My Mother's case was the opposite to your own; as her sister died in 2005, her early dementia symptoms were put down to grief & depression.

As regards UTIs you are leaning against an open door here with that one!!
You'll find it cropping up again & again on this forum, and yet at times family members seem to have to prompt medics to check for an infection.

I hope you find the wealth of family-carer experience shared here to be helpful;
if only a few medical professionals would get off their high horses & look in, they might learn something to their advantage!

 

[sue38]

UTI's

The fact that despite the fact that UTI's are so common and yet the information on them is either not there or difficult to find came up in a thread some time ago.

Took me a while to find it but here it is:-

http://www.alzheimers.org.uk/talkingpoint/discuss/showthread.php?t=13046

Still there is nothing on TP, nor on the main AS website, about UTI's. Not even under the new A-Z.

 

[jenniferpa]

Thanks for reminding us about this Sue - I'll raise the issue.

 

[Lilygilly]

UTIs

Thank you to all who responded, but would it be possible to preface the link on the sticky with the advice that urinary tract infections in the dementia patient very often do not display the usual physical symptoms, but that they can cause significant mental confusion, aggression and hallucinations?

Whilst Mum has had a few UTIs, the most recent two displayed no obvious physical symptoms and when we spoke to her GP about her being unusually verbally aggressive, she issued a prescription for Seroquel. This, we found, is an anti-psychotic drug prescribed for schizophrenia, and having read of it's side effects and the fact that it should not be given to elderly dementia sufferers, we did not give it. I can't remember what prompted us, but shortly afterward we had her urine tested which revealed a UTI. Antibiotics returned her to herself.

This latest episode began with her being a bit verbally aggressive, then the next morning as she left the toilet she told a carer "there's someone in there". That night she was put to bed and at 1am she woke my sister complaining her chest hurt and then broke into a tirade about someone having stolen her pyjamas while she was being undressed and putting some in their place that didn't belong to her. She was hallucinating that people were in the house who shouldn't have been and was angry and frightened, which we realised was causing the chest pain as she was in such a state. At 3am and still awake, my sister heard her praying out loud, begging Jesus to please help her. So sad to see her so very frightened.

She now has antibiotics and is slowly getting back to normal, but this awful disease is cruel enough as it is without a fairly common complaint such as a UTI being able to go undetected whilst wreaking havoc on a helpless victim, so if my posts are of help to anyone in the future, I will be very grateful.

Barbara

 

[Skye]

Barbara, this thread is the story of my experience with my husband John's undiagnosed UTI.

It's long, and scary, but hopefully will contain valuable information for others.

http://www.alzheimers.org.uk/talkingpoint/discuss/showthread.php?t=7730

Have you noticed that there's now a sticky on the subject?

 

[Margarita]

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[johne]

The second big thing is urinary tract infections which can be difficult to recognise. Perhaps something could be flagged at the top of this website suggesting that depression or urinary infections can sometimes make Alzheimer's symptoms worse?

Barbara

My Dad has just been diagnosed with urinary infection, as you imply, if the symptoms are similar to dementia how can it be recognised? Dad is fortuneate in that his lunchtime carers thought his confusion was increasing more rapidly than 'normal' in their experience and so suggested I contact his GP. Those of us who don't see a number of people each week really have no idea whether deterioration is due to dementia or something else.
John.

 

[Brucie]

Hi John

Good question.

I think that we might take a leaf out of the doctor's book here.

When diagnosing dementia, they tend to rule out all other possible causes for symptoms first, because many things [UTIs, depression, stress] can give dementia-like symptoms.

If a UTI has been identified, then that should be sorted and afterwards his symptoms reviewed.

... all just my opinion....

 

[Margarita]

When diagnosing dementia, they tend to rule out all other possible causes for symptoms first, because many things [UTIs, depression, stress] can give dementia-like symptoms.

My mother has been diagnosing with a dementia 02 , after they thought it was depresstion .But then my father had also died so it was natural to feel depressed .


Then my mother was given medication for depression that never help , until my mother had brain scan was told it was AZ , was given medcation for AZ

Living in it, experience the symptoms of dementia it amazes me that anyone could mistake depression for the symptoms of a dementia.

With urinary tract infections which my mother has never had, but has had few drops in my mother dementica . Is always put down to a urinary tract infections. when urine come back negtive

Then it’s put down to changes in the brain due to the dementia .

so yes its always best to get urine check out, to rule it out.

 

[Skye]

Those of us who don't see a number of people each week really have no idea whether deterioration is due to dementia or something else.

I think it's a sudden, rapid deterioration that is a possible sign of UTI.

Normally with AD, the deterioration is gradual, and a sudden change in behaviour or awareness is a warning sign. In my husband's case, it was aggression, when he had never previously been aggessive, and falls due to a loss of balance.

If there is vascular dementia present, this sort of change could signal further vascular damage to the brain rather than infection. Either way, you would need to see the GP as soon as possible, and get the urine checked.

 

[Mameeskye]

To make matters worse Mum originally just appeared to be depressed and different. It was put down to my Dad dying a wee while earlier. But the depression -like symptoms increased and then the forgetfulness started. I will always remember shortly after the birth of my sons my Mum looking at me and saying "nothing good has happened at all this year" It so hurt at the time without knowing it was dementia causing it.

I generally got them to check for UTIs when Mum fell over. We started to realise that although Mum was really mostly steady on her feet she always fell over at the start of a UTI. So we started to put 2 + 2 together and when Mum fell over her urine was tested and mostly she had a UTI.

|This was after the first time that landed her in hospital. The increase in confusion, hallucinations etc. at that time were scary and the staff did not cope at all.

MAmeeskye

 

[Lilygilly]

I think I may have been somewhat ambiguous in my original message. What I meant in regard to depression was that when a person is newly diagnosed with Alzheimer's it might be worth looking into whether the person has depression, which was the case with Mum because although I'm sure she knew things weren't right, she was in denial and very afraid of losing control of her life and independence. Low dosage antidepressants have helped but of course every patient is different.

In regard to UTIs, the "experts" know that these can cause problems in the brain, so that if the behaviour of the person you are caring for tends to be fairly consistent, but then suddenly changes, deteriorating rapidly, with symptoms that perhaps they haven't previously displayed, a UTI might possibly be the cause.

Among Mum's unusual changes were 1)she started to be verbally aggressive 3) she was having hallucinations, and seeing people as intruders in her home, 3) she became a lot more unsteady on her feet and 4) she became weepy.

The day that she refused to come out of the toilet for her shower, my sister put her on the phone to me and she sobbed to me, asking to be allowed to "go home". That's when we knew she was in real trouble because although she displays lots of typical Alzheimer's behaviour, these things all appeared over just 2-3 days, out of the blue. That's how you might be able to tell - it's not their "usual" behaviour.

If only we'd known to look out for this, she (and we), might not have had to suffer distress for so long, especially since the medication can take some time to take effect. Of course, nothing is straightforward with dementia, and we have had negative results from a urine test only to find after a further test, that there was an infection! The GP says that often happens, although on the most recent occasions when she did the "dipping" test at the surgery, both times she got positives.

Barbara