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Hardy CC, Ramasamy R, Rosenberg DA, Kuchel GA, Yan R, Hu X, Smith PP. Alzheimer's disease amyloidogenesis is linked to altered lower urinary tract physiology. Neurourol Urodyn 2022; 41:1344-1354. [PMID: 35579273 DOI: 10.1002/nau.24952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/04/2022] [Accepted: 04/14/2022] [Indexed: 11/07/2022]
Abstract
AIMS While most Alzheimer's disease (AD) research emphasizes cognitive and behavioral abnormalities, lower urinary tract symptoms (LUTS) are observed in a third of AD patients, contributing to morbidity, poor quality of life, and need for institutionalization. Alzheimer's disease-associated urinary dysfunction (ADUD) has been assumed to be due to cognitive decline alone. While mouse studies have suggested that bladder innervation and voiding behavior may be altered in AD models, technical challenges precluded voiding reflex assessments. This study seeks to establish a mouse model of ADUD, and it seeks to characterize the noncognitive sequelae involved in AD-pathology associated alterations in the voiding reflex. METHODS Having developed techniques permitting the assessment of bladder volume, pressure, and flow in mice, we now provide evidence of alterations in involuntary bladder control and increased response heterogeneity in a transgenic amyloidosis mouse model of AD using cystometry and tissue pharmacomyography. Tg-APP/PS1DE9 (PA) mice and their wild-type (WT) littermates (n = 6-8 per group) were used before plaque onset in the PA mice (4-6 months) and after plaque accumulation in the PA mice (8-10 months) in comparison to their WT control littermates. RESULTS Novel findings include data suggestive of sphincteric discoordination, with pharmacological evidence of altered adrenergic mechanisms. CONCLUSIONS Together, these data highlight the importance of addressing noncognitive sequelae of AD and offer novel translational insights into the debilitating impact of AD on LUTS and incontinence.
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Affiliation(s)
- Cara C Hardy
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
- CT Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Surgery, University of Connecticut SOM, Farmington, Connecticut, USA
| | - Ramalakshmi Ramasamy
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
- CT Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Surgery, University of Connecticut SOM, Farmington, Connecticut, USA
- Department of Neuroscience, University of Connecticut SOM, Farmington, Connecticut, USA
| | - Dawn A Rosenberg
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
- Department of Surgery, University of Connecticut SOM, Farmington, Connecticut, USA
- Department of Cell Biology, University of Connecticut SOM, Farmington, Connecticut, USA
| | - George A Kuchel
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
- CT Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Riqiang Yan
- Department of Neuroscience, University of Connecticut SOM, Farmington, Connecticut, USA
| | - Xiangyou Hu
- Department of Neuroscience, University of Connecticut SOM, Farmington, Connecticut, USA
| | - Phillip P Smith
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
- CT Institute for Brain and Cognitive Sciences, University of Connecticut, Storrs, Connecticut, USA
- Department of Surgery, University of Connecticut SOM, Farmington, Connecticut, USA
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2
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Xu Z, Elrashidy RA, Li B, Liu G. Oxidative Stress: A Putative Link Between Lower Urinary Tract Symptoms and Aging and Major Chronic Diseases. Front Med (Lausanne) 2022; 9:812967. [PMID: 35360727 PMCID: PMC8960172 DOI: 10.3389/fmed.2022.812967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Aging and major chronic diseases are risk factors for lower urinary tract symptoms (LUTS). On the other hand, oxidative stress (OS) is one of the fundamental mechanisms of aging and the development of chronic diseases. Therefore, OS might be a candidate mechanism linking these two clinical entities. This article aims to summarize the studies on the prevalence of LUTS, the role of OS in aging and chronic diseases, and the potential mechanisms supporting the putative link. A comprehensive literature search was performed to identify recent reports investigating LUTS and OS in major chronic diseases. In addition, studies on the impact of OS on the lower urinary tract, including bladder, urethra, and prostate, were collected and summarized. Many studies showed LUTS are prevalent in aging and major chronic diseases, including obesity, metabolic syndrome, diabetes, cardiovascular disease, hypertension, obstructive sleep apnea, autoimmune diseases, Alzheimer’s disease, and Parkinson’s disease. At the same time, OS is a key component in the pathogenesis of those chronic diseases and conditions. Recent studies also provided evidence that exacerbated OS can cause functional and/or structural changes in the bladder, urethra, and prostate, leading to LUTS. The reviewed data support the concept that OS is involved in multiple risk factors-associated LUTS, although further studies are needed to confirm the causative relationship. The specific ROS/RNS and corresponding reactions/pathways involved in chronic diseases and associated LUTS should be identified in the future and could serve as therapeutic targets.
