Sepsis and Dementia

Dementia is a condition that affects your brain. It causes memory loss, personality changes, and – as the condition progresses – your body’s ability to function physically. Someone with advanced dementia may forget how to eat or drink or may choke easily. This often results in malnutrition or infections like pneumonia. People with advanced dementia may be unable to move about independently, staying in bed or in a wheelchair for extended periods. Poor nutrition and staying in one place for extended periods can cause skin breakdown or pressure sores (also called bed sores).

As people age, their immune system also becomes less effective in fighting infections. They may develop illnesses like diabetes or take medications that affect how their immune system works. Nutritional status is also important. Malnutrition, not consuming enough nutrients for your needs, can lower your body’s ability to fight infection.

These issues all result in an increased risk of contracting an infection. But people with advanced dementia also have the additional problem of not being able to tell you there is something wrong if they do have an infection. For example, someone with dementia who has a urinary tract infection (UTI) may not tell you that they have pain when urinating. If the person is incontinent (urinates in a brief, has “accidents”, or has a urinary catheter), you may not notice if they are urinating more frequently. The first sign of anything being wrong may be an extreme change in personality or sudden worsening of dementia. Urinary tract infections are one of the most common causes of sepsis, along with pneumonia.

Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Suggested Citation:
Sepsis Alliance. Sepsis and Dementia. 2023. https://www.sepsis.org/sepsisand/dementia/

Updated December 15, 2023.

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Sepsis and Dementia

Not a lot of research has been done yet on patients with dementia and their outcomes following sepsis. A study published in 2015 looked at patients with COPD who also had dementia. The researchers found that patients in this group had a higher risk of dying than patients with COPD who did not have dementia.

Sepsis, specifically severe sepsis or septic shock, can worsen dementia or bring out into the open symptoms that weren’t obvious before the illness. Many people with early-onset dementia manage quite well, and those around them may not have realized there’s a problem until the infection and sepsis changed their daily routines.

A study published in 2017 looked at more than 20,000 patients with no history of dementia who were admitted to the hospital with sepsis for the first time. The researchers found that patients who had sepsis were more likely to develop signs of dementia after discharge. The researchers also found that younger age didn’t protect patients from dementia. In this study, some patients in their 20s were affected. And for all ages, the worse the sepsis, the greater the risk of developing dementia. Another study published in 2010 estimates that there may be as many as 20,000 new cases of dementia every year caused by sepsis.

For Caregivers

Caring for a loved one with dementia is challenging, but watching for signs of infections is important. Since people with dementia may not be able to tell you they are unwell or have pain, it can be hard to detect some types of infections. Here are some tips that may help:

Signs of a fever or lower than normal temperature. Not everyone with dementia will allow their caregiver to take their temperature. If you can’t check for fever that way, watch for other signs, such as the skin is warmer to touch than usual, flushing (red skin), lips or skin dryer than usual, or shivering even if it is warm. Don’t forget that a lower than normal temperature may also be a sign of sepsis.
Increasing confusion or agitation, personality change, drowsiness. If there is a significant change in behavior, it could be a sign of an infection. The person may become drowsier, just wanting to sleep. Or someone who is usually calm may become agitated or aggressive.
Signs of pain or discomfort. Body language may tell you if your loved one can’t say that something hurts or where there’s pain. Some signs could include: protecting or guarding a part of the body, moaning or grimacing, eating less than usual, increasing restlessness, unwillingness to move, falling or having difficulty balancing, or crying.
Coughing, wheezing, or shortness of breath. Pneumonia can cause these signs.

Other things to keep in mind is if your loved one had an invasive procedure or hurt themself in some way:

Are there any scrapes, burns, cuts, or bites on the skin?
Did your loved one have a medical procedure, like having a urinary catheter, an intravenous (IV), dental work, or a procedure that broke the skin or inserted a medical device into the body?
Has your loved one been exposed to someone who is or may be sick with a contagious illness like the flu?
Has your loved one been hospitalized recently?

Prevention and Recognition

The only way to prevent sepsis is to prevent infection. The most effective way to reduce the spread of infection is through regular and thorough hand washing. Vaccinations for preventable diseases, such as influenza (the flu), COVID-19, shingles, and some types of pneumonia are also important. If there is an infection, early recognition and treatment can help reduce the risk of it triggering sepsis.

We can’t prevent all sepsis cases. Sometimes infections aren’t detected, and sometimes infections don’t respond well to treatments. In these cases, it is important to know what to watch for. The earlier we recognize sepsis and treat it, the better the outcome.

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Dementia

Dementia is a condition that affects your brain. It causes memory loss, personality changes, and – as the condition progresses –your body’s ability to function. Someone with advanced dementia may forget how to eat or drink, or may choke easily. This often results in malnutrition or infections like pneumonia. People with advanced dementia may be unable to move about on their own, staying in bed or in a wheelchair for extended periods. Poor nutrition and staying in one place for extended periods can cause skin breakdown, or pressure sores (also called bed sores).

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