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Kancheva AK, Lyall DM, Millard L, Wardlaw JM, Quinn TJ. Clinical Phenotypes Associated With Cerebral Small Vessel Disease: A Study of 45,013 UK Biobank Participants. Neurology 2024; 103:e209919. [PMID: 39321409 DOI: 10.1212/wnl.0000000000209919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral small vessel disease (cSVD) is the most common pathology underlying vascular cognitive impairment. Although other clinical features of cSVD are increasingly recognized, it is likely that certain symptoms are being overlooked. A comprehensive description of cSVD associations with clinical phenotypes at scale is lacking. The objective of this study was to conduct a large-scale, hypothesis-free study of associations between cSVD and clinical phenotypes in UK Biobank (UKB). METHODS We included participants from the UKB imaging study who had available information on total volume of white matter hyperintensities (WMHs), the most common cSVD neuroimaging feature. We included various UKB variables describing clinical phenotypes, defined as observable signs and symptoms of individuals with concurrent neuroimaging evidence of cSVD. We conducted a phenome scan using the open-source PHESANT software package. Total volume of WMHs was introduced as the independent variable and clinical phenotypes as the dependent variables in the regression model. The association of each phenotype with total volume of WMHs was tested using one of several regression analyses (all age at recruitment and sex-adjusted). All associations were corrected for multiple comparisons using the false discovery rate (FDR) correction method. RESULTS We included 45,013 participants in the analysis (mean age = 54.97 years, SD = 7.55). We confirm previously reported associations with depression (odds ratio [OR] = 1.07 [95% CI 1.05-1.10]), apathy (OR = 1.11 [95% CI 1.08-1.14]), falls (OR = 1.11 [95% CI 1.09-1.13]), respiratory problems (OR = 1.14 [95% CI 1.04-1.25]), and sleep disturbance (OR = 1.07 [95% CI 1.04-1.09], all FDR-adjusted p < 0.001). We further identified associations with all-cause dental issues (OR = 0.94 [95% CI 0.96-0.92]), hearing problems (OR = 1.06 [95% CI 1.03-1.08]), and eye problems (OR = 0.93 [95% CI 0.91-0.95], all FDR-adjusted p < 0.001). DISCUSSION Our findings suggest that presence of cSVD associates with concurrent clinical phenotypes across several body systems. We have corroborated established associations of cSVD and present novel ones. While our results do not provide causality or direction of association because of the cross-sectional nature of our study, they support the need for a more holistic view of cSVD in research, practice, and policy.
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Affiliation(s)
- Angelina K Kancheva
- From the School of Cardiovascular and Metabolic Health (A.K.K., T.J.Q.) School of Health and Wellbeing (D.M.L.), University of Glasgow; MRC Integrative Epidemiology Unit (L.M.), University of Bristol; and Centre for Clinical Brain Sciences (J.M.W.), University of Edinburgh, United Kingdom
| | - Donald M Lyall
- From the School of Cardiovascular and Metabolic Health (A.K.K., T.J.Q.) School of Health and Wellbeing (D.M.L.), University of Glasgow; MRC Integrative Epidemiology Unit (L.M.), University of Bristol; and Centre for Clinical Brain Sciences (J.M.W.), University of Edinburgh, United Kingdom
| | - Louise Millard
- From the School of Cardiovascular and Metabolic Health (A.K.K., T.J.Q.) School of Health and Wellbeing (D.M.L.), University of Glasgow; MRC Integrative Epidemiology Unit (L.M.), University of Bristol; and Centre for Clinical Brain Sciences (J.M.W.), University of Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- From the School of Cardiovascular and Metabolic Health (A.K.K., T.J.Q.) School of Health and Wellbeing (D.M.L.), University of Glasgow; MRC Integrative Epidemiology Unit (L.M.), University of Bristol; and Centre for Clinical Brain Sciences (J.M.W.), University of Edinburgh, United Kingdom
| | - Terence J Quinn
- From the School of Cardiovascular and Metabolic Health (A.K.K., T.J.Q.) School of Health and Wellbeing (D.M.L.), University of Glasgow; MRC Integrative Epidemiology Unit (L.M.), University of Bristol; and Centre for Clinical Brain Sciences (J.M.W.), University of Edinburgh, United Kingdom
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Xu K, Wang Y, Jiang Y, Wang Y, Li P, Lu H, Suo C, Yuan Z, Yang Q, Dong Q, Jin L, Cui M, Chen X. Analysis of gait pattern related to high cerebral small vessel disease burden using quantitative gait data from wearable sensors. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108162. [PMID: 38631129 DOI: 10.1016/j.cmpb.2024.108162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND AND OBJECTIVES Sensor-based wearable devices help to obtain a wide range of quantitative gait parameters, which provides sufficient data to investigate disease-specific gait patterns. Although cerebral small vessel disease (CSVD) plays a significant role in gait impairment, the specific gait pattern associated with a high burden of CSVD remains to be explored. METHODS We analyzed the gait pattern related to high CSVD burden from 720 participants (aged 55-65 years, 42.5 % male) free of neurological disease in the Taizhou Imaging Study. All participants underwent detailed quantitative gait assessments (obtained from an insole-like wearable gait tracking device) and brain magnetic resonance imaging examinations. Thirty-three gait parameters were summarized into five gait domains. Sparse sliced inverse regression was developed to extract the gait pattern related to high CSVD burden. RESULTS The specific gait pattern derived from several gait domains (i.e., angles, phases, variability, and spatio-temporal) was significantly associated with the CSVD burden (OR=1.250, 95 % CI: 1.011-1.546). The gait pattern indicates that people with a high CSVD burden were prone to have smaller gait angles, more stance time, more double support time, larger gait variability, and slower gait velocity. Furthermore, people with this gait pattern had a 25 % higher risk of a high CSVD burden. CONCLUSIONS We established a more stable and disease-specific quantitative gait pattern related to high CSVD burden, which is prone to facilitate the identification of individuals with high CSVD burden among the community residents or the general population.
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Affiliation(s)
- Kelin Xu
- Department of Biostatistics, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Yingzhe Wang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanfeng Jiang
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Yawen Wang
- Department of Biostatistics, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Peixi Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Heyang Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Suo
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China; Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Ziyu Yuan
- Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Qi Yang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China; Fudan University Taizhou Institute of Health Sciences, Taizhou, China.
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Nguyen HXT, Hyde Z, McNamara BJ, Hughson JA, Radford K, Russell S, Flicker L, Quigley R, Malay R, Strivens E, Withall A, Lavrencic L, Draper B, Delbaere K, Cumming R, LoGiudice D. Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies. BMC Neurol 2024; 24:185. [PMID: 38824519 PMCID: PMC11143581 DOI: 10.1186/s12883-024-03688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia. METHODS/DESIGN Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI). DISCUSSION Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.
