Mom is 90, sudden on set confusion and memory loss, due, we think to a uti. How long does it take for the "fog" to clear?

Hi - just had Mum in hospital with serious UTI and delirum. We followed up with visit to geriatrician. Basically serious infections impact negatively on cognition and he advised that every time she got an infection (particularly UTI) her cognition would deteriorate. However, she would recover but not to where she was at prior to the infection. So our strategy is to avoid UTIs and this has involved some "intimate' and ongoing discussions with Mum about how to maintain good personal hygiene - wiping front to back, using flushable wipes where there might be difficultly in wiping. We are about to put a sign up in the toilet on the "rules". Also ensuring clean underwear daily and even at night. Another tip was a glass of cranberry juice at least once a day (I find she prefers the rasberry/cranberry). Cranberry apparently has a slight antiseptic affect in stopping the infection attaching to the urethra - but someone more qualified might be able to explain this. I have now become aware of how dangerous UTIs are in elderly women particularly where some cognitive impairment already exists. Mum is nearly back to her old self after about 6 weeks but not quite and probably wont be. It will be an ongoing battle and if there is a propensity for UTIs, as my Mum had, we were told to get a urine test if we notice the slightest change in cognition or otherwise. The worse UTIs like the one she just experienced are asymptomatic so you dont even know they have it till they completely crash. Good luck - its a battle.

Hi - some good discussion. I think the key issue here is that cognitive impairment has been due to previous stroke. I really do not accept the "oh its just a part of ageing". Sorry but the new findings on the plasticity of the brain put paid to the old acceptance that memory loss is a "natural" part of ageing. No cognitive impairment is due to specific changes that impact on the brain. Luckily my Mum's damage is vascular and not altzheimers. The fact of this damage what is suspected to be micro strokes in the past caused the initial cognitive impairment. Infections, particularly UTIs are, besides strokes, the biggest threat to further impairment. I think that it is about accepting that there will be a gradual decline with each infection episode - a fog afterwards, a recovery but not back to where she was. In the end as the Geriatrician said there is no magic pill and the best results for cognitive impairment arise from ensuring social interaction and participation, lots of mind stimulating activity - not anything strenuous. We saw the best result in my mother after this episode when a noisy bunch of family sat around her table for dinner (and we made sure she wore her hearing aids). I was nearly in tears when I saw the incredible change in her, the participation in talk and smiles AND she ate all her meal!! It was a real eye opener to me. I love Geriatricians - they are whole people clinicians and his advice was right and is one that is so neglected. Loneliness and inactivity are the enemy of cognition regardless of everything else. BUT do watch out for those UTIs.

I forgot to mention the use of probiotics, like acidophilus, or yogurts, especially after the use of antibiotics. Antibiotics will kill off beneficial bacteria in your system as well as the bad, and it's important to repopulate the good bacteria as quickly as possible. Some claim regular use of probiotics can drastically reduce recurrence of UTI's, and it makes sense since it's the good bacteria that are keeping the bad in check.

Thanks LadeeC for your list of some of the key signs of a UTI in your Mum. Yes we saw the physical weakness and given your experience we will watch for it as a major sign for my mother that it might be a UTI.

Re the issue of antibiotics. One of the huge problems is administration of antibiotics prior to a culture being taken particularly for the elderly and where a UTI is suspected. Mum spent two weeks in hospital with not a real recovery, then a recurrence where we ended up taking her to the ED. I said to the ED doctors and nurses that they were not to bring an antibiotic near her until they took urine and blood for cultures. The upshot is that for about 4 weeks she was on antibiotics that had little or no chance against the specific bacteria she was fighting. She started improving about 3 days on the right antibiotics and needed two courses. This is the second time I have seen assumptions made on antibiotics in an older person that nearly cost them their life. (The bug Mum had has a 61% fatality rate in older women and boy was she ill).