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Affiliation(s)
- Zhenqun Xu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Rania A. Elrashidy
- Department of Biochemistry, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Bo Li
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- Department of Urology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Guiming Liu
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
- *Correspondence: Guiming Liu,
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Bartolone SN, Sharma P, Chancellor MB, Lamb LE. Urinary Incontinence and Alzheimer's Disease: Insights From Patients and Preclinical Models. Front Aging Neurosci 2022; 13:777819. [PMID: 34975457 PMCID: PMC8718555 DOI: 10.3389/fnagi.2021.777819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease effects a large percentage of elderly dementia patients and is diagnosed on the basis of amyloid plaques and neurofibrillary tangles (NFTs) present in the brain. Urinary incontinence (UI) is often found in the elderly populations and multiple studies have shown that it is more common in Alzheimer's disease patients than those with normal cognitive function. However, the link between increased UI and Alzheimer's disease is still unclear. Amyloid plaques and NFTs present in micturition centers of the brain could cause a loss of signal to the bladder, resulting in the inability to properly void. Additionally, as Alzheimer's disease progresses, patients become less likely to recognize the need or understand the appropriate time and place to void. There are several treatments for UI targeting the muscarinic and β3 adrenergic receptors, which are present in the bladder and the brain. While these treatments may aid in UI, they often have effects on the brain with cognitive impairment side-effects. Acetylcholine esterase inhibitors are often used in treatment of Alzheimer's disease and directly oppose effects of anti-muscarinics used for UI, making UI management in Alzheimer's disease patients difficult. There are currently over 200 pre-clinical models of Alzheimer's disease, however, little research has been done on voiding disfunction in these models. There is preliminary data suggesting these models have similar voiding behavior to Alzheimer's disease patients but much more research is needed to understand the link between UI and Alzheimer's disease and discover better treatment options for managing both simultaneously.
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Affiliation(s)
- Sarah N Bartolone
- Department of Urology, Beaumont Health, Royal Oak, MI, United States
| | - Prasun Sharma
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States
| | - Michael B Chancellor
- Department of Urology, Beaumont Health, Royal Oak, MI, United States.,Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States
| | - Laura E Lamb
- Department of Urology, Beaumont Health, Royal Oak, MI, United States.,Oakland University William Beaumont School of Medicine, Rochester Hills, MI, United States
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Qin C, Wang Y, Gao Y. Overactive Bladder Symptoms Within Nervous System: A Focus on Etiology. Front Physiol 2021; 12:747144. [PMID: 34955876 PMCID: PMC8703002 DOI: 10.3389/fphys.2021.747144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/16/2021] [Indexed: 12/02/2022] Open
Abstract
Overactive bladder (OAB) is a common debilitating condition characterized by urgency symptoms with detrimental effects on the quality of life and survival. The exact etiology of OAB is still enigmatic, and none of therapeutic approaches seems curative. OAB is generally regarded as a separate syndrome, whereas in clinic, OAB symptoms could be found in numerous diseases of other non-urogenital systems, particularly nervous system. The OAB symptoms in neurological diseases are often poorly recognized and inadequately treated. This review provided a comprehensive overview of recent findings related to the neurogenic OAB symptoms. Relevant neurological diseases could be mainly divided into seven kinds as follows: multiple sclerosis and related neuroinflammatory disorders, Parkinson’s diseases, multiple system atrophy, spinal cord injury, dementia, peripheral neuropathy, and others. Concurrently, we also summarized the hypothetical reasonings and available animal models to elucidate the underlying mechanism of neurogenic OAB symptoms. This review highlighted the close association between OAB symptoms and neurological diseases and expanded the current knowledge of pathophysiological basis of OAB. This may increase the awareness of urological complaints in neurological disorders and inspire robust therapies with better outcomes.
