From the Research
Yes, constipation can contribute to increased confusion and agitation in patients with dementia. This connection occurs because physical discomfort from constipation can trigger behavioral changes in dementia patients who may be unable to effectively communicate their distress. When managing dementia patients with sudden increases in confusion or agitation, healthcare providers should always assess for constipation as a potential underlying cause. The most recent and highest quality study, 1, found a high prevalence of constipation in elderly individuals, particularly in those with dementia, suggesting a close connection between the two conditions. Treatment typically involves ensuring adequate hydration (at least 6-8 glasses of water daily), increasing dietary fiber (aim for 25-30g daily), encouraging physical activity as tolerated, and establishing regular toileting routines. Medications such as docusate sodium (100mg twice daily), polyethylene glycol (17g daily in water), or senna (8.6mg tablets, 1-2 at bedtime) may be needed for immediate relief, as supported by 2. The physiological basis for this connection involves both the discomfort of constipation causing stress responses and potentially the systemic effects of retained waste products, which may exacerbate cognitive symptoms, as discussed in 3 and 4. Addressing constipation often results in noticeable improvements in behavior and cognition, making this a crucial but often overlooked aspect of dementia care. Some key points to consider when managing constipation in dementia patients include:
- Assessing for constipation as a potential underlying cause of confusion or agitation
- Ensuring adequate hydration and dietary fiber intake
- Encouraging physical activity and establishing regular toileting routines
- Using medications such as docusate sodium, polyethylene glycol, or senna as needed for immediate relief
- Recognizing the potential connection between constipation and cognitive symptoms in dementia patients, as highlighted in 5 and 1.