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Affiliation(s)
- Huong X T Nguyen
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia.
| | - Zoë Hyde
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
- Centre for Aboriginal Medical and Dental Health, Medical School, University of Western Australia, Perth, Australia
| | - Bridgette J McNamara
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, VIC, Australia
- Barwon South-West Public Health Unit, Barwon Health, Geelong, VIC, Australia
| | - Jo-Anne Hughson
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia
| | - Kylie Radford
- Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Sarah Russell
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Rachel Quigley
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Roslyn Malay
- Western Australian Centre for Health and Ageing, Medical School, University of Western Australia, Perth, Australia
| | - Edward Strivens
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia
| | - Adrienne Withall
- School of Psychology, University of New South Wales, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Louise Lavrencic
- Neuroscience Research Australia, Sydney, Australia
- Ageing Futures Institute, University of New South Wales, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Brian Draper
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- School of Population Health, University of New South Wales, Sydney, Australia
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, Sydney, Australia
| | - Dina LoGiudice
- Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Royal Park Campus, Administration Building 21, 34 -54 Poplar Road, Melbourne, VIC, 3050, Australia
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Zillioux J, Slopnick EA, Vasavada SP. Third-line therapy for overactive bladder in the elderly: Nuances and considerations. Neurourol Urodyn 2022; 41:1967-1974. [PMID: 35645033 PMCID: PMC9796112 DOI: 10.1002/nau.24965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) disproportionally affects older adults in both incidence and severity. OAB pharmacotherapy is often problematic in the elderly due to polypharmacy, adverse side effect profiles and contraindications in the setting of multiple comorbidities, and concerns regarding the risk of incident dementia with anticholinergic use. The burden of OAB in older patients coupled with concerns surrounding pharmacotherapy options should motivate optimization of nonpharmacologic therapies in this population. At the same time, several aspects of aging may impact treatment efficacy and decision-making. This narrative review critically summarizes current evidence regarding third-line OAB therapy use in the elderly and discusses nuances and treatment considerations specific to the population. METHODS We performed an extensive, nonsystematic evidence assessment of available literature via PubMed on onabotulinumtoxinA (BTX-A), sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS) for OAB, with a focus on study in elderly and frail populations. RESULTS While limited, available studies show all three third-line therapies are efficacious in older populations and there is no data to support one option over another. BTX-A likely has a higher risk of urinary tract infection and retention in older compared to younger populations, especially in the frail elderly. PTNS incurs the lowest risk, although adherence is poor, largely due to logistical burdens. CONCLUSION Advanced age and frailty should not preclude third-line therapy for refractory OAB, as available data support their efficacy and safety in these populations. Ultimately, treatment choices should be individualized and involve shared decision-making.
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Affiliation(s)
- Jacqueline Zillioux
- Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandOhioUSA
| | - Emily A. Slopnick
- Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandOhioUSA
| | - Sandip P. Vasavada
- Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandOhioUSA
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Komiya H, Umegaki H, Ogama N, Sakurai T, Kuzuya M. Relationships between overactive bladder and cerebral white matter hyperintensity in outpatients at a memory clinic. Geriatr Gerontol Int 2021; 21:996-1002. [PMID: 34545679 DOI: 10.1111/ggi.14279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 12/01/2022]
Abstract
AIM Cerebral small vessel disease and lower urinary tract symptoms are common in older people. However, the association between white matter hyperintensity (WMH) and overactive bladder (OAB) is not fully understood. We aimed to identify the relationship between WMH and OAB. METHODS We carried out neuropsychological testing and head magnetic resonance imaging (T2-weighted and fluid-attenuated inversion recovery) of 72 outpatients at a memory clinic and evaluated their Overactive Bladder Symptom Score. WMH was assessed using the Fazekas scale, and WMH volumes were determined using Software for Neuro-Image Processing in Experimental Research. OAB was diagnosed based on a urinary urgency score (the third question of the Overactive Bladder Symptom Score) of two or higher and a total Overactive Bladder Symptom Score of three or higher. Multivariate logistic analysis was carried out, with the presence/absence of overactive bladder as the outcome variable, and age, sex, body mass index and diabetes mellitus as covariates. RESULTS Of the 72 participants, 17 (24%) were diagnosed with OAB. WMH assessed by the visual rating scale was not associated with OAB. However, participants with OAB showed significantly higher WMH volume than those without OAB. Regionally, participants with OAB showed high WMH volume in the frontal, occipital and parietal lobes. Multiple logistic regression analysis showed that WMH was significantly associated with OAB (OR 1.82, 95% CI 1.11-2.98), after adjustment for clinically important confounders. CONCLUSIONS Cerebral WMH volume is associated with OAB, independent of age, sex, body mass index and diabetes mellitus. Geriatr Gerontol Int 2021; 21: 996-1002.
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Affiliation(s)
- Hitoshi Komiya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriko Ogama
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,The Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu-shi, Japan
| | - Takashi Sakurai
- The Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu-shi, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Hamilton M, Isaacs A. Natural History, Treatment Outcomes and Quality of Life in Idiopathic Normal Pressure Hydrocephalus (iNPH). Neurol India 2021; 69:S561-S568. [DOI: 10.4103/0028-3886.332281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Northwood M, Ploeg J, Markle-Reid M, Sherifali D. The Complexity of Living with Diabetes and Urinary Incontinence for Older Adults with Multiple Chronic Conditions Receiving Home Care Services: An Interpretive Description Study. Glob Qual Nurs Res 2021; 8:2333393621993452. [PMID: 33628868 PMCID: PMC7882747 DOI: 10.1177/2333393621993452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Over 40% of older adults with diabetes receiving home-care services experience urinary incontinence. However, experiential knowledge is lacking on how these older adults live with diabetes and incontinence. Interpretive description methodology was used to explore the experiences of 18 older adults with diabetes and urinary incontinence receiving home-care services in Ontario, Canada. Five themes emerged from the findings: (a) enduring urinary incontinence: "patch it in pads"; (b) struggling to manage diabetes, incontinence, and multiple chronic conditions: "a balancing act"; (c) covering the costs of care: "I can't afford it"; (d) counting on a caregiver: "he does everything"; and (e) home-care services not meeting my needs: "it's not individual." These findings suggest that living with urinary incontinence and diabetes is a complex and challenging experience. This evidence could inform the provision of comprehensive home care to support self-care for this population.
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Affiliation(s)
| | | | | | - Diana Sherifali
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, ON, Canada
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Abstract
Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.
