Confusion due to constipation in a dementia patient

I had two cases of the past week where the patient (elderly with dementia) was admitted for worsening AMS. Infectious/metabolic etiologies were ruled out and the AMS was linked to constipation. On one of the cases the neurologist stated that this was a metabolic encephalopathy secondary to severe constipation superimposed on dementia. Does anyone know if constipation can cause a metabolic encephalopathy? I always just thought that the discomfort/pain from constipation causes worsening confusion in an already demented patient because they can't figure out why they are hurting. Any thoughts?

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