GERIATRICS
421
Re: Urge Urinary Incontinence and the Brain Factor C. L. Morris Department of Geriatrics, University of Michigan, Ann Arbor, Michigan Neurourol Urodyn 2013; 32: 441e448.
Abstract available at http://jurology.com/ Editorial Comment: Normal urinary storage and voiding is a complex process that requires coordinated function of multiple neuromuscular components. Recent research has focused on understanding neurological changes associated with aging that may predispose older adults to urinary incontinence and other forms of voiding dysfunction. This study used a battery of validated neuropsychological tests to assess how changes in these parameters might be related to alterations in bladder function. The sample consisted of 100 women with urge incontinence and 100 control subjects with no urinary symptoms. None of the subjects had known underlying neurological disorders. There were some measurable differences between groups regarding attention demands on cognitive testing but no differences in terms of higher executive function. As the author notes, additional research will be needed to help elucidate how previously identified alterations in brain function based on functional imaging studies in those with urinary incontinence correlate with neuropsychological processing. These areas could be important targets for future therapies to address bladder dysfunction in older adults. Tomas L. Griebling, MD, MPH
Suggested Reading Krhut J, Tintera J, Holy P et al: A preliminary report on the use of functional magnetic resonance imaging with simultaneous urodynamics to record brain activity during micturition. J Urol 2012; 188: 474.
Re: The Prevalence of Incontinence in People with Cognitive Impairment or Dementia Living at Home: A Systematic Review V. M. Drennan, G. Rait, L. Cole, R. Grant and S. Iliffe Faculty of Health and Social Care, Kingston University and St. George’s University of London, London, United Kingdom Neurourol Urodyn 2013; 32: 314e324.
Abstract available at http://jurology.com/ Editorial Comment: Cognitive impairment, particularly due to dementia from Alzheimer disease, vascular causes and other etiologies, is often cited as a common contributing cause of urinary incontinence in the geriatric population. However, there is a paucity of accurate data regarding the incidence and prevalence of these associated conditions. These authors sought to perform a systematic review of the literature on the relationships between dementia and urinary incontinence among older adults residing in the community. Only 8 published studies met inclusion criteria. Prevalence of urinary incontinence reported in these studies ranged from 1.1% to 38%, and for fecal incontinence 0.9% to 27%, depending on the nature of the population examined. Lower rates were seen in general populations and higher rates in those needing specialized care services. The authors concluded that this systematic review did not definitively answer the question about prevalence of incontinence among those with dementia. This is a complex and challenging area of clinical care in geriatric urology, and additional research is warranted. Tomas L. Griebling, MD, MPH
Suggested Reading DuBeau CE: The aging lower urinary tract. J Urol, suppl., 2006; 175: S11.
421
Re: Urge Urinary Incontinence and the Brain Factor C. L. Morris Department of Geriatrics, University of Michigan, Ann Arbor, Michigan Neurourol Urodyn 2013; 32: 441e448.
Abstract available at http://jurology.com/ Editorial Comment: Normal urinary storage and voiding is a complex process that requires coordinated function of multiple neuromuscular components. Recent research has focused on understanding neurological changes associated with aging that may predispose older adults to urinary incontinence and other forms of voiding dysfunction. This study used a battery of validated neuropsychological tests to assess how changes in these parameters might be related to alterations in bladder function. The sample consisted of 100 women with urge incontinence and 100 control subjects with no urinary symptoms. None of the subjects had known underlying neurological disorders. There were some measurable differences between groups regarding attention demands on cognitive testing but no differences in terms of higher executive function. As the author notes, additional research will be needed to help elucidate how previously identified alterations in brain function based on functional imaging studies in those with urinary incontinence correlate with neuropsychological processing. These areas could be important targets for future therapies to address bladder dysfunction in older adults. Tomas L. Griebling, MD, MPH
Suggested Reading Krhut J, Tintera J, Holy P et al: A preliminary report on the use of functional magnetic resonance imaging with simultaneous urodynamics to record brain activity during micturition. J Urol 2012; 188: 474.
Re: The Prevalence of Incontinence in People with Cognitive Impairment or Dementia Living at Home: A Systematic Review V. M. Drennan, G. Rait, L. Cole, R. Grant and S. Iliffe Faculty of Health and Social Care, Kingston University and St. George’s University of London, London, United Kingdom Neurourol Urodyn 2013; 32: 314e324.
Abstract available at http://jurology.com/ Editorial Comment: Cognitive impairment, particularly due to dementia from Alzheimer disease, vascular causes and other etiologies, is often cited as a common contributing cause of urinary incontinence in the geriatric population. However, there is a paucity of accurate data regarding the incidence and prevalence of these associated conditions. These authors sought to perform a systematic review of the literature on the relationships between dementia and urinary incontinence among older adults residing in the community. Only 8 published studies met inclusion criteria. Prevalence of urinary incontinence reported in these studies ranged from 1.1% to 38%, and for fecal incontinence 0.9% to 27%, depending on the nature of the population examined. Lower rates were seen in general populations and higher rates in those needing specialized care services. The authors concluded that this systematic review did not definitively answer the question about prevalence of incontinence among those with dementia. This is a complex and challenging area of clinical care in geriatric urology, and additional research is warranted. Tomas L. Griebling, MD, MPH
Suggested Reading DuBeau CE: The aging lower urinary tract. J Urol, suppl., 2006; 175: S11.
