In addition to the symptoms of Alzheimer's disease, a person with Alzheimer's may have other medical problems over time, as all older adults do. These problems can cause more confusion and behavior changes. The person may not be able to tell you what is wrong. As a caregiver, you need to watch for signs of illness and tell the doctor about what you see. Here are some common medical problems to watch for.

Fever

Having a fever means that the person's temperature is 2 degrees or more above his or her normal temperature.

A fever may be a sign of:

Infection, caused by germs

Dehydration, caused by a lack of fluids

Heat stroke

Constipation (discussed later in this section)

Don't use a glass thermometer because the person might bite down on the glass. Use a digital thermometer, which you can buy at a grocery store or drugstore. Call the doctor right away if the person with Alzheimer's disease has a fever.

Flu and Pneumonia

These diseases spread quickly from one person to another, and people with Alzheimer's are more likely to get them. Make sure that the person gets a flu shot each year and a pneumonia shot once after age 65. Some older people need to get more than one pneumonia vaccine. The shots lower the chances that the person will get the flu or pneumonia. For more information on pneumonia, visit the Centers for Disease Control and Prevention (CDC). For more information on the flu, visit the CDC or the National Institute of Allergy and Infectious Diseases.

Flu and pneumonia may cause:

Fever (Not everyone with pneumonia has a fever.)

Chills

Aches and pains

Vomiting

Coughing

Trouble breathing

Falls

As Alzheimer's disease gets worse, the person may have trouble walking and keeping his or her balance. He or she also may have changes in depth perception, which is the ability to understand distances. For example, someone with Alzheimer's may try to step down when walking from a carpeted to a tile floor. This puts him or her at risk for falls.

To reduce the chance of a fall:

Clean up clutter.

Remove throw rugs.

Use chairs with arms.

Put grab bars in the bathroom.

Use good lighting.

Make sure the person wears sturdy shoes with good traction.

Dehydration

Our bodies must have a certain amount of water to work well. If a person is sick or doesn't drink enough fluid, he or she may become dehydrated.

Signs of dehydration to look for include:

Dry mouth

Dizziness

Hallucinations (Don't forget that hallucinations may be caused by Alzheimer's itself.)

Rapid heart rate

Be aware of how much fluid the person is drinking. This is even more important during hot weather or in homes without air conditioning. Also, look for signs of dehydration during the winter months when heat in your home can create a lot of dry air.

Constipation

People can have constipation—trouble having a bowel movement—when they:

Change what they eat

Take certain medicines, including Namenda®

Get less exercise than usual

Drink less fluid than usual

Try to get the person to drink at least 6 glasses of liquid a day.

Besides water, other good sources of liquid include:

Juice, especially prune juice

Gelatin, such as Jell-O®

Soup

Milk or melted ice cream

Decaffeinated coffee and tea

Liquid cereal, such as Cream of Wheat®

Have the person eat foods high in fiber. Foods like dried apricots, raisins, or prunes; some dry cereals; or soybeans might help ease constipation.

If possible, make sure that the person gets some exercise each day, such as walking. Call the doctor if you notice a change in the person's bowel habits.

Diarrhea

Some medicines, including Alzheimer's medications, may cause diarrhea—loose bowel movements. Certain medical problems also may cause diarrhea. Make sure the person takes in lots of fluids when he or she has diarrhea. Also, be sure to let the doctor know about this problem.

Incontinence

Incontinence means a person can't control his or her bladder and/or bowels. This may happen at any stage of Alzheimer's disease, but it is more often a problem in the later stages. Signs of this problem are leaking urine, problems emptying the bladder, and soiled underwear and bed sheets. Be sure to let the doctor know if this happens. He or she may be able to treat the cause of the problem.

Here are some examples of things that can be treated:

Urinary tract infection

Enlarged prostate gland

Too little fluid in the body (dehydration)

Diabetes that isn't being treated

Taking too many water pills

Drinking too much caffeine

Taking medicines that make it hard to hold urine

When you talk to the doctor, be ready to answer the following questions:

What medicines is the person taking?

