A Cohort Study of Urinary Tract Infections in People Living with Dementia: Epidemiology and Diagnostic Challenges

Abstract Background Urinary tract infections (UTIs) are a leading cause of hospitalisation in people living with dementia (PLWD), making accurate detection and prompt treatment essential in this vulnerable population. Methods This retrospective longitudinal cohort study assessed the concordance between self-reported symptoms, urine colony counts > 10⁵ CFU/mL, dipstick results positive for leukocytes and/or nitrites, and urinary IL-8 levels in identifying UTIs among PLWD. The study included 78 community-dwelling individuals aged over 50 with a confirmed dementia diagnosis, recruited from cohorts established by the Surrey and Borders Partnership NHS Foundation Trust and the Hammersmith & Fulham Partnership Primary Care Network between late 2019 and 2023. Results UTI frequency among PLWD was highly variable, with some individuals experiencing recurrent infections whilst others had none throughout the study period. The microbial taxa identified were consistent with those seen in other populations. There was no clear concordance between self-reported symptoms and laboratory indicators of UTI. However, dipstick-positive results correlated with urine samples showing > 10⁵ CFU/mL of a single colony morphology growth and elevated IL-8 concentrations. Conclusions Urinary dipstick tests for nitrites and leukocytes may serve as a practical screening tool for UTIs in PLWD, particularly in individuals unable to reliably report symptoms. However, future research is needed to evaluate the clinical impact of this diagnostic approach on outcomes such as hospitalisation rates, delirium incidence, and antibiotic resistance and stewardship in this vulnerable population.