Is Dehydration Masking as Dementia or Making Dementia Symptoms Worse?

Mostly Water
The adult body is comprised of about 60% water. Water is important for flushing toxins from the body, digestion, skin complexion, headache prevention, and immune system function.  Water also provides the brain with the necessary energy for brain function, including thought and memory.  Body water is lost each day through breathing, talking, sweating, urinating, stooling, and crying. Therefore, a certain amount of fluid intake each day is needed to make up for what is lost. Fluids can be replaced through drinking and eating, as certain foods have a high water content.

What is Dehydration?
Dehydration happens when you don’t consume enough fluid to make up for losses through breathing, sweating, urinating, and digestion. Sometimes, dehydration can be hard to detect. Children and adults over the age of 60 are especially susceptible to dehydration.1

Remembering to Drink
Older adults often struggle with remembering to drink enough fluids. Individuals suffering from memory loss may simply not remember to drink or they may not remember how much they have consumed. Likewise, they may make a cup of tea or glass of water and then not remember where they put it. It can be a vicious cycle.

Diuretic Effects and Incontinence
Some medications, particularly blood pressure medications, have diuretic properties that cause increased urination. As people age they often have to use the restroom more often and with more urgency. Also, the ease of getting in and out of a chair, walking to the restroom, and actually using the restroom often becomes more difficult with age. As such, it is not uncommon for older adults to limit their fluid intake to limit their trips to the restroom.

Stools and Fluid Loss
Diarrhea, which is a side effect of some medications, causes increased fluid loss. Also, older adults tend to be more susceptible to illnesses such as the flu, which also lead to fluid loss. Therefore, fluid replacement becomes more important when sick and when taking certain medicines.

The most common symptoms of dehydration include:
• Light headedness,
• Fatigue,
• Confusion,
• Dizziness,
• Headache,
• Less-frequent urination,
• Dark colored and strong smelling urine,
• Sunken eyes,
• Dry, papery skin,
• Dry mouth and lips,
• Increased heart rate and breathing., and
• Low blood pressure.1

Dehydration can be particularly difficult to identify in older adults who may already be experiencing confusion, dizziness, and fatigue. Often caregivers struggle with separating symptoms of dehydration from symptoms of dementia. It is therefore important to carefully track fluid intake in adults who are suffering from cognitive decline to ensure they are not becoming dehydrated.

Fluid Tracking
There are subtle ways to encourage a family member to drink more water. First, place re-usable bottles with a lid and straw in various locations throughout the house to increase convenience. Set a bottle of water on the night stand, at the kitchen table, next to a favorite chair, in the car, and other convenient places to make water more available. Also, using the bottle method will allow you to measure each day how much they have consumed when you gather their bottles at the end of the day.

Gentle Reminders
There are cell phone or iPad alarm apps that can be set to buzz every so often to remind a person to take a drink. There are also watches that can be set with up to 8 discrete vibrating alarms to help people remember to drink or use the restroom, such as the WOBL watch. These gentle reminders may be all that is needed for a person with mild cognitive decline to begin drinking more often.

Variety of Drinks and Eating Fluids
Sometimes simply changing how fluids are offered will increase intake. Try adding a slice of lemon, cucumber, orange, or strawberry to a glass of filtered water or sparkling water with bubbles; just make sure you are choosing plain sparkling water without added sugars or artificial flavorings. Green teas, served warm or cold, may also be more palatable to some and can even lead to a routine or ritual that makes their consumption more special, such as tea with a snack. However, it is best to choose a green tea that does not contain caffeine, as caffeine can increase the need to use the restroom and may interfere with your ability to fall asleep at night. Finally, adding foods to meals that have a high water content, such as low-sodium soups, apples, oranges, berries, grapes, watermelon, and cucumber, will increase fluid intake.

Your body needs water to function normally, and signs of dehydration may mask themselves as signs of dementia. Help yourself or the person you care for avoid these symptoms of non-dementia related “brain fog” by taking steps to encourage increased fluid intake. Whether it is plain water, water with bubbles, hot or cold green tea, or water infused with fresh fruit, find enjoyable foods and beverages to ensure enough water is consumed each day.

Written by Marci L. Hardy, PhD

1. John Hopkins Medicine Health Library: Dehydration and Heat Stroke.,P00828/ Retrieved on April 10, 2017.


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