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Affiliation(s)
- Chuying Qin
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunliang Gao
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
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Chang CW, Juan YS, Yang YH, Lee HY. The Relationship Between Lower Urinary Tract Symptoms and Severity of Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2021; 36:1533317521992657. [PMID: 33635087 PMCID: PMC10623918 DOI: 10.1177/1533317521992657] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Urinary incontinence (UI) is more prevalent in elderly populations with dementia than those without dementia. Alzheimer's disease (AD) is the most common cause of dementia. Urge UI, the most common type of UI in AD patients, causes more morbidity and mortality. However, it is inconvenient to obtain the report of urodynamic study from AD patient to diagnose urinary incontinence. Nevertheless, it is easier to obtain subjective or objective questionnaires from the patients or the caregivers. The data collected from the questionnaires are used to evaluate if severity of dementia is associated with urge UI and other lower urinary tract symptoms (LUTs). PATIENTS AND METHODS A total of 43 AD patients were enrolled in this study, all of whom were checked post-void residual (PVR) urine amount by sonography after voiding. The severity of dementia was evaluated by questionnaire including Cognitive Abilities Screening Instrument (CASI), Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), and Clinical Dementia Rating Sub-of-Box (CDR-SB). The LUTs were assessed with International Consultation of Incontinence Questionnaire (ICIQ) and Overactive bladder symptom scores (OABSS) questionnaire. Independent t test and Pearson's correlation analysis were calculated. RESULTS The average age in both AD with/without urge UI patients is 78 years old. The scores of CDR-SB, OABSS and ICIQ are significantly different in these 2 groups (p = 0.023, p = 0.003, p = 0.001; respectively). However, the neurophysiological scores of CASI, MMSE, CDR, CDR-SB is not correlated with OABSS (r = 0.047, p = 0.382; r = 0.074, p = 0.317; r = 0.087, p = 0.288; r = 0.112, p = 0.237; respectively). Interestingly, if we separate each individual symptom of OAB, there is a significant correlation between CDR-SB and urge UI score (r = 0.314, p = 0.023). CONCLUSIONS Higher lower urinary tract symptom scores are noted in AD patients with urge UI. The CDR-SB score is highly correlated with urge UI in AD patients.
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Affiliation(s)
- Che-Wei Chang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yung-Shun Juan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung
| | - Hsiang-Ying Lee
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Haddad R, Monaghan TF, Joussain C, Phé V, Bower W, Roggeman S, Robain G, Everaert K. Nocturia in patients with cognitive dysfunction: a systematic review of the literature. BMC Geriatr 2020; 20:230. [PMID: 32631237 PMCID: PMC7336631 DOI: 10.1186/s12877-020-01622-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/18/2020] [Indexed: 01/17/2023] Open
Abstract
Background The objective of this study is to evaluate current literature on the association between cognitive dysfunction and nocturia. Methods A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted through MEDLINE, EMBASE and COCHRANE databases and completed in November 2019. Randomized and non-randomized studies were included if they assessed the association between cognitive dysfunction and nocturia in older participants with or without neurological diseases. The quality of included studies was evaluated using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). Results A total of 8 cross-sectional studies conducted in older patient populations met the criteria for inclusion. A statistically significant association was identified in 6 studies on univariate analysis, which persisted in 2 studies after controlling for confounding factors. The association between cognitive dysfunction and nocturia was positive for all 6 significant analyses. The overall risk of bias was unclear. Conclusion A significant positive association between cognitive dysfunction and nocturia was identified. However, research has been limited to cross-sectional studies, which precludes identification of causality between cognitive dysfunction and nocturia. Heightened awareness of the complex interplay between cognition and nocturia would allow professionals involved in the care of cognitively impaired patients with concomitant nocturia to more effectively manage these symptoms.
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Affiliation(s)
- Rebecca Haddad
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium. .,GRC 001 GREEN Neuro-Urology Research Group, Sorbonne Université Rothschild Academic Hospital AP-HP, F-75012, Paris, France.