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9
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[Diagnosis and treatment of vascular dementia]. Z Gerontol Geriatr 2020; 53:687-698. [PMID: 32975634 DOI: 10.1007/s00391-020-01786-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/28/2020] [Indexed: 01/26/2023]
Abstract
Vascular dementias (VD, due to the various expressions of VD the plural form is used) are the second most common form of dementia after Alzheimer's dementia. These dementias play an important role especially in geriatric patients. They can occur due to acute events (e.g. stroke) and due to slowly progressive cerebrovascular damage. This article focuses on VD due to cortical and strategic infarcts, microangiopathic infarcts with lacunae as well as intracerebral bleeding. In addition to the clinical description and radiological findings, a special focus is on education, prevention and rehabilitation aspects.
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Chatterjee S, Talwar A, Aparasu RR. Anticholinergic medications and risk of dementia in older adults: Where are we now? Expert Opin Drug Saf 2020; 19:1251-1267. [PMID: 32797761 DOI: 10.1080/14740338.2020.1811227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Anticholinergic medications are effective for a wide variety of indications, but are associated with significant central adverse effects, especially cognitive decline and dementia in older adults. AREAS COVERED We conducted a review of relevant literature in the past decade to address anticholinergic scales and evidence of anticholinergic-related dementia/cognitive decline in older adults. We discussed various anticholinergic scales used to classify anticholinergic medications. The review focused on the evidence from previous reviews and individual studies evaluating the anticholinergic-related risk of developing cognitive decline/dementia. This review also discussed clinical and methodological issues of studies along with recommendations for practice and research. EXPERT OPINION The review demonstrates moderate to strong risk of dementia with anticholinergic use in multiple studies involving older adults, irrespective of the study design, analytical approach, anticholinergic exposure and outcome definition. This risk is particularly significant with the cumulative burden and high-level anticholinergics. There also exists a dose-response relationship between anticholinergic use and increased risk for dementia. Therefore, anticholinergic agents can be considered as a modifiable risk factor for dementia and cognitive decline in older adults. Based on the current evidence, regular assessment and optimization of anticholinergic burden prior to prescribing these medications can minimize anticholinergic-related morbidity in older adults.
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Affiliation(s)
- Satabdi Chatterjee
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston , Houston, TX, USA
| | - Ashna Talwar
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston , Houston, TX, USA
| | - Rajender R Aparasu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston , Houston, TX, USA
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11
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Ruangritchankul S, Peel NM, Hanjani LS, Gray LC. Drug related problems in older adults living with dementia. PLoS One 2020; 15:e0236830. [PMID: 32735592 PMCID: PMC7394402 DOI: 10.1371/journal.pone.0236830] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M. Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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12
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Tish MM, Geerling JC. The Brain and the Bladder: Forebrain Control of Urinary (In)Continence. Front Physiol 2020; 11:658. [PMID: 32719609 PMCID: PMC7349519 DOI: 10.3389/fphys.2020.00658] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/25/2020] [Indexed: 12/11/2022] Open
Abstract
Neural circuits extending from the cerebral cortex to the bladder maintain urinary continence and allow voiding when it is socially appropriate. Injuries to certain brain regions produce a specific disruption known as urge incontinence. This neurologic symptom is distinguished by bladder spasticity, with sudden urges to void and frequent inability to maintain continence. The precise localization of neural circuit disruptions responsible for urge incontinence remains poorly defined, partly because the brain regions, cell types, and circuit connections that normally maintain continence are unknown. Here, we review what is known about the micturition reflex circuit and about forebrain control of continence from experimental animal studies and human lesion data. Based on this information, we hypothesize that urge incontinence results from damage to a descending pathway that normally maintains urinary continence. This pathway begins with excitatory neurons in the prefrontal cortex and relays subcortically, through inhibitory neurons that may help suppress reflex micturition during sleep and until it is safe and socially appropriate to void. Identifying the specific cell types and circuit connections that constitute the continence-promoting pathway, from the forebrain to the brainstem, will help us better understand why some brain lesions and neurodegenerative diseases disrupt continence. This information is needed to pave the way toward better treatments for neurologic patients suffering from urge incontinence.
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Affiliation(s)
- Margaret M Tish
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Joel C Geerling
- Department of Neurology, University of Iowa, Iowa City, IA, United States
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Ades-Aron B, Yeager S, Miskin N, Fieremans E, George A, Golomb J. Diffusional Kurtosis along the Corticospinal Tract in Adult Normal Pressure Hydrocephalus. AJNR Am J Neuroradiol 2018; 39:2218-2223. [PMID: 30385473 DOI: 10.3174/ajnr.a5845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 08/28/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Normal Pressure Hydrocephalus is a reversible form of dementia characterized by enlarged ventricles, which can deform and cause disruptions to adjacent white matter fibers. The purpose of this work was to examine how diffusion and kurtosis parameters vary along the corticospinal tract and determine where along this path microstructure is compromised in patients diagnosed with normal pressure hydrocephalus. We hypothesized that disruption of the corticospinal tract from ventricular enlargement can be measured using diffusion MR imaging and this will be quantified in periventricular regions. MATERIALS AND METHODS We developed a method to analyze diffusion parameters at discrete points along neural tracts. We then used diffusion MR imaging data from patients with Alzheimer disease and healthy controls to compare whether diffusion along the corticospinal tract differs from that of patients with normal pressure hydrocephalus. RESULTS We found that diffusion parameters can differentiate patients with normal pressure hydrocephalus from those with Alzheimer disease and healthy controls: Axial diffusion, axial kurtosis, and the axonal water fraction were found to differ significantly across groups (P < .05) in an area located close to the superior internal capsule and corona radiata but below the cortex. CONCLUSIONS A lower axonal water fraction indicates a lower axonal density in the corticospinal tract, which may indicate permanent damage. Lower axial kurtosis may imply that axons are being more aligned due to compression.
