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• W2056331505 abstract "It is well recognized that in the geriatric population, urinary incontinence (UI) is most often associated with dementia. This is not only because UI occurs secondarily from dementia (functional UI in advanced cases; urinating in the corner of the corridor etc.), but also because UI and dementia originate from the same brain pathology (neurogenic UI in relatively early cases, cannot defer urinating because of overactive bladder [OAB]/urinary urgency).1 Among the underlying diseases of OAB/urge UI in elderly dementia, the most important are white matter disease (WMD; also called vascular dementia) and dementia with Lewy bodies (DLB) because of the high frequency of OAB/urge UI, being estimated to be 80–90%.2 The second important factor is Alzheimer's disease (AD), with the frequency of OAB/urge UI being estimated to be 40%.2 However, it remained not well known about the relationship between UI with cognitive function and activities of daily living (ADL) in this population. In this study, Lee et al.3 studied the relationship between bladder function (the Incontinence Questionnaire on Urinary Incontinence Short Form [ICIQ-UI] questionnaire and standard urodynamics) with cognitive (the Mini-Mental State Examination [MMSE] and the Clinical Dementia Rating [CDR]) and ADL measures (Barthel Index [B-ADL]) in 144 AD patients (48 male, 96 female; aged 56–97 years, including some young-onset cases; moderate cognitive decline [MMSE score 13.9–15/30, normal >24]). As a result, they found the most common UI type was urge UI in both men and women. Detrusor overactivity was found in 57.6% of patients. They found no relationship between ICIQ-UI with cognitive (MMSE, CDR) or ADL measures; whereas there was a clear relationship between detrusor overactivity and CDR and B-ADL (P < 0.05). Within the brain, several areas are thought to be crucial to regulate/inhibit the micturition reflex, including the prefrontal cortex, anterior cingulate cortex, supplementary motor area and insular cortex. AD mainly affects the temporal and parietal cortex; and less severely, the frontal cortex including the central cholinergic pathway. UI and detrusor overactivity in patients might reflect lesions in the prefrontal cortex, which also cause frontal executive dysfunction. Also, co-occurring WMD might cause loss of initiative and gait difficulty in AD, which could worsen the B-ADL in patients. UI in demented older adults can result in impaired self-esteem, medical morbidity, early institutionalization, stress on caregivers and considerable financial cost. The author's conclusion is impressive: the most common UI type in patients with AD was urge UI, which is potentially treatable. Anticholinergic medication that does not easily penetrate the blood–brain barrier (but check cognitive status regularly),1, 4 or the newer drug, milabeglon, that has a selective affinity for beta-3 adrenergic receptors5 can become options to maximize the quality of life in patients with AD." @default.
• W2056331505 created "2016-06-24" @default.
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• W2056331505 date "2014-03-17" @default.
• W2056331505 modified "2023-10-03" @default.
• W2056331505 title "Editorial Comment to Urinary incontinence in patients with Alzheimer's disease: Relationship between symptom status and urodynamic diagnoses" @default.
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• W2056331505 doi "https://doi.org/10.1111/iju.12436" @default.
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