Most of us think about a urinary tract infection in terms of burning, urgency, frequent trips to the bathroom or discomfort, but we don't usually think about the brain. But in older adults—particularly those who are medically vulnerable or already experiencing cognitive impairment—an infection can sometimes contribute to delirium.

Without getting too technical, delirium is a sudden disturbance in brain function. A person may become confused, disoriented, unusually sleepy or agitated. They may have difficulty concentrating or simply seem noticeably different from their usual selves.

And there's one word I want you to remember: Sudden.

Delirium and Dementia Are Not the Same Thing

When an older person becomes confused, it can be easy to think: Maybe she's developing dementia. But dementia and delirium are not the same thing. Dementia generally develops gradually. Changes in memory, reasoning and other cognitive abilities tend to occur over time.

Delirium can appear much more quickly—sometimes over hours or days. Someone who seemed like herself yesterday may suddenly seem very different today. That's one reason my mother-in-love's experiences stayed with us. When she suddenly wasn't herself, we learned not to immediately write it off as aging. Something else might be happening.

The infection isn't simply traveling from the bladder to the brain. Instead, think about the brain responding to what is happening elsewhere in the body. When our immune system detects an infection, it launches a response to fight it. That response can involve inflammation and chemical messengers that affect multiple systems in the body—including the brain.

An older or already vulnerable brain may have less reserve for handling the additional stress of infection, inflammation, dehydration, medication changes, disrupted sleep or illness. The result can sometimes be a dramatic change in attention, awareness and thinking.

This is something I want us to understand as we talk about brain health: Your brain is part of your body.

We can't separate the two. What's happening with your sleep can affect your brain. What's happening with your hormones can affect your brain.

What's happening with hydration and nutrition can affect your brain. Stress can affect your brain. And yes, sometimes an infection somewhere else in the body can affect how the brain functions.

But Don't Diagnose Grandma From the Couch

Now, hubby and I could sit on our couch watching Driving Miss Daisy and declare, “She probably has a UTI.” It's a movie. We can't do that with real people. And this distinction is important.

Sudden confusion does not automatically mean someone has a UTI. Older adults can sometimes have bacteria in their urine without actually having a symptomatic urinary tract infection. And there are many other reasons someone could suddenly become confused. Dehydration. certain medications, electrolyte and metabolic problems can affect thinking. Even pain and sleep deprivation can affect thinking. Other infections and illnesses can affect thinking.

So I don't want the takeaway from this newsletter to be: Grandma is confused. She must have a UTI. I want it to be: Something has suddenly changed. We need to find out why. That's a very different conversation.

This may be the most important part of this conversation for me. I don't want us to become so accustomed to associating aging with memory loss and confusion that we stop asking questions.

“I’m just getting older.”  Maybe. But what if something else is going on? What if it's something that can be identified and treated?

When there is a sudden or significant change from someone's normal thinking or behavior, it deserves attention. Ask the questions. When did this start? Was the change sudden or gradual?

What else has changed? Those are the kinds of questions that can help us give healthcare professionals better information as they look for the cause.

And this is where this conversation becomes important even if you aren't caring for someone in her 70s, 80s or 90s. We need to learn our own normal now. How is your memory when you've had a good night's sleep? How well can you focus when your stress is under control? How does your thinking change when you're exhausted? What happens when you haven't had enough water? Have you noticed changes since menopause? What happens when you're trying to do five things at once?

We don't have to become obsessed with every forgotten word or misplaced set of keys.

But we should become more aware. Part of aging well is learning what's happening in our bodies before there is a crisis. The better we understand our own patterns, the better equipped we are to recognize when something truly has changed.

There's another reason I think women should know about this connection. Menopause changes more than our periods. Declining estrogen affects tissues in the vagina and urinary tract, and those changes can make some women more susceptible to recurrent urinary tract infections after menopause.

So while UTI-related delirium is primarily a concern for older and medically vulnerable adults, learning how our bodies change as we age is something we can begin doing much earlier.

That's what proactive brain health looks like to me. Not fear. Not assuming that every forgotten name means dementia. Not diagnosing ourselves from something we saw on social media.

Awareness. Learning our bodies. Learning our brains. Asking better questions. And knowing when a change deserves attention.

The more I learn about the brain, the more convinced I am that we need to start paying attention to our cognitive health before something scares us. We shouldn't have to wait until we can't remember something important, can't focus the way we used to, or somebody we love says, “You don't seem like yourself.” And we certainly shouldn't assume every memory lapse means dementia or that every change is simply part of getting older.

Sometimes we need to look at sleep, stress, hydration, hormones, nutrition or medications. Sometimes we need to talk with our healthcare provider. And sometimes we simply need to become more aware of what our own “normal” looks like so we can recognize when something changes.

That's part of what we'll be doing in my: 14-day In Her Right Mind: Midlife Memory and Focus Renewal Bootcamp. Visit InHerRightMind.com for more information and to register. 

We're going to slow down and pay attention. We'll look at everyday factors that can influence memory and focus and practice simple strategies for supporting our brains. We'll also begin developing habits that can continue long after our 14 days together. Because I don't want us waiting until we're frightened about our memory to start taking care of it.

I want us asking: What can I do today to support the brain I want to have tomorrow? 

I keep coming back to my mother-in-love. There were times when something was simply off and she wasn't herself. Because we had seen it before, we learned that a change in her thinking or behavior could be a signal that something else was happening physically. That's a lesson I haven't forgotten. Maybe that's why hubby and I could sit on the couch watching Driving Miss Daisy and both immediately say: “She probably has a UTI.”

We weren't really talking about the movie anymore, we were remembering someone we loved.

And we were remembering what her experiences taught us: When the mind suddenly changes, pay attention to the body. Because sometimes what looks like a memory problem isn't primarily a memory problem at all. Sometimes the brain is telling us that something else in the body needs our attention. And that's one more reason I want all of us to learn how to get—and stay—in our right minds as we age.

This newsletter is for educational purposes and is not a substitute for medical advice. A sudden change in mental status or behavior warrants prompt medical evaluation.

Blessings,

Dr. Janice R. Love
In Her Right Mind