# Urinary tract infection‐related delirium in Alzheimer's disease and related dementias: Clinical challenges and translational opportunities **Authors:** Sarah Kim, Sarah Kremen, Itai Danovitch, Shouri Lahiri PMC · DOI: 10.1002/alz.71184 · Alzheimer's & Dementia · 2026-02-03 ## TL;DR This paper explores how urinary tract infections can lead to delirium in Alzheimer's patients, worsening their condition and how to manage it. ## Contribution The paper highlights the unique challenges of diagnosing UTI-related delirium in ADRD and proposes emerging therapies targeting IL-6 signaling. ## Key findings - UTI-related delirium accelerates cognitive decline in Alzheimer's patients. - Diagnosing UTI in ADRD is difficult due to atypical symptoms. - Emerging therapies target IL-6 trans-signaling and hormonal neuroprotection. ## Abstract Alzheimer's disease and related dementias (ADRD) affects millions of patients worldwide and is a leading cause of morbidity in older adults. Patients with ADRD are particularly susceptible to developing urinary tract infection (UTI) and UTI‐related delirium, creating a self‐perpetuating cycle in which ADRD increases vulnerability to infection and delirium, while delirium itself accelerates cognitive and functional decline. This review summarizes the epidemiology, clinical implications, and diagnostic guidelines for UTI and UTI‐related delirium in ADRD. It also examines emerging biological mechanisms, including interleukin‐6–mediated pathways, and discusses evidence‐based strategies for prevention and management. Individuals with Alzheimer's disease and related dementias (ADRD) are highly susceptible to developing urinary tract infection (UTI) and UTI‐related delirium.Delirium increases risk of incident ADRD and accelerates cognitive decline in patients with ADRD.UTI is challenging to diagnose in patients with ADRD and/or delirium due to atypical or absent genitourinary symptoms.Prompt initiation of antimicrobial therapy for UTI may improve delirium, ADRD, and survival outcomes.Emerging therapies for UTI‐related delirium target interleukin‐6 (IL‐6) trans‐signaling and hormonal neuroprotection. Individuals with Alzheimer's disease and related dementias (ADRD) are highly susceptible to developing urinary tract infection (UTI) and UTI‐related delirium. Delirium increases risk of incident ADRD and accelerates cognitive decline in patients with ADRD. UTI is challenging to diagnose in patients with ADRD and/or delirium due to atypical or absent genitourinary symptoms. Prompt initiation of antimicrobial therapy for UTI may improve delirium, ADRD, and survival outcomes. Emerging therapies for UTI‐related delirium target interleukin‐6 (IL‐6) trans‐signaling and hormonal neuroprotection. ## Linked entities - **Proteins:** IL6 (interleukin 6) - **Diseases:** Alzheimer's disease (MONDO:0004975), urinary tract infection (MONDO:0005247), delirium (MONDO:0045057) ## Full-text entities - **Genes:** CASP3 (caspase 3) [NCBI Gene 836] {aka CPP32, CPP32B, SCA-1}, IL6 (interleukin 6) [NCBI Gene 3569] {aka BSF-2, BSF2, CDF, HGF, HSF, IFN-beta-2}, IL6ST (interleukin 6 cytokine family signal transducer) [NCBI Gene 3572] {aka CD130, CDW130, GP130, HIES4, HIES4A, HIES4B}, S100B (S100 calcium binding protein B) [NCBI Gene 6285] {aka NEF, S100, S100-B, S100beta} - **Diseases:** neurodegeneration (MESH:D019636), sensory impairments (MESH:D012678), dystonia (MESH:D004421), Mental Disorders (MESH:D001523), vaginal atrophy (MESH:D014627), neuroinflammation (MESH:D000090862), language or hearing difficulties (MESH:D007806), TBI (MESH:D000070642), Clostridium difficile infection (MESH:D003015), stroke (MESH:D020521), infection (MESH:D007239), Confusion (MESH:D003221), acute coronary syndromes (MESH:D054058), pulmonary embolism (MESH:D011655), bacteriuria (MESH:D001437), hot flashes (MESH:D019584), atrophy (MESH:D001284), sepsis (MESH:D018805), Infectious Disease (MESH:D003141), UTI (MESH:D014552), neuronal injury (MESH:D009410), Lewy body dementia (MESH:D020961), Dementia (MESH:D003704), HELP (MESH:D003428), Diseases (MESH:D004194), constipation (MESH:D003248), FACTORS (MESH:D005171), neural injury (MESH:D014947), Delirium (MESH:D003693), heart failure (MESH:D006333), DIAGNOSTIC CHALLENGES (MESH:D005119), cognitive and functional decline (MESH:D003072), malnutrition (MESH:D044342), agitation (MESH:D011595), multi-organ damage (MESH:D000092124), AD (MESH:D000544), pyelonephritis (MESH:D011704), memory impairment (MESH:D008569), psychosis (MESH:D011618), diabetes (MESH:D003920), mood disturbance (MESH:D019964), incontinence (MESH:D014549), inflammation (MESH:D007249), dysuria (MESH:D053159), cystitis (MESH:D003556), executive dysfunction (MESH:D006331), Parkinson's disease (MESH:D010300), brain dysfunction (MESH:D001927), fever (MESH:D005334), vision and hearing loss (MESH:D054062), prostate hyperplasia (MESH:D011470), brain injury (MESH:D001930), prolongation of the QT interval (MESH:D008133) - **Chemicals:** risperidone (MESH:D018967), cefepime (MESH:D000077723), ascorbic acid (MESH:D001205), 5-HT receptor antagonists (-), dexmedetomidine (MESH:D020927), 17beta-estradiol (MESH:D004958), gabapentin (MESH:D000077206), olanzapine (MESH:D000077152), methenamine (MESH:D008709), Haloperidol (MESH:D006220), quetiapine (MESH:D000069348), D-mannose (MESH:D008358), Benzodiazepines (MESH:D001569), trazodone (MESH:D014196) - **Species:** Mus musculus (house mouse, species) [taxon 10090], Homo sapiens (human, species) [taxon 9606] ## Full text _Full body text omitted from this summary view._ Fetch the complete paper as Markdown: https://tomesphere.com/paper/PMC12865330/full.md ## Figures 1 figure with captions in the complete paper: https://tomesphere.com/paper/PMC12865330/full.md ## References 133 references — full list in the complete paper: https://tomesphere.com/paper/PMC12865330/full.md --- Source: https://tomesphere.com/paper/PMC12865330