I cant understand the hesitation in taking a urine sample by clinicians or nursing support. Its not costly and besides the normal dip stick that identifies if there is blood and white cells in the urine (not a definitive but pretty good inidication of infection) there is another dip stick can indicate pretty definitively that there is an infection (but not the type). That at least ensures that an analysis on the exact bacteria can be done in 24 hrs and the right antibiotic delivered. Given the incredible impact of UTIs on further cognitive damage Im going to talk to her doctor about regular urine tests. Certainly we have been told if we notice any change at all straight in for a urine test. On the issue of ongoing prophylactic antibiotics we have been told this is an option but not a great one - lots of issues with this apparently. And YES BGills probiotics are absolutely a must. While yogurt etc is great we use a one a day major dose of probiotics in capsule form - here it is called "Inner Health Plus" Easier to get Mum to take one or two of these a day than get her to eat the amount of yogurt etc needed.

Excellent discussion and so useful to hear about other's experiences and opinions.

Everyone will probably hate me for this answer, but as I mentioned in a previous comment, why do we keep bombarding elderly dementia patients with antibiotics for UTI's? My 81 y.o. mother sleeps 20+ hours a day, eats, pees, poops, and when she's awake all she does is complain about pains here and there (which change almost daily) that the doctor can't find a cause for. What kind of life is that? If it was me, I would rather let the UTI turn into a kidney infection, and then just go the way the universe probably would have wanted me to go. (Kind of like DNR?) Before antibiotics were around (I agree, they're great for some things, despite the negative side effects on one's GI tract!) in the "old days" people didn't live to be 95 ~ because the Universe helped them in a natural way to their next life, and most likely shortening their suffering. If my mother gets another UTI I'm not going to refuse her having antibiotics, but I do think this is a very strange and sad scenario for people at the end of their lives. I love my mom with all my heart, but it's heartwrenching to see her this way.

Did they do a culture to test for what kind of bacteria is causing the uti? If they do that, they can tell what antibiotic will clear it.

Ferris .. UTIs are indeed a contributing factor to failing cognition .. whether it's officially called dementia or not, frankly I don't care, lol. It ends up amounting to the same thing.

Jools .. we have almost exactly the same issue: stroke, followed slowly by vascular dementia along with recurrent, persistent UTIs. We've learned her signs at early onset of them: she weakens, physically first, then shows signs of aphasic speech, often accompanied by muscle twitches/tics. Rarely does she present with other symptoms like fever, burning while urinating, etc. So, we had to learn HER signs/symptoms.

We also follow a strict regime with diet, supplements to help keep her bladder flushed, exercise, hygiene, etc.

And yet, the UTIs keep coming back .. and with each one, after the 'fog' clears, there's some small decline, compared with prior to the infection and treatment. It *does* help to add some cognitive exercises to her regime: logic questions, memory questions, hand-eye coordination, etc. I turn every normal daytime activity into an 'opportunity' to learn or a physical therapy type routine.

An aside: among her other conditions, she has diverticulosis. Normally, this just means we control flare ups with diet. Very recently, one of them bled out. Wanna know scary?? Ugh. Simultaneous to the GI bleed, she had another UTI and while they were testing and diagnosing she began her antibiotics; . She ended up needing a transfusion because of the blood loss. After her hospital release, within less than two days, her cognitive functions improved SO much, I felt like we'd gone back two years. Dunno if it was the transfusion and/or this specific round of meds, but I'll take it.

Just to catch you all up on this, my mom had a stroke 4 dsys after I posted this. We have no way of knowing if her initial confusion and word finding was a tia in addition to the uti.

I don't hate Rosebud's comment at all. Last week my husband and I watched as his mother suffered a stroke and was placed in the care of hospice with a DNR and withhold treatment request. She had lost her ability to swallow so trying to give her anything to drink choked her . for a little over a week we watched her slowly slip away with the assistance of sublingual morphine to comfort her demise. I'm not sure what was worse, the prolonged waiting for it to be "over" or the anguish on her children's faces as they watched her life ebb away. I don't know if keeping the elderly "alive" just for the sake of keeping them "alive" cuts it in these cases. Watching this with my mother-in- law just didn't seem humane to me. Maybe I'm wrong, but I don't want to lie there for however long it takes without food or water until my organs shut down. I'm just saying ...

Whilst my father is 80, 4 weeks ago he could answer 90% of the general knowledge questions on the Mastermind TV programme! Now, after a severe UTI, he forgets his children's names. This is not normal progression old age memory loss and I am shocked at how an UTI can impair the mind to this extent and at such speed. The doctor assures us that after the antibiotics have cleared up the infection, he should recover in 3 to 4 weeks. I sincerely hope so!