Between-subject similarity of functional connectivity-based organization of the human periaqueductal gray related to autonomic processing

Literature review on noninvasive central nervous system (brain and spinal cord) stimulation to improve bladder and pelvic floor function in the aging population

PURPOSE OF REVIEW

The literature was reviewed for all noninvasive central nervous system (CNS) stimulation techniques, which includes transcranial brain or trans-spinal stimulation, in the aging population. Given the rising ubiquity of this technology, noninvasive nature, and low side-effect profile reported, this technology can have a big impact on the aging population. As patients afflicted with neurogenic disorders are living longer lives, a special emphasis is placed on the aging neurogenic population.

RECENT FINDINGS

Noninvasive CNS stimulation techniques have been applied to major bladder and pelvic floor disorders such as voiding dysfunction, chronic pelvic pain, urgency and urge incontinence, lower urinary tract dysfunction, and situational urge incontinence in both the idiopathic and neurogenic populations. Overall, these noninvasive technologies demonstrate effectiveness for the treatment of these conditions with some studies showing effectiveness with longer-term follow-up suggesting lasting CNS remodeling.

SUMMARY

Most manuscripts had a generally small number of patients and an even smaller number of geriatric patients represented. No studies were specifically designed to investigate geriatric outcomes. It is the hope of this systematic review to help model future studies according to existing literature, but with a focus on the geriatric population as they stand to gain the most from noninvasive technologies with limited adverse events.

Is the insomnia phenotype the common denominator in LUTS during transition periods? An expert NOPIA research group review

AIMS

As people age, sleep stages and characteristics transition over time, but sleep deficits can profoundly impact health and cognitive functioning. Chronic sleep deprivation is linked to impaired attention and productivity, weakened immunity, increased risk of cardiovascular disease, obesity, and mental health disorders. Insomnia, obstructive sleep apnea syndrome, hormonal changes, nocturia, neurological disorders, and life events interfere with sleep patterns and some are linked to lower urinary tract symptoms (LUTS). This NOPIA symposium on Lifelong LUTS aimed to analyze the literature on associations between sleep and LUTS, generate ideas for future research, and explore whether there is support for the concept of lifelong LUTS in relation to changes in sleep throughout the lifespan.

METHODS

An international panel of experts took part in an online meeting addressing the role of lifelong LUTS in relationship to sleep and the brain organized by the NOPIA research group. The manuscript summarizes existing literature, hypotheses, future research ideas, and clinical recommendations.

RESULTS

Insomnia, sleep fragmentation, hyperarousal, and sensory processing disorders emerged as potential factors in the relationship between sleep and LUTS. Insomnia is often a persistent factor and may have been the initial symptom; however, it is often unrecognized and/or unaddressed in healthcare settings. By recognizing insomnia as a primary driver of various health issues, including nocturia, transitional care aims to address root causes and underlying problems earlier to initiate appropriate treatment.

CONCLUSIONS

A multidisciplinary approach with collaboration between healthcare professionals from various disciplines, such as urology, sleep medicine, gynecology, pediatrics, and geriatrics, is needed and should include validated measurements such as the insomnia severity index and sleep and voiding diaries. Ensuring ongoing follow-up and monitoring through transitional care is crucial for individuals with persistent sleep problems and LUTS, allowing issues that arise or fluctuate over the lifespan to be addressed.