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Affiliation(s)
- B Ades-Aron
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - S Yeager
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - N Miskin
- Department of Radiology (N.M.), Brigham and Women's Hospital, Boston, Massachusetts
| | - E Fieremans
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - A George
- From the Center for Biomedical Imaging (B.A.-A., S.Y., E.F., A.G.), Department of Radiology
| | - J Golomb
- Department of Neurology (J.G.), New York University School of Medicine, New York, New York
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Wagg A. Choosing oral drug therapy for overactive bladder in older people. Expert Opin Pharmacother 2018; 19:1375-1380. [DOI: 10.1080/14656566.2018.1502270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Adrian Wagg
- Capital Health Chair in Healthy Ageing Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Lower Urinary Tract Symptoms in Subjects with Subclinical Cerebral White Matter Lesions. J Aging Res 2018; 2018:1582092. [PMID: 30155303 PMCID: PMC6091337 DOI: 10.1155/2018/1582092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/02/2018] [Accepted: 07/09/2018] [Indexed: 01/15/2023] Open
Abstract
Aim We assessed the impact of cerebral white matter lesions (WMLs) on lower urinary tract symptoms in subjects with normal neurological and cognitive function. Methods A cohort of community-dwelling subjects aged ≥65 years were recruited to undergo MRI brain assessment. WMLs were graded using the Fazekas scale from 0 to 3. A separate telephone interview was carried out to assess the urinary symptoms in these subjects using the questionnaire Overactive Bladder-Validated 8-Question Awareness Tool (OAB-V8). Results 800 community-dwelling elderly subjects were recruited to undergo MRI brain. In this cohort, 431 subjects responded to the telephone interview concerning their urinary symptoms. Among the respondents, 21.1% did not exhibit any WML on their MRI brain. Most of the subjects (52.6%) exhibited grade 1 WML. On logistic regression, age was found to be positively correlated with the Fazekas score (correlation coefficient 0.203, p ≤ 0.01). Using a cutoff of 8 on OAB-V8, 22% of the respondents experienced OAB. Presence of WML, hypertension, or diabetes mellitus was not found to be correlated with storage urinary symptoms or OAB-V8 total score. Multiple logistic regression analysis did not show the presence of WML to be associated with the diagnosis of OAB (adjusted OR 1.13, 95% CI 0.65–1.96, p=0.659). Conclusions WML is associated with age and is common in the elderly population. Mild WML is subclinical, with no obvious neurological and urinary symptoms. Our cohort did not demonstrate a relationship between WML and lower urinary tract symptoms.
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Clarkson BD, Griffiths D, Resnick NM. Do brain structural abnormalities differentiate separate forms of urgency urinary incontinence? Neurourol Urodyn 2018; 37:2597-2605. [PMID: 29672906 DOI: 10.1002/nau.23591] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/27/2018] [Indexed: 11/11/2022]
Abstract
AIMS Urgency urinary incontinence (UUI) is a major problem for seniors. The underlying mechanisms of disease and therapy are unknown. We sought structural brain abnormalities that might underlie the functional differences previously observed by functional Magnetic Resonance Imaging in UUI patients versus controls, or among UUI responders versus non-responders to therapy-and thereby reveal potential disease mechanisms and therapeutic targets. METHODS Secondary study of a trial of biofeedback-assisted pelvic floor muscle training (BFB) in 60 women (>60 yrs) with UUI, plus 11 age-matched continent controls. Brain structural abnormalities were investigated using: (1) white-matter hyperintensities (WMH); (2) diffusion tensor imaging (DTI) to reveal white-matter pathways with impaired integrity; and (3) voxel-based morphometry (VBM) to show regions of atrophy or hypertrophy. RESULTS WMH burden was greater in UUI patients than controls (globally and in superior longitudinal fasciculus and cingulum), suggesting a possible causal connection. WMH burden was unexpectedly greater in responders than non-responders to BFB, and appeared to increase in non-responders but not in responders. DTI revealed even worse integrity of the cingulum than was apparent by WMH. VBM showed parahippocampal atrophy in UUI. CONCLUSIONS Many women with UUI have white-matter damage that interferes with pathways critical to bladder control; they can be taught by techniques like BFB to exert stronger control over the bladder. For others, in whom abnormalities of key brain areas are less marked, UUI's cause may reside elsewhere, and therapy targeting these brain centers may be less effective than therapy targeting the bladder or other brain centers.
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Affiliation(s)
- Becky D Clarkson
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Griffiths
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Neil M Resnick
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Affiliation(s)
- Lesley Butcher
- Lecturer in Adult Nursing, Cardiff University, School of Healthcare Sciences, Cardiff
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Rektor I, Bohnen NI, Korczyn AD, Gryb V, Kumar H, Kramberger MG, de Leeuw FE, Pirtošek Z, Rektorová I, Schlesinger I, Slawek J, Valkovič P, Veselý B. An updated diagnostic approach to subtype definition of vascular parkinsonism - Recommendations from an expert working group. Parkinsonism Relat Disord 2018; 49:9-16. [PMID: 29310988 PMCID: PMC5857227 DOI: 10.1016/j.parkreldis.2017.12.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 11/25/2022]
Abstract
This expert working group report proposes an updated approach to subtype definition of vascular parkinsonism (VaP) based on a review of the existing literature. The persistent lack of consensus on clear terminology and inconsistent conceptual definition of VaP formed the impetus for the current expert recommendation report. The updated diagnostic approach intends to provide a comprehensive tool for clinical practice. The preamble for this initiative is that VaP can be diagnosed in individual patients with possible prognostic and therapeutic consequences and therefore should be recognized as a clinical entity. The diagnosis of VaP is based on the presence of clinical parkinsonism, with variable motor and non-motor signs that are corroborated by clinical, anatomic or imaging findings of cerebrovascular disease. Three VaP subtypes are presented: (1) The acute or subacute post-stroke VaP subtype presents with acute or subacute onset of parkinsonism, which is typically asymmetric and responds to dopaminergic drugs; (2) The more frequent insidious onset VaP subtype presents with progressive parkinsonism with prominent postural instability, gait impairment, corticospinal, cerebellar, pseudobulbar, cognitive and urinary symptoms and poor responsiveness to dopaminergic drugs. A higher-level gait disorder occurs frequently as a dominant manifestation in the clinical spectrum of insidious onset VaP, and (3) With the emergence of molecular imaging biomarkers in clinical practice, our diagnostic approach also allows for the recognition of mixed or overlapping syndromes of VaP with Parkinson's disease or other neurodegenerative parkinsonisms. Directions for future research are also discussed.
