Based on PubMed | Is blood in the urine a symptom of Alzheimer’s disease, or does it usually indicate another condition that should be evaluated in an older adult with dementia?

Blood in the urine is not considered a symptom of Alzheimer’s disease itself; it most often suggests a separate urinary or kidney issue that deserves its own evaluation, especially in an older adult with dementia. ^{[1] [2]} As Alzheimer’s progresses to late stages, people may develop trouble with bladder control and become more prone to infections, but Alzheimer’s does not directly cause blood to appear in urine. ^[3]

Why blood in urine matters

• Hematuria (blood in urine) can come from anywhere in the urinary tract kidneys, ureters, bladder, prostate, or urethra and ranges from benign to serious causes. ^{[4] [5]}
• In adults, common causes include urinary tract infection (UTI), kidney/bladder stones (urolithiasis), prostate enlargement, and urologic cancers such as bladder or kidney cancer. ^{[6] [7]}
• Because some causes can be serious, documented hematuria warrants a careful, timely evaluation rather than being attributed to dementia. ^{[6] [7]}

Alzheimer’s and urinary issues: what is and isn’t linked

• Alzheimer’s disease primarily causes memory, thinking, and behavior changes, not bleeding in the urine. ^{[1] [2]}
• In advanced stages, Alzheimer’s can affect bladder control and swallowing/balance, which may increase the risk of infections and other complications, but again, hematuria is not a core Alzheimer’s symptom. ^[3]

What to do if you see blood in urine

• Any visible red, pink, or cola-colored urine should prompt medical attention to confirm that blood is present and to find the cause. ^[8]
• Even when there is no pain, blood or clots in urine needs evaluation, because the source may still be important. ^[8]

How clinicians usually evaluate hematuria

A stepwise approach helps find the cause efficiently and safely:

1. Confirm it’s blood

   • A urinalysis (urine dipstick plus microscopy) confirms red blood cells and checks for white cells, bacteria, nitrites, protein, and other markers. This first step distinguishes true hematuria from pigment or medication effects. ^{[7] [5]}

2. History and physical exam

   • Symptoms (burning, urgency, flank pain, fever), timing of bleeding, smoking history, prior radiation/chemical exposures, medications (e.g., blood thinners), trauma, and known stones or prostate issues guide next steps. ^{[9] [10]}
   • Age and sex matter; risk of prostate causes and urinary tract cancers increases with age. ^[11]

3. Laboratory tests

   • Urine culture if infection is suspected. ^[7]
   • Consider urine cytology in some cases to look for abnormal cells. ^[12]

4. Imaging of the upper urinary tract

   • Ultrasound or CT urography evaluates kidneys and ureters for stones, tumors, or structural problems. ^{[6] [7]}

5. Cystoscopy for the lower urinary tract

   • A direct look inside the bladder and urethra is often recommended, especially in older adults or anyone with visible blood in urine, to detect bladder tumors, stones, or inflammation. ^{[6] [4]}

6. Follow‑up when no cause is found

   • If the initial work‑up is negative, periodic urinalysis and monitoring are advised to detect any emerging disease early. ^{[4] [12]}

Special considerations for older adults with dementia

• People with dementia may be less able to report symptoms like burning or pain, so hematuria can be a key visible sign of a UTI, stones, or catheter-related trauma if one is used. ^{[4] [7]}
• UTIs are common in older adults and can sometimes worsen confusion; still, the presence of blood should be evaluated rather than assumed to be harmless. ^{[4] [7]}
• Because cancer risk rises with age, clinicians are generally cautious and pursue appropriate imaging and cystoscopy when indicated. ^{[11] [6]}

When to seek urgent care

• Seek urgent evaluation if blood in urine is accompanied by fever, inability to pass urine, severe pain, large clots, weakness/dizziness, or signs of significant blood loss, as these can indicate a more serious situation needing prompt treatment. ^[8]

Key takeaways

• Hematuria is not a symptom of Alzheimer’s disease; it typically points to a separate urinary or kidney condition. ^{[1] [2]}
• Common causes include UTI, stones, prostate enlargement, and cancers, and these should be assessed with urinalysis, possible culture, imaging, and often cystoscopy. ^{[6] [7]}
• Do not dismiss blood in urine in an older adult with dementia; appropriate evaluation helps identify treatable issues and rule out serious causes. ^{[6] [4]}