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Dementia and Diuretics

Updated on December 1, 2013

Diuretic Medication Statistics

In 2003 there were roughly 220 million adults living in America. Ten percent of those adults were being treated medically with a diuretic medication. Since then those numbers have continued to grow as have the number of adult patients in America. The highest concentration of diuretic users lies in the adult population ages 65 and up.

Dementia Statistics

The statistical numbers for dementia are similar to those of diuretics. Dementia is more prevalent in the adult population ages 65 and up. In 2003 there was an average of about 3.4 million Americans diagnosed with dementia. By 2030 the number is expected to be about 10 million. The increase is due to the 77 million baby boomers who will be above the age of 70 by then.

Diuretics, Dementia and Dehydration

Diuretics are prevalent among adult patients in America as are many forms of dementia. Diuretics cause the body to release, what is thought to be, excess water. Another thing prevalent in adult patients in America is dehydration due to a gradual loss of the thirst sensation in their older years. An older adult in a temporary state of dehydration is known to mimic behavior similar to that of Senile Dementia. This is caused by the brain becoming dehydrated and more or less blowing a fuse or two. Once the patient is hydrated, symptoms usually go away and normal behavior resumes. Although, I should add that dehydrated brain cells eventually die and never regenerate. This information is important because older adults already have problems with dementia and dehydration without being on any form of diuretic medication. You can find evidence of this if you research hypernatremia, specifically in the older adult population. “The development of hyperosmolality from the water loss can lead to neuronal cell shrinkage and resultant brain injury” (emedicine.medscape.com) Hyperosmolality is a fancy word meaning to have concentrated blood due to lack of water intake.


High Blood Pressure and CHF

Diuretics are prescribed so much among the older population due to the elevated number of patients with of high blood pressure and congestive heart failure. In high blood pressure, too much water in the body causes increased pressure inside of the blood vessels. In CHF, the body tends to pool water in the lower extremities due to the diminished ability of the heart to pump blood. This is important information because chronic dehydration can mimic both of the previously mentioned scenarios.

Chronic dehydration can cause high blood pressure because it forces the body to continuously deal with the problem of water shortage by releasing histamine in the body. Histamine controls the flow of water in the body by opening and closing blood vessels as needed. In a state of chronic dehydration, many vessels stay closed and others are continuously constricted in order to purposely raise the blood pressure. Low water intake leads to low blood pressure which forces the body to purposely raise the blood pressure to ensure blood flow to the brain and extremities. In extremely chronic cases, the body uses yet another method to purposely increase the blood pressure; it intentionally pools water in certain areas of the body. By pooling the water, mostly in the lower extremities, it raises the pressure in the vessels by using compression. The water is used to surround the lower extremity blood vessels and squeeze the blood upward toward the heart and brain. The pooled water is referred to as edema. When most doctors see edema in a patient, they will prescribe a diuretic and direct the patient to limit their fluid intake.

You can now begin to see what the problem is. We have a population of people who are chronically dehydrated to the point that they sometimes develop high blood pressure and edema. The doctors come along and order a diuretic. The patients follow their doctor’s orders and use the diuretic. The excess water is released as planned… Let’s not forget that this same patient demographic already has an increased chance of dementia. (a problem resulting from the death of lots of brain cells) So, when the excess water is released from diuretic use, there is less available water and less pressure pushing the, already diminished, blood flow upward toward the brain. Less blood, water and oxygen to the brain - brain cells die - onset of dementia or already existing dementia gets worse.

The Caregiver

As the old saying goes: You can’t teach an old dog new tricks. Many older people are set in their ways and you couldn’t make them drink water if you paid them. However, consider the situation and how important hydration can be to them. As the caregiver, make note of the patient’s behavior before and after the diuretic medication is given. Many patients will not fall into this category but a good number of them can benefit from consistently staying hydrated.

“There are potentially multiple problems resulting from the links between dementia and dehydration.