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Affiliation(s)
- Ivan Rektor
- Masaryk University, Central European Institute of Technology - CEITEC, Neuroscience Centre and Movement Disorders Centre, Brno, Czech Republic.
| | - Nicolaas I Bohnen
- Departments of Radiology and Neurology, University of Michigan, and Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Amos D Korczyn
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv 69978, Israel
| | - Viktoria Gryb
- Ivano-Frankivsk Medical University, Department of Neurology and Neurosurgery, Ivano-Frankivsk Regional Hospital, Vascular Neurology Department, Ivano-Frankivsk, Ukraine
| | - Hrishikesh Kumar
- Department of Neurology, Institute of Neurosciences, Kolkata, India
| | | | - Frank-Erik de Leeuw
- Radboud University Nijmegen Medical Center, Donders Institute Brain Cognition & Behaviour, Center for Neuroscience Department of Neurology, Nijmegen, The Netherlands
| | - Zvezdan Pirtošek
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Irena Rektorová
- Masaryk University, Central European Institute of Technology - CEITEC, Neuroscience Centre and Movement Disorders Centre, Brno, Czech Republic
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Technion Faculty of Medicine, Haifa, Israel
| | - Jaroslaw Slawek
- Neurology Department, St. Adalbert Hospital, Department of Neurological-Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
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Carnahan R, Johnson T. Making a Bad Diagnosis Worse? Suspect Drug Management of Urinary Incontinence in Persons with Dementia. J Am Geriatr Soc 2017; 65:238-240. [PMID: 27882548 PMCID: PMC6996241 DOI: 10.1111/jgs.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ryan Carnahan
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Theodore Johnson
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
- Department of Medicine, Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Bey E, Nicot B, Casez O, Le Normand L. [Lower urinary tract dysfunction in normal pressure hydrocephalus: Review of the literature]. Prog Urol 2016; 26:1191-1199. [PMID: 27816462 DOI: 10.1016/j.purol.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunction in normal pressure hydrocephalus has received little attention from the scientific community. The aim of this review article was to discuss diagnostic and therapeutic options for these patients. SOURCES A literature review of MedLine publications on urinary incontinence in normal pressure hydrocephalus was conducted. The following keywords were used: "hydrocephalus, normal pressure" and "bladder dysfunction" or "urinary incontinence" or "overactive bladder" or "urinary bladder, neurogenic". Prospective and retrospective studies as well as previous reviews were analyzed. RESULTS Urinary symptoms in normal pressure hydrocephalus are mainly represented by overactive bladder, which is a significant burden for the concerned patients. Isolated overactive bladder is more frequent (64%) than urinary incontinence (57%). Detrusor overactivity is seen in 95.2% of the cases. Neuro-surgery is efficient on urinary symptoms for 61.5% of the patients. Bladder recovery after surgery relates with increased mid-cingulate perfusion, probably linked with a functional restoration of the mid-cingulate that normally inhibits the micturition reflex. Medical options, added or not to surgery, include anticholinergic drugs unable to pass through the blood-brain barrier, Transcutaneous Electrical Nerve Stimulation and sacral neuromodulation. CONCLUSION There is actually an insufficient concern about urinary symptoms in normal pressure hydrocephalus. This article highlights the importance of a harmonization of neuro-urological practices in the pre-therapeutic evaluation of patients suffering from normal pressure hydrocephalus.
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Affiliation(s)
- E Bey
- Département de chirurgie urologique, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France.
| | - B Nicot
- Département de neuro-chirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - O Casez
- Département de neurologie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - L Le Normand
- Département de chirurgie urologique, CHU de Nantes, 85, rue Saint-Jacques, Nantes, France
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McDonald C, Winge K, Burn DJ. Lower urinary tract symptoms in Parkinson's disease: Prevalence, aetiology and management. Parkinsonism Relat Disord 2016; 35:8-16. [PMID: 27865667 DOI: 10.1016/j.parkreldis.2016.10.024] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/25/2016] [Accepted: 10/31/2016] [Indexed: 01/23/2023]
Abstract
Lower urinary tract symptoms (LUTS) are common in Parkinson's disease (PD), effecting 27-85% of patients with PD. Irritative symptoms predominate and urodynamic studies confirm high prevalence of detrusor overactivity in PD. LUTS are present early in PD and are more common in PD than in age matched controls. The assessment of LUTS in PD is complicated by coexisting bradykinesia and cognitive impairment. Although LUTS become more troublesome as PD progresses it remains unclear if LUTS severity correlates with motor symptoms and/or duration of PD. The underlying cause of LUTS in PD remains to be fully elucidated. Animal and human studies suggest the net effect of the basal ganglia is to supress micturition. Although LUTS are a common in PD, few studies have examined the assessment and management of LUTS specifically in patients with PD. Pilot studies have suggested that bladder training, antimuscarinic drugs and intravesical botulinum toxin maybe helpful but these trials have been small and frequently lacked a suitable control group making them vulnerable to the placebo effect. Furthermore the adverse effects of antimuscarinic drugs on cognitive and gastrointestinal function may limit the use of these drugs in PD. In this review we summarise the literature describing the prevalence of LUTS in PD, discuss the emerging data delineating the underlying pathophysiology of LUTS and examine interventions helpful in the management of LUTS in people with PD.
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Affiliation(s)
- Claire McDonald
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - Kristian Winge
- Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - David J Burn
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Saji N, Ogama N, Toba K, Sakurai T. White matter hyperintensities and geriatric syndrome: An important role of arterial stiffness. Geriatr Gerontol Int 2016; 15 Suppl 1:17-25. [PMID: 26671153 DOI: 10.1111/ggi.12673] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/16/2022]
Abstract
White matter hyperintensities (WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a "tsunami effect" on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome.
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Affiliation(s)
- Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Noriko Ogama
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.,Biobank, National Center for Geriatrics and Gerontology, Obu, Japan.,Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenji Toba
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan
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Anticholinergic Medication Use and Risk of Dementia Among Elderly Nursing Home Residents with Depression. Am J Geriatr Psychiatry 2016; 24:485-95. [PMID: 26976294 DOI: 10.1016/j.jagp.2015.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 12/16/2015] [Accepted: 12/22/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression. DESIGN Population-based nested case-control study. SETTING Population-based study involving 2007-2010 Minimum Data Set-linked Medicare data from all 50 states. PARTICIPANTS Medicare beneficiaries aged 65 years and older, diagnosed with depression, and no history of dementia as of 2007 (baseline period). Cases were identified as patients with incident dementia following the baseline period. For each case, four age- and sex-matched control subjects were selected using incidence density sampling. MEASUREMENTS Anticholinergic exposure was defined using Anticholinergic Drug Scale. Prescription of clinically significant anticholinergic medications (levels 2 and 3) 30 days preceding the event date formed the primary exposure. The primary outcome was dementia diagnosis, between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was performed to assess dementia risk, after controlling for other risk factors. RESULTS The study sample included 28,388 cases diagnosed with dementia and 113,352 matched control subjects. After adjusting for other risk factors, clinically significant anticholinergic use was associated with significant risk of dementia (OR: 1.26; 95% CI: 1.22-1.29) compared with non-use. The findings remained consistent across levels of anticholinergic potency (level 2, OR: 1.37, 95% CI: 1.31-1.44; level 3, OR: 1.15, 95% CI: 1.10-1.19). CONCLUSION Use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.