| | - Thomas F Monaghan
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Charles Joussain
- Medical School Paris Île-de-France Ouest Inserm U1179, Versailles Saint-Quentin University, Versailles, France.,Department of Physical Medicine and Rehabilitation, Raymond-Poincaré Academic Hospital AP-HP, Garches, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université Pitié-Salpêtrière Academic Hospital AP-HP, Paris, France
| | - Wendy Bower
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Saskia Roggeman
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Gilberte Robain
- GRC 001 GREEN Neuro-Urology Research Group, Sorbonne Université Rothschild Academic Hospital AP-HP, F-75012, Paris, France
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Wicaksono I, Rahardjo HE. Factors Associated With Postoperative Voiding Dysfunction Post Renal Transplantation. Transplant Proc 2020; 52:3197-3203. [PMID: 32593439 DOI: 10.1016/j.transproceed.2020.04.1817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/23/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Renal transplantation offers a better quality of life and survival rate for patients with end-stage renal disease. However, voiding dysfunction may have results such as decreased bladder capacity that have been observed in patients with prolonged oliguria or anuria, impacting a patient's quality of life. This study aimed to investigate preoperative factors associated with the occurrence of voiding dysfunction after renal transplantation. METHODS Seventy-one patients' data who had undergone successful renal transplantation at Cipto Mangunkusumo General Hospital in Jakarta were collected. Preoperative characteristics including age, sex, history of hypertension, diabetes mellitus, preoperative anuria, and duration of renal substitution therapy were obtained. Multivariate analysis were performed examining the correlation of preoperative characteristics with postoperative voiding dysfunction measured by International Prostate Symptom Score storage (IPSS-s) sub-score > 5, overactive bladder symptom score (OABSS) > 5, maximum flow rate (Qmax) > 15 mL/cc, and postvoid residual volume (PVR) > 50 mL. RESULTS A significant correlation of IPSS-s score suggesting storage problem with duration of preoperative dialysis was observed (odds ratio [OR] 1.052; 95% confidence interval [CI] 1.006-1.1001, P = .027). Older age and preoperative anuria were positively correlated with OABSS score > 5 (OR 1.104 and 33.567, P value .004 and .002, respectively). Negative correlation was observed between male sex and Qmax > 15mL/s (OR 1.73; 95% CI 0.033-1.907, P = .038). Male sex was negatively correlated with PVR > 50 mL (OR 0.231; P = .043) but positively correlated with the presence history of diabetes mellitus (OR 8.146; 95% CI 1.548-42.864, P = .013). CONCLUSION This study demonstrated that assessment of patient age, sex, and past medical history could help determine patients' risk for developing voiding dysfunction after renal transplantation.
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Affiliation(s)
- Indra Wicaksono
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Harrina Erlianti Rahardjo
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
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Karakaya İÇ, Yenişehir S, Karakaya MG. Nursing Home Residents' Level of Knowledge About Urinary Incontinence. Ann Geriatr Med Res 2019; 23:20-26. [PMID: 32743281 PMCID: PMC7387602 DOI: 10.4235/agmr.19.0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background A common problem in nursing home residents, urinary incontinence (UI) can lead to hygiene and skin problems, sleep disturbance, and decreased quality of life. This study evaluated the level of knowledge regarding UI among nursing home residents in Muğla, Turkey. Methods This study included 64 (19 females, 45 males) nursing home resident volunteers. Their physical and sociodemographic characteristics; daily living activities (Barthel Index); and the presence, frequency, severity, and type of UI as well as its impact on daily living were evaluated (International Consultation on Incontinence Questionnaire-Short Form) and history of treatment was queried. An Incontinence Quiz was used to assess the residents’ knowledge of incontinence. Results The participants were living in nursing homes for 34.48±33.16 months. Their educational level was low and most were single. The mean Barthel Index score was 89.75±13.00. Twenty-five participants had UI (18.8% urge, 4.7% stress, 15.6% mixed/other type), and the mean International Consultation on Incontinence Questionnaire-Short Form score was 8.08±4.24. Forty-four percent of the participants had no treatment and none had physiotherapy for incontinence. The mean Incontinence Quiz score was 4.88±1.96, indicating a low level of knowledge. The items with the highest ratio of incorrect responses (second and 14th) were related to the causes of incontinence and care seeking. Conclusion These findings underscore the necessity of increasing knowledge among nursing home residents about the reasons and health care options for UI. Further studies on appropriate strategies to improve UI knowledge in this population will be of great value.
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Affiliation(s)
- İlkim Çıtak Karakaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Semiha Yenişehir
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Mehmet Gürhan Karakaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
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Kim JH. Re: Insufficient conclusions regarding the association between overactive bladder symptoms and degree of dementia. Int Braz J Urol 2017; 43:998-999. [PMID: 28727380 PMCID: PMC5678540 DOI: 10.1590/s1677-5538.ibju.2017.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/26/2017] [Indexed: 11/21/2022] Open
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