It seemed to happen overnight.

Andrea entered the assisted living facility to join her 94-year-old mother for casino night. Unable to find her at the event, Andrea went to her mother’s room.

She was shocked by what she saw. Her mom was sitting on her bed wearing half her wardrobe— two summer dresses, pants, multiple shirts and sweaters, many scarves and lots of pieces of jewelry.

“I asked Mom why she had on all those clothes. She seemed confused and couldn’t give me an explanation,” Andrea said. “I asked her why she wasn’t at the casino night event, and she began to get agitated. Up until this point, my mom was of sound mind.”

In another case, 77-year-old Barbara, who is a full-time caregiver for her husband, woke up one morning so dizzy she had difficulty getting out of bed.

When she tried to phone her daughter, she couldn’t remember the number. When she finally did reach her daughter and told her what was wrong, Barbara couldn’t find the right words to answer her daughter’s questions.

Later Barbara said, “I just couldn’t think straight.”

Both seniors were experiencing signs of dementia—confusion, agitation, memory loss and loss of cognitive skills. However, in these cases, neither woman had dementia; each had a urinary tract infection (UTI).

Anna Treinkman, past president of the National Conference of Gerontological Nurse Practitioners,said, “A sudden change in behavior is one of the best indicators of a urinary tract infection in older adults.

“ Some common warning signs might include confusion or not being able to do tasks the patient could easily do a day or two before. Anytime there’s a change in an older adult—if one day they’re able to dress themselves or feed themselves and then there’s a sudden change—a red flag should go up.”

UTIs are one of the most common infections in elderly people. Women experience UTIs more often than men. And as we get older, the frequency of UTIs in both men and women increases.

UTIs place stress on the body, and in older adults that stress can result in confusion and abrupt changes in behavior.

For people suffering from Parkinson’s disease, Alzheimer’s or other dementias, any kind of stress, including UTIs, will often make their dementia temporarily worse.

Andrea’s mom’s infection went untreated until she was taken to the hospital a week later, when her behavior became unmanageable. The hospital tested her for a UTI and she was treated.

Barbara went to her doctor that same day, mainly for her dizziness, and she was diagnosed with a UTI.

Since Barbara had decreased her fluid intake to reduce the frequent urination that can come with a UTI, she was also dehydrated, resulting in vertigo or dizziness.

Barbara was prescribed antibiotics for the infection and was advised to drink plenty of water.

Women, like Andrea’s mom and Barbara, who have had a UTI are likely to have another infection.

Treinkman said that caregivers can’t be too careful when they notice a change in behavior in an older adult, no matter how subtle.

“Falls, confusion, new onset of incontinence in someone who’d been getting to the bathroom, decrease in appetite—any of these can be a sign of a urinary tract infection,” Treinkman said. “For a caregiver, it really requires a detective-like index of suspicion.”

Whether we are a senior and notice abrupt changes in our own cognitive ability or we are caring for an elderly loved one and notice changes, it’s important to be aware that a sudden change in behavior might be a warning sign of a UTI.

Visiting a physician immediately is the best advice.

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