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Canavan M, Smyth A, Robinson SM, Gibson I, Costello C, O'Keeffe ST, Walsh T, Mulkerrin EC, O'Donnell MJ. Attitudes to outcomes measured in clinical trials of cardiovascular prevention. QJM 2016; 109:391-7. [PMID: 26231089 DOI: 10.1093/qjmed/hcv132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Selecting outcome measures in cardiovascular prevention trials should be informed by their importance to selected populations. Major vascular event outcomes are usually prioritized in these trials with considerably less attention paid to cognitive and functional outcomes. AIM To examine views on importance of outcome measures used in clinical trials. DESIGN Cross-sectional survey. METHODS Of 367 individuals approached, 280 (76%) participated: outpatients attending cardiovascular prevention clinics (n = 97), active retirement groups members (n = 75), medical students (n = 108). Participants were asked to rank, in order of importance, outcome measures, which may be included in cardiovascular prevention trials. Results were compared between two groups: <65s (n = 157) and ≥65s (n = 104). RESULTS When asked what outcomes were most important to measure in cardiovascular prevention trials, respondents reported: death (31.6%) stroke (28.5%), dementia (26.9%), myocardial infarction (MI) (7.9%) and requiring nursing home (NH) care (5.1%). When asked the most relevant outcomes regarding successful ageing respondents reported; maintaining independence (32.4%), avoiding major illness (24.3%), good family life (23.6%), living as long as possible (15.8%), avoiding NH care (3.1%) and contributing to society (0.8%) as most important. When asked what outcome concerned them most about the future, respondents reported: dementia (32.6%), dependence (30.4%), death (12.8%), stroke (12.5%), cancer (6.2%) requiring NH care (4.8%) and MI (0.7%). Maintaining independence was considered most important in younger and older cohorts. CONCLUSION Cognitive and functional outcomes are important patient-relevant outcomes, sometimes more important than major vascular events. Incorporating these outcomes into trials may encourage patient participation and adherence to preventative regimens.
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Affiliation(s)
- M Canavan
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland, HRB Clinical Research Facility, National University of Ireland, Galway, Ireland and
| | - A Smyth
- HRB Clinical Research Facility, National University of Ireland, Galway, Ireland and
| | - S M Robinson
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - I Gibson
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - C Costello
- Croí-The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, Galway, Ireland
| | - S T O'Keeffe
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - T Walsh
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - E C Mulkerrin
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland
| | - M J O'Donnell
- From the Department of Geriatric Medicine, University Hospital Galway, Galway, Ireland, HRB Clinical Research Facility, National University of Ireland, Galway, Ireland and
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Undiagnosed neurological disease as a potential cause of male lower urinary tract symptoms. Curr Opin Urol 2016; 26:11-6. [DOI: 10.1097/mou.0000000000000243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lower Urinary Tract Symptoms Are Associated with Increased Risk of Dementia among the Elderly: A Nationwide Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:187819. [PMID: 26290863 PMCID: PMC4531168 DOI: 10.1155/2015/187819] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/22/2014] [Indexed: 12/20/2022]
Abstract
Studies show a strong association between dementia and lower urinary tract symptoms (LUTS). The aim of this study was to investigate whether LUTS are a risk factor for cognitive impairment. We enrolled 50-year-old and older subjects with LUTS (LUTS[+]) (n = 6801) and controls without LUTS (LUTS[−]) (n = 20,403) from Taiwan's National Health Insurance Research Database. LUTS, dementia, and other confounding factors are defined by International Classification of Diseases, Ninth Revision, Clinical Modification Codes. Participants were recruited from 2000 to 2004 and then followed up until death or the end of 2011. The outcome was the onset of dementia, which was assessed using Poisson regression analysis, Cox hazards models, and Kaplan-Meier survival curves. The incidence of dementia was significantly higher in the LUTS[+] group than in the LUTS[−] group (124.76 versus 77.59/1000 person-years). The increased risk of dementia related to LUTS remained significant after adjustment for potential confounders (adjusted hazard ratio (AHR): 1.61, 95% confidence interval (CI) 1.47–1.76, P < 0.0001) and higher than that related to cerebrovascular disease (AHR: 1.43, 95% CI 1.26–1.61, P < 0.0001). The outcome suggests the need for early screening and appropriate intervention to help prevent cognitive impairment of patients with LUTS.
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Kitta T, Mitsui T, Kanno Y, Chiba H, Moriya K, Shinohara N. Brain-bladder control network: The unsolved 21st century urological mystery. Int J Urol 2015; 22:342-8. [DOI: 10.1111/iju.12721] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/13/2014] [Accepted: 12/30/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Takahiko Mitsui
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Yukiko Kanno
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Hiroki Chiba
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine; Hokkaido University; Sapporo Hokkaido Japan
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Winge K. Lower urinary tract dysfunction in patients with parkinsonism and other neurodegenerative disorders. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:335-56. [DOI: 10.1016/b978-0-444-63247-0.00019-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sakakibara R. Lower urinary tract dysfunction in patients with brain lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:269-87. [PMID: 26003249 DOI: 10.1016/b978-0-444-63247-0.00015-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Stroke and brain tumor are well-known brain diseases. The incidence of lower urinary tract dysfunction (LUTD) in these patients ranges from 14% to 53%, mostly overactive bladder (OAB), and is higher when the frontal cortex is involved. This presumably reflects damage at the prefrontal cortex, cingulate cortex, and other areas that regulate (mainly inhibit) the micturition reflex. White-matter disease (WMD) is a chronic, bilateral form of cerebrovascular disease, leading to a high prevalence of OAB (up to 90%). Since WMD is particularly common in the elderly, WMD may be one of the anatomic substrates for elderly OAB. Traumatic brain injury and normal-pressure hydrocephalus are rather diffuse brain diseases, which cause OAB with a prevalence rate of 60-95%. Recent neuroimaging studies have shown a relationship between LUTD and the frontal cortex in these diseases. Data on other brain diseases, particularly affecting deep brain structures, are limited. Small infarctions, tumors, or inflammatory diseases affecting the basal ganglia, hypothalamus, and cerebellum lead to mainly OAB. In contrast, similar diseases affecting the brainstem lead to either OAB or urinary retention. The latter reflects damage at the periaqueductal gray and the pontine micturition center that directly relay and modulate the micturition reflex. Urinary incontinence (UI) in brain disease can be divided into two types: neurogenic UI (due to OAB) and functional UI (immobility and loss of initiative/cognition). These two types of UI may occur together, but management differs significantly. Management of neurogenic UI includes anticholinergic drugs that do not penetrate the blood-brain barrier easily. Management of functional UI includes behavioral therapy (timed/prompted voiding with physical assistance and bladder/pelvic floor training) and drugs to treat gait as well as cognition that facilitate continence. These treatments will maximize the quality of life in patients with brain diseases.
