Why Hydration Matters in Early-Stage Alzheimer’s Disease

“People with Alzheimer's disease may forget to drink enough water throughout the day,” says James Bateman, MD, MPH, a neurologist and the director of VCU Health’s Alzheimer’s and Cognitive Disorders Clinic. “When you combine memory loss with loss of sensitivity to thirst, which increases as we age, the risk [of dehydration] can go up.”

Below, learn how to manage hydration and early-stage Alzheimer’s disease, why staying hydrated matters so much, how to recognize dehydration, and what you can do to prevent it.

Why Hydration Matters for Brain Health

• Body temperature regulation
• Prevention of UTIs and constipation

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• Keeping your eyes, nose, and mouth moist
• Organ, joint, and body tissue protection and lubrication
• Better transport of oxygen and nutrients around the body
• Helps the kidneys and liver flush away waste
• Dissolves medications and food so your body can use them

How Alzheimer’s Increases the Risk of Dehydration

Alzheimer’s symptoms like confusion and memory loss can increase your risk of dehydration. From brain changes to difficulty communicating, drinking enough can pose a challenge.

• Inability to Recognize Thirst With both aging and Alzheimer’s, your brain gets less sensitive to thirst cues, so you may not feel thirsty even when your body needs more water.

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• Communication Limits If you have trouble thinking of the right word or you easily lose your train of thought, you may find it difficult to ask for a drink when you need it.

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• Less Mobility If you can’t easily get around, it may be harder to get yourself a drink when you need one.
• Forgetfulness Memory loss can make it hard to remember to drink throughout the day.
• Drug Side Effects Some medications — like blood pressure drugs and diuretics for heart disease — can cause more fluid loss and lead to dehydration.

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• Taste Changes Water and other formerly favorite drinks may be less appetizing because of changes in how you smell and taste.
• Apathy Mood changes can stop you from getting a drink even if you feel thirsty.
• Fear of Incontinence If you feel worried about leaking urine, you may avoid drinking.

Recognizing Dehydration in a Person With Alzheimer’s

• Mouth dryness
• Thirst
• Dark urine
• Headache
• Fatigue
• Confusion
• Hallucinations
• Fast heart rate
• Dizziness, especially after standing up

When evaluating dehydration in Alzheimer’s, Bateman looks for sudden shifts in attention and wakefulness. If someone seems sleepier, more confused, or develops hallucinations or behavior changes, this shouldn’t be confused with the progression of Alzheimer’s disease, says Bateman.

Alzheimer’s symptoms typically take longer than days or even weeks to get worse, says Dylan Wint, MD, a neurologist specializing in memory and cognitive disorders at Cleveland Clinic in Las Vegas.

Preventive Strategies for Caregivers and Individuals

Your provider can help you decide on an appropriate daily fluid goal. Once you have it, you can follow these tips to hit that mark.

Make Hydration a Routine

Include drinking fluids in consistent parts of your day, says Dr. Wint. For example, take a few sips every time you:

• Go to the bathroom
• Watch a favorite TV show
• Eat a meal
• Get out of your chair
• Take medications

Try Other Drinks

Try different flavors in your fluids until you find one that you really like, says Wint. The pleasure of drinking something that tastes good can prompt you to drink even more than thirst and simply remembering to do it, Wint adds.

• Tea
• Coffee
• Chocolate milk
• Hot chocolate
• No-sugar-added fruit juice
• Smoothies
• Broth

Keep Fluids Visible

Eat Water-Rich Foods

If drinking doesn’t sound great to you, you have other options. “Foods that contain a lot of water can be a good way to increase hydration,” says Bateman, who recommends eating fluid-rich foods like popsicles, fruits, and vegetables.

• Soup
• Yogurt
• Cucumber
• Lettuce
• Celery
• Tomatoes
• Watermelon

Use Helpful Tools

Partnering With Your Healthcare Provider

Your healthcare provider can serve as a valuable resource in keeping you hydrated. “Every patient will have individualized needs, and talking to their medical doctor or primary care provider is the best place to start here,” says Bateman.

At your next appointment, you can ask your provider about:

• Your Fluid Goals Exactly how many ounces of fluid you should drink daily
• Medications If any of your current medications increase the risk of dehydration or electrolyte imbalance, and how you can address this concern
• Swallowing Concerns Difficulty swallowing (dysphagia) and if thickened liquids may help
• Incontinence Management Tips on how to balance your hydration with the fear of toileting accidents

If you are a caregiver and your loved one with Alzheimer’s refuses to drink, you can also ask their provider about approaches you can take to encourage more liquid intake.

The Takeaway

• Forgetfulness and confusion with Alzheimer’s disease can make it difficult to stay hydrated, but drinking enough fluids each day can help diminish symptoms.
• Dehydration symptoms like confusion and irritability can mimic Alzheimer’s, but they come on a lot faster.
• You can stay hydrated with Alzheimer’s by scheduling drink breaks, keeping fluids visible and available, eating water-rich foods, and trying tasty drinks besides water.