Not every change in a person living with dementia is caused by dementia. Sometimes, what appears to be a decline in cognitive ability is actually a sign of an underlying medical problem that needs immediate attention.
This story is based on a real client experience. The name and some identifying details have been changed to protect the individual’s privacy.
Recognizing That Something Was Different
“Rose” was living with early-stage progressive dementia and experiencing some difficulty with communication (aphasia). Although she had changes in her ability to express herself, she was generally able to communicate how she was feeling.
One day, however, something wasn’t quite right. Rose had recently undergone a dental procedure, and her face was still slightly swollen. Two days later, she began feeling unwell. She was unusually tired, slower to respond, and not speaking as much as she normally would. She continued telling her caregivers that she didn’t feel well.
At first, there were a couple of possible explanations.
Could she have a urinary tract infection (UTI)?
Could her recent dental procedure, the swelling, and possible pain be affecting how she was feeling and behaving?
Or, was this another change associated with her dementia?
Taking Action Instead of Making Assumptions
Rose’s caregivers noticed that her energy, alertness, and communication had changed. She was more lethargic, slower to speak, and simply wasn’t herself.
There was some discussion about whether these changes could represent a normal progression of her dementia. However, rather than making that assumption, her caregivers decided to investigate.
They arranged an appointment for laboratory testing to check for a possible UTI and contacted her dentist to have the swelling and discomfort examined.
What Was Really Behind the Change?
The dental examination revealed an abscess infection at the site of Rose’s recent dental procedure. The infection was treated with antibiotics, and Rose began feeling much better.
What initially appeared to be a possible decline in her dementia was actually associated with an underlying infection and pain.
This is an important distinction because infections and untreated pain can trigger delirium – a sudden disturbance in a person’s mental functioning that can affect their attention, awareness, thinking, communication, and behaviour.
Delirium is a medical emergency because it can signal an underlying illness or medical problem requiring prompt attention. It can develop over hours or days and may cause someone to become confused, unusually sleepy, withdrawn, restless, or very hyper and/or exhibit other strange behaviours.
For Rose, she became unusually quiet, tired, and withdrawn. This is known as hypoactive delirium, and it can be particularly easy to overlook because it may resemble depression, fatigue, or a progression in dementia.
How Can Pain and Infection Affect the Brain?
When the body develops an infection, the immune system responds by releasing inflammatory substances to help fight it. This response is necessary for healing, but it can also affect how the brain functions.
In some people, particularly older adults and those living with dementia, the brain is more vulnerable to these physical stresses. Inflammation, changes in the body’s normal chemical balance, and the effects of illness can interfere with the brain systems responsible for attention, alertness, and clear thinking.
Pain can add another layer of stress. Persistent or untreated pain can affect sleep, concentration, mood, and the body’s ability to cope with illness. Together, pain and infection can contribute to delirium.
This helps explain why a seemingly localized problem, such as a dental abscess, can have effects that extend well beyond the area of infection.
Looking Beyond the Behaviour Can Make All the Difference
Rose’s story is a reminder that behaviour is not always a reflection of dementia itself. Sometimes, it is the body’s way of telling us that something is wrong.
When delirium is mistaken for dementia-related behavioural changes, symptoms may be managed as though they are behavioural or psychological problems rather than signs of an underlying illness. This can lead to inappropriate treatment, including medications that may further contribute to confusion or delirium. Certain medications can themselves increase delirium risk, making careful assessment and medication review essential.
At Dementia Solutions, we share these stories because education can change how people respond. We want caregivers, healthcare professionals, families, and everyone involved in a person’s life to look beyond what they see and ask an important question: Why? Could there be something else going on?
Listen. Observe. Question. Investigate.
By doing so, we can come up with solutions to best help preserve a person’s comfort, dignity, independence, and overall quality of life.
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If you found this article helpful and if you’re worried about a loved one or a friend and aren’t sure where to turn, you’re not alone. We’re here to help! Reach out, and together we can brainstorm solutions tailored to your unique situation. Start by visiting our website at https://dementiasolutions.ca/private-consulting/ to schedule your free 20-minute consultation with one of our experienced Dementia Care Advisors. We’re here to support you every step of the way.
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DISCLAIMER:
This article is based on a true story; however, names, locations, and certain events have been altered to protect the privacy and confidentiality of the individuals involved. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.