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Affiliation(s)
- Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan.
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Small vessel disease and memory loss: what the clinician needs to know to preserve patients' brain health. Curr Cardiol Rep 2014; 15:427. [PMID: 24105643 DOI: 10.1007/s11886-013-0427-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Small vessel disease (SVD) in the brain manifests in the periventricular and deep white matter and radiographically is described as "leukoaraiosis". It is increasingly recognized as a cause of morbidity from middle age onward and this clinical relevance has paralleled advances in the field of neuroradiology. Overall, SVD is a heterogenous group of vascular disorders that may be asymptomatic, or a harbinger of many conditions that jeopardize brain health. Management and prevention focuses on blood pressure control, lifestyle modification, and symptomatic treatment.
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Campos-Juanatey F, Gutiérrez-Baños JL, Portillo-Martín JA, Zubillaga-Guerrero S. Assessment of the urodynamic diagnosis in patients with urinary incontinence associated with normal pressure hydrocephalus. Neurourol Urodyn 2014; 34:465-8. [PMID: 24729303 DOI: 10.1002/nau.22600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 03/03/2014] [Indexed: 11/06/2022]
Abstract
AIMS To assess the urodynamic patterns present in patients with adult normal pressure hydrocephalus (NPH) in our institution. METHODS Retrospectively conducted study on patients diagnosed with NPH by the Neurosurgery Department of our institution, without etiological treatment or urogynecological disorders, who underwent an urodynamic study (UDS) performed according to methods proposed by the International Society of Continence (ICS). Clinical information, complementary tests and UDS were collected, and descriptive analysis was performed, with special focus in urodynamic final diagnosis. RESULTS Eighty-one UDS performed between 2003 and 2013. Fifty-one Males (63%). Mean age: 74.89 ± 8.58 years old (range 52-88 years). Classical triad of symptoms: gait disturbance, dementia, and urinary incontinence (UI) presented in 48.1%. Urinary urgency in 80.9% and UI in 70%. In two cases (2.5%) UDS was not valuable. Urodynamic features of the 79 remaining studies revealed overactive detrusor (OD) in 56 patients (70.9%), being associated with Stress UI (SUI) in one case and with bladder outlet obstruction (BOO) in 19. SUI in six patients (7.6%) and BOO in five (6.3%). Detrusor underactivity in four cases (5%) and normal study in eight (10.1%). About 47.1% of males presented BOO. Cerebrospinal fluid shunt surgery was performed on 32 patients during follow-up, with subsequent clinical improvement in 90.6% of them. CONCLUSIONS OD was the most frequent diagnosis within UDS conducted on adult NPH patients in our institution, with BOO in an elevated percentage of them. Etiological treatment led to symptomatic improvement in most of patients.
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Affiliation(s)
- Félix Campos-Juanatey
- Urology Department, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain
| | - José Luis Gutiérrez-Baños
- Urology Department, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain.,School of Medicine, University of Cantabria, Santander, Spain
| | - José Antonio Portillo-Martín
- Urology Department, Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain.,School of Medicine, University of Cantabria, Santander, Spain
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Lee SH, Cho ST, Na HR, Ko SB, Park MH. Urinary incontinence in patients with Alzheimer's disease: Relationship between symptom status and urodynamic diagnoses. Int J Urol 2014; 21:683-7. [DOI: 10.1111/iju.12420] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Seong Ho Lee
- Department of Urology; College of Medicine; Hallym University; Seoul Korea
| | - Sung Tae Cho
- Department of Urology; College of Medicine; Hallym University; Seoul Korea
| | - Hae Ri Na
- Department of Neurology; Bobath Memorial Hospital; Seongnam-si Korea
| | - Seok Bum Ko
- Department of Neurology; Bobath Memorial Hospital; Seongnam-si Korea
| | - Moon Ho Park
- Department of Neurology; College of Medicine; Korea University; Seoul Korea
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Sakakibara R, Kishi M, Tsuyusaki Y, Tateno F, Uchiyama T, Yamamoto T. [Neurology and the bladder: how to assess and manage neurogenic bladder dysfunction. With particular references to neural control of micturition]. Rinsho Shinkeigaku 2014; 53:181-90. [PMID: 23524597 DOI: 10.5692/clinicalneurol.53.181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bladder dysfunctions are one of the most common features seen in the failure of the autonomic nervous system. Among those, overactive bladder (urinary urgency and frequency) worsens quality of life of the patients, and a large amount of post-voiding residual urine or urinary retention causes urinary tract infection, kidney dysfunction, and may bring renal failure. In the present paper we discussed neural control of micturition and how to assess it. Also, we proposed appropriate management of bladder dysfunction in elderly white matter lesions (a common cause of OAB) and diabetic neuropathy (a usual pathology underlying urinary retention). For OAB, anti-cholinergics are the mainstay, whereas for the pathological post-voiding residual urine or urinary retention, alpha-blockers, cholinergic agents and clean, intermittent self-catheterization are the choice. Treatment of bladder dysfunctions is the important target for maximizing patients' quality of life.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University
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Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyusaki Y, Yamanishi T, Uchiyama T, Yamamoto T, Yano M. Is overactive bladder a brain disease? The pathophysiological role of cerebral white matter in the elderly. Int J Urol 2013; 21:33-8. [PMID: 24118122 DOI: 10.1111/iju.12288] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/26/2013] [Indexed: 12/30/2022]
Abstract
Small-vessel disease of the brain affecting the deep white matter characteristically manifests with neurological syndromes, such as vascular dementia and vascular parkinsonism. There is, however, compelling evidence to suggest that white matter disease can cause overactive bladder and incontinence, and in some patients these might be the initial manifestation. As white matter disease increases significantly with age, and preferentially affects the prefrontal deep white matter, white matter disease becomes an anatomical substrate in the brain etiology of overactive bladder. Treatment entails the management of small-vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood-brain barrier, to improve bladder control. In short, when caring for elderly overactive-bladder patients, we should look at both the brain and the bladder.
