Background Maintaining urinary continence is not an automatic process, but relies on continuous processing of sensory signals from the bladder and suppression of the desire to void. Urinary incontinence (UI) and lower urinary tract symptoms (LUTS), including urinary urgency, frequency, and nocturia are highly prevalent among the general population. This prevalence rises in association with increasing age, and this may be in part due to changes in the central nervous system rather than the urinary tract. The aim of this study was to assess if older adults with overactive bladder (OAB) had demonstrable impairment in executive function. Methods This was a cross-sectional study comparing the performance of adults aged 65 and over with and without OAB on two cognitive tests, the Trail Making Test B (TMT-B) and simple reaction time (SRT). OAB was defined as urgency, with at least weekly urgency incontinence and a daytime urinary frequency of 8 or more. The control group were defined as a Bladder control Self-Assessment Questionnaire (B-SAQ) score of ≤4. Results 56 participants were recruited, of whom 35 met criteria for OAB. The OAB group took significantly longer to complete the TMT-B than the control group (103s vs. 77s, p = .003). There was no difference in the SRT Conclusions In this sample of older adults, OAB was associated with measurