New stage?

urinary incontinence can happen in the elderly or at any stage of dementia. Signals to and from her brain don’t connect. Has she been tested for a UTI? If not I would start there. She may not be aware of symptoms. I would get her to wear depends. They also make liners for them that will prevent leaks. If she is walking by herself maybe it’s time for someone to go with her. She could wander off. Progression is unique to each PWD and it can be steady or stair steps. If you are with her all the time you should observe behaviors. But behaviors can show up and then pause. Someone posted that it’s like the wires in their brain have a short and sometimes connect making their caregiver question the diagnosis. Is she in assisted living? If so I would alert the caregivers of your 2 concerns. Is it time for a walker? Falls are common in dementia and she could break her hip.

@JulietteBee

Often elderly women, even without dementia, have UTIs without the usual symptoms. That said, often there is a change in mental status or demeanor that is striking. I would not wait for a urology appointment for this, but would ask her PCP to order a test. If you can get a clean catch at the facility, you won't even need to transport her to the lab.

Have you noticed a sudden change in her demeanor or striking change in cognition? Did the ER do a urinalysis? IME, mom was in the ED 7 times in the last year (2 UTIs, 4 pneumonias and 1 sepsis) they often do.

Or it could be that this is the start of urinary incontinence related to dementia. It generally starts with occasional accidents before becoming the new baseline. Sometime bedwetting will happen for a time before daytime accidents. Often you'd see missed steps in bathroom hygiene— flushing, incomplete wiping, disposal of used TP in the trash or left on the sink and skipped handwashing. Since you don't live with her, you may not be privvy to this happening.

Falls are also common in the elderly. Sometimes mechanical falls can be the result of muscle weakness unrelated to dementia. But they can also result from impair spatial reasoning, visual processing issues and lack of focus related to dementia. A UTI that exacerbated her dementia symptoms would increase the risk of a fall, so they could be related. Or maybe not. It's very hard to parse out.

The transition between stages can be striking or subtle. With dad, who had Alzheimer's as his primary diagnosis, the decline was slower and steadier. My aunt who had vascular dementia had more of a stair-step progression where she'd have a long plateau in one stage and wake up one day in a completely different one. Sometimes an illness or injury can fast-forward a PWD through stages; another aunt broke a hip in stage 4 cusp of 5 which left her in stage 7 overnight.

HB