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Affiliation(s)
- Ryuji Sakakibara
- Neurology Division, Department of Internal Medicine, Toho University, Sakura, Japan
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Sakakibara, Tateno F, Yano M, Takahashi O, Sugiyama M, Ogata T, Kishi M, Tsuyusaki Y, Yamamoto T, Uchiyama T, Yamanishi T, Shibata C. Tolterodine activates the prefrontal cortex during bladder filling in OAB patients: a real-time NIRS-urodynamics study. Neurourol Urodyn 2013; 33:1110-5. [PMID: 24038213 DOI: 10.1002/nau.22471] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
AIMS Studies of overactive bladder (OAB) have shown urothelial/suburothelial changes and increased bladder afferents, while in the brain the frontal micturition area that normally suppresses the bladder is deactivated. It has been unclear whether anticholinergic medication could reverse this suppression. To address this question, we performed a real-time NIRS (near-infrared spectroscopy)-urodynamic study in OAB patients before and after the administration of an anticholinergic agent, tolterodine. METHODS We recruited 13 OAB patients in our outpatient clinic (9 males, 4 female; mean age 73 years). Before and after the administration of 4 mg/day tolterodine for 3 months, all patients completed the OAB-symptom scale and a NIRS-urodynamics examination. Cerebral changes in the oxy-hemoglobin concentration (oxy-Hb) were sampled. Concentration changes in oxy-Hb were calculated based on a modified Beer-Lambert approach. RESULTS Tolterodine significantly reduced the OAB patients' nighttime frequency (P < 0.05) and increased their first-sensation volume (290-359 ml, P < 0.01). The number of patients with detrusor overactivity did not lessen significantly (11-9). The real-time NIRS-urodynamic study showed that, during slow bladder filling between start and bladder capacity, tolterodine significantly activated the right frontal micturition area of the OAB patients (P < 0.05). The activation was prominent in Brodmann's area 8, 9, 10 of the prefrontal cortex. CONCLUSIONS Tolterodine reduced bladder sensation together with a significant activation of the frontal micturition area of OAB patients, particularly Brodmann's area 8, 9, 10 of the right prefrontal cortex. This activation seems to be a secondary phenomenon, since tolterodine does not easily penetrate the blood-brain barrier.
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Affiliation(s)
- Sakakibara
- Department of Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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Memon HU, Handa VL. Vaginal childbirth and pelvic floor disorders. ACTA ACUST UNITED AC 2013; 9:265-77; quiz 276-7. [PMID: 23638782 DOI: 10.2217/whe.13.17] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Childbirth is an important event in a woman's life. Vaginal childbirth is the most common mode of delivery and it has been associated with increased incidence of pelvic floor disorders later in life. In this article, the authors review and summarize current literature associating pelvic floor disorders with vaginal childbirth. Stress urinary incontinence and pelvic organ prolapse are strongly associated with vaginal childbirth and parity. The exact mechanism of injury associating vaginal delivery with pelvic floor disorders is not known, but is likely multifactorial, potentially including mechanical and neurovascular injury to the pelvic floor. Observational studies have identified certain obstetrical exposures as risk factors for pelvic floor disorders. These factors often coexist in clusters; hence, the isolated effect of these variables on the pelvic floor is difficult to study.
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Affiliation(s)
- Hafsa U Memon
- Department of Gynecology & Obstetrics, Johns Hopkins School of Medicine, MD, USA.
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Wehrberger C, Jungwirth S, Fischer P, Tragl KH, Krampla W, Marlies W, Madersbacher S. The relationship between cerebral white matter hyperintensities and lower urinary tract function in a population based, geriatric cohort. Neurourol Urodyn 2013; 33:431-6. [PMID: 23775725 DOI: 10.1002/nau.22419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/05/2013] [Indexed: 01/23/2023]
Abstract
INTRODUCTION White matter hyperintensities (WHM) in cerebral MRI-scan have been suspected to be involved in the pathogenesis for geriatric LUTS. Aim of this study was to investigate this association in a geriatric cohort. MATERIALS AND METHODS The VITA-study is a prospective, population-based study initiated 2000/2001. All inhabitants of a well-defined area in Vienna aged 75 years were recruited and underwent detailed regular visits including cerebral MRI-scans. Subcortical and periventricular WMHs were classified according to the Fazekas-classification. In 2010, all subjects alive were contacted to complete the Bristol LUTS questionnaire. RESULTS Two hundred seventeen participants (75 men, 142 women), all 85 years old, entered this analysis. Urgency, frequency, and nocturia was present in 39 (50.7%), 53 (52%), and 55 (73.3%) men and 79 (55.6%), 81 (78.2%), and 68 (47.9%) women, respectively. OAB symptoms were seen in 55% of women and 50% of men. At baseline, WMH were present in 68.2% and this percentage increased to 85.7% at the most recent follow-up. Several symptoms were more prevalent in participants without WMH as compared to those with WMH, (urgency: 71% vs. 53%, P=0.06, nocturia: 77% vs. 53%, P=0.01: OAB-symptoms: 71% vs. 51%, P=0.05. Only frequency was more prevalent in participants with WMH (77% vs. 68%, P=0.27). In general, sub-categorization into periventricular and subcortical WMH confirmed these data. Furthermore the amount of WMH-burden did not correlate to LUT dysfunction. CONCLUSION This study failed to demonstrate a clear association between several aspects of LUTS and WMH in a rather healthy, population-based 85-year-old cohort.
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Takahashi O, Sakakibara R, Panicker J, Fowler CJ, Tateno F, Kishi M, Tsuyusaki Y, Yano H, Sugiyama M, Uchiyama T, Yamamoto T. White Matter Lesions or Alzheimer's Disease: Which Contributes More to Overactive Bladder and Incontinence in Elderly Adults with Dementia? J Am Geriatr Soc 2012; 60:2370-1. [DOI: 10.1111/jgs.12004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Osamu Takahashi
- Clinical Physiology Unit; Sakura Medical Center; Toho University; Sakura Japan
| | - Ryuji Sakakibara
- Division of Neurology; Department of Internal Medicine; Sakura Medical Center; Toho University; Sakura Japan
| | - Jalesh Panicker
- Department of Uro-Neurology; National Hospital for Neurology and Neurosurgery; Queen Square; London UK
| | - Clare J. Fowler
- Department of Uro-Neurology; National Hospital for Neurology and Neurosurgery; Queen Square; London UK
| | - Fuyuki Tateno
- Division of Neurology; Department of Internal Medicine; Sakura Medical Center; Toho University; Sakura Japan
| | - Masahiko Kishi
- Division of Neurology; Department of Internal Medicine; Sakura Medical Center; Toho University; Sakura Japan
| | - Yohei Tsuyusaki
- Division of Neurology; Department of Internal Medicine; Sakura Medical Center; Toho University; Sakura Japan
| | - Hitoshi Yano
- Department of Urology; Sakura Medical Center; Toho University; Sakura Japan
| | - Megumi Sugiyama
- Clinical Physiology Unit; Sakura Medical Center; Toho University; Sakura Japan
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