Does the person leak urine when he or she laughs, coughs, or lifts something?

Does the person urinate often?

Can the person get to the bathroom in time?

Is the person urinating in places other than the bathroom?

Is the person soiling his or her clothes or bed sheets each night?

Do these problems happen each day or once in a while?

Here are some ways you can deal with incontinence:

Remind the person to go to the bathroom every 2 to 3 hours.

Show him or her the way to the bathroom, or take him or her.

Make sure that the person wears loose, comfortable clothing that is easy to remove.

Limit fluids after 6 p.m. if problems happen at night. Do not give the person fluids with caffeine, such as coffee or tea.

Give the person fresh fruit before bedtime instead of fluids if he or she is thirsty.

Mark the bathroom door with a big sign that reads "Toilet" or "Bathroom."

Use a stable toilet seat that is at a good height. Using a colorful toilet seat may help the person identify the toilet. You can buy raised toilet seats at medical supply stores.

Help the person when he or she needs to use a public bathroom. This may mean going into the stall with the person or using a family or private bathroom.

Accidents happen. Be understanding when they occur. Stay calm and reassure the person if he or she is upset.

Incontinence supplies, such as adult disposable briefs or underwear, bed protectors, and waterproof mattress covers, may be helpful. You can buy these items at drugstores and medical supply stores. A drainable pouch may be useful for the person who can't control his or her bowel movements. Talk to a nurse about how to use this product.

Some people find it helpful to keep a record of how much food and fluid the person takes in and how often he or she goes to the bathroom. You can use this information to make a schedule of when he or she needs to go to the bathroom.

Dental Problems

As Alzheimer's disease gets worse, people need help taking care of their teeth or dentures.

Check the person's mouth for any problems such as:

Sores

Decayed teeth

Food "pocketed" in the cheek or on the roof of the mouth

Lumps

Be sure to take the person for dental checkups. Some people need medicine to calm them before they can see the dentist.

Watch for Signs the Person Is in Pain Always remember that the person with Alzheimer's may not be able to tell you when he or she is in pain. Watch the person's face to see if it looks like he or she is in pain or feeling ill. Also, notice sudden changes in behavior such as increased yelling or striking out. If you are unsure what to do, call the doctor for help.

Other Medical Problems

People with Alzheimer's can have the same medical problems as many older adults. Research suggests that some of these medical problems may be related to Alzheimer's disease.

For example, some heart and blood circulation problems, stroke, and diabetes are more common in people who have Alzheimer's than in the general population. Diseases caused by infections also are common.

Visiting the Doctor

It's important that the person with Alzheimer's gets regular medical care. Make sure the person sees a health professional on a regular basis. This is the best thing you can do to help prevent medical problems.

Here are some tips to help you get ready for a visit to the doctor's office:

Make an appointment during the person's best time of day and when the office is not very crowded.

Let the office staff know before the visit about the person's Alzheimer's disease. Ask them for help to make the visit go smoothly.

Don't tell the person with Alzheimer's about the visit until the day of the visit or even right before it is time to go if visiting the doctor makes the person nervous. Be positive and matter of fact.

Take something he or she likes to eat or drink and any materials or activities the person enjoys.

For more information on preparing for hospital and emergency room visits, read Going to the Hospital: Tips for Dementia Caregivers.

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For More Information About Alzheimer's and Common Medical Problems

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center

800-438-4380 (toll-free)

adear@nia.nih.gov

www.nia.nih.gov/alzheimers

The National Institute on Aging’s ADEAR Center offers information and free print publications about Alzheimer’s disease and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

This content is provided by the National Institute on Aging (NIA), part of the National Institutes of Health. NIA scientists and other experts review this content to ensure that it is accurate, authoritative, and up to date.