Alzheimer's disease Featured The Memory Doctor

The top 3 medical problems to watch for in people with dementia

daughter and father with dementia
Dr. Nathan Herrmann

You’d think that for the person coping with an illness like dementia, forgetfulness, difficulties with daily activities and behaviour problems would be enough to cope with. Unfortunately, individuals with dementia are also likely to have a number of medical problems that will require monitoring and treatment.

When new medical problems arise, there is a significant chance that a person’s cognition or thinking, ability to function and behaviour may worsen. That is why it is very important for caregivers to continuously monitor the person with dementia and seek appropriate medical care whenever there is concern.

Rather than assuming a change, or any “worsening,” is being caused by the “natural” deterioration of the dementia, caregivers must be aware that any sudden change in cognition, function and behaviour is a clue that something medical might be happening.

While older persons with dementia are susceptible to all the medical problems that typically occur at this age, there are several conditions that are more common and worth paying particular attention to.

Urinary incontinence

With disease progression, and commonly in the moderate to severe stages of the illness, people with dementia often lose the ability to control their bladder function, referred to as urinary incontinence. However, urinary incontinence that occurs early in the disease, or that occurs suddenly at any stage, could be associated with a bladder, or urinary tract infection (UTI).

UTIs are very common in older females and the person with dementia may not be able to complain about frequently associated symptoms such as pain and burning with urination. Caregivers should ensure that a UTI is ruled-out with a simple test of the urine, because UTIs can also cause delirium in the person with dementia, leading to acute and dramatic changes in cognition and behaviour.

Treatment of UTIs with antibiotics is also simple and straightforward and can lead quickly to improvements in symptoms including both the incontinence and the dementia. Besides UTIs, there are many other causes of urinary incontinence that may require medical treatment. Again, caregivers should not necessarily consider this a sign of dementia progression, but rather should seek prompt medical attention.

Interestingly, when urinary incontinence occurs early in the course of dementia, and is accompanied by an unsteady gait, this could be the sign of a specific and relatively rare form of dementia called Normal Pressure Hydrocephalus, notable for being potentially treatable with a neurosurgical procedure.

Shaking, stiffness and unsteady

Parkinsonism, or symptoms of Parkinson’s Disease, include tremor (shaking), stiffness/rigidity, and unsteadiness. These symptoms can worsen function and lead to falls. The relationship between dementia and Parkinsonian symptoms is extremely complicated, because patients with Parkinson’s Disease can also have cognitive impairment and dementia (referred to as Parkinson’s Disease Dementia). Prominent Parkinson’s symptoms are also a part of another common dementia called Dementia with Lewy Bodies. Furthermore, patients with Alzheimer’s Disease can have mild Parkinson’s symptoms, which become more common in the advanced stages of the illness.

Finally, there are a number of medications that can cause Parkinson’s symptoms. This is a particularly common side-effect of the antipsychotics, which are used to treat agitation and aggression in persons with dementia. Depending on the cause of the Parkinsonism, the symptoms may be more or less treatable, but caregivers should always be aware of these symptoms and report them to the treating physician because it’s important to diagnose and in terms of quality of life.

Seizures

Seizures are generally brief episodes of abnormal electrical brain activity that cause periods of shaking, either generalized or focal (e.g. a single limb), with variable states of consciousness (frequently a complete loss of consciousness).

People who suffer from multiple episodes of seizures associated with a brain disorder are said to have epilepsy. People with epilepsy earlier in life can develop dementia, but it also not uncommon for people with dementia to have a seizure for the first time after they have been diagnosed with dementia.

Seizures in patients with dementia can be caused by many conditions including strokes (either brain blood vessel blockage or bleeding), brain tumours, fever, infection, head injuries and medications. About 10% of patients with Alzheimer’s disease will have a seizure, usually in the moderate to severe stages of the illness with no obvious cause being found, and likely due to the brain degeneration.

All persons with dementia who have a first seizure should be investigated for potentially treatable conditions. Seizures associated with progressive Alzheimer’s Disease may not recur and may not require treatment with anti-epileptic drugs. Finally, people with long-standing epilepsy treated with anti-epileptic drugs who develop cognitive impairment and dementia may require reassessment of the doses and type of drug used, as these medications can be associated with prominent negative cognitive effects.

Good general medical care is synonymous with good dementia care. People with dementia should be monitored regularly by their primary care physician, and any significant change in their condition should be brought to the attention of the physician by the caregiver, and investigated and treated appropriately. It is only with excellent medical care, that we can optimize the cognition, function, behaviour and quality of life of the person with dementia.

About the author

Dr. Nathan Herrmann

Dr. Nathan Herrmann

Dr. Nathan Herrmann holds the Lewar Chair in Geriatric Psychiatry and is Head of the Division of Geriatric Psychiatry at Sunnybrook Health Sciences Centre. For 25 years, Dr. Nathan Herrmann has been a memory disorders specialist. He has done research in the fields of mental health in the aging, including dementia, Alzheimer’s disease, depression, and suicide. Read his blog series: The Memory Doctor.