Dementia and Diuretics
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.
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.
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.