  • First, dehydration can cause symptoms which can be confused with dementia

  • Second, dementia can cause dehydration

  • Thirdly, dehydration can aggravate dementia

  • Fourthly, dehydration is an increased danger when dementia is in its final stages

  • Finally, ensuring that a person with dementia is sufficiently hydrated is very difficult

Dehydration has symptoms in common with senile dementia symptoms, age dementia symptoms and Alzheimer’s symptoms. Rehydrating an older person can often allow them to return to a full and normal life.

The most common symptoms of dehydration include thirst, persistent fatigue and lethargy, muscle cramps or weakness, decreased urination and a dark yellow colour of the urine, nausea and headaches, dizziness, memory function loss, confusion, deep rapid breathing, and increased heart rate.

Left unchecked, dehydration can even be fatal” (QCS - Quality Compliance Systems)

“ Dementia is caused by many conditions. Some conditions that cause dementia can be reversed, and others cannot. Further, many different medical conditions may cause symptoms that seem like Alzheimer's disease, but are not. Some of these medical conditions may be treatable. Reversible conditions can be caused by a high fever, dehydration, vitamin deficiency and poor nutrition, bad reactions to medicines, problems with the thyroid gland, or a minor head injury.” (Web MD)

Finally, to the caregiver, I think you should be aware of any possibility of reversible symptoms and also of any possibility of prevention. This article is especially for the caregivers who are caring for an older person still in possession of all or most of their cognitive abilities. If your patient’s cognitive ability suddenly takes a turn for the worst, take notice of any changes to their diet and medication regimen.


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    • jpcmc profile image

      JP Carlos 3 years ago from Quezon CIty, Phlippines

      This is a very useful hub especially if one lives with an elderly family member. Sooner or later, we will all go to this stage in life. we'd better read up on what to expect.

    • RTalloni profile image

      RTalloni 3 years ago from the short journey

      There are so many connect-the-dot questions we should be asking and I'm glad to see this one highlighted so I can give it some consideration and talk to others about it. It will be interesting to do some reading on hypernatremia. Thanks for giving care givers a head's up.

    • CraftytotheCore profile image

      CraftytotheCore 3 years ago

      This is very interesting information. My grandfather is at the end of his life. He still has amazing alertness and awareness. But my grandmother on the other hand, when she passed, had a total loss of mental awareness.

    • Scott P Williams profile image
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      Scott P Williams 3 years ago from Miami, Florida

      JPCMC - I wish more people could see what goes on inside of a nursing facility and understand what this disease is like. Its very difficult and sad for the family members who can no longer be remembered by their mother of father.s to remember.

    • Scott P Williams profile image
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      Scott P Williams 3 years ago from Miami, Florida

      RTalloni - Being the caregiver is extremely difficult because caring for a person with dementia can take over your life, easily.

    • Scott P Williams profile image
      Author

      Scott P Williams 3 years ago from Miami, Florida

      Crafty - That picture is my grandmother. She is going to be 97 next May. She is still with it but her memory is starting to go. She is as stubborn as they come so when she periodically forgets things my dad has a rough time as he is the only one she ALWAYS seems to remember.

    • profile image

      Julia 2 years ago

      Fantastic article. Dehydration is seems such a small thing but the effects are an overwhelming reason for hospital admissions. We have to plead with my relative, with dementia, to drink water/fluids every hour. Everyday we go through the same routine. She complains about not being able "to go" and we explain the need for fluids. We started her on miralax as dehydration was causing severe constipation. Since then - no problems. It is good to remind caregivers that fluid can be given in many forms...smoothies, yogurt, watermelon, hot chocolate (decaffeinated and sugar free). Offer a very small salty snack(cracker & cheese) and then a beverage.

    • Scott P Williams profile image
      Author

      Scott P Williams 2 years ago from Miami, Florida

      Thanks. Your right, when hydration is a problem, the fluids can come in many forms.

    • Larry Rankin profile image

      Larry Rankin 22 months ago from Oklahoma

      The elderly dehydrate easier and we give them diuretics.

      Very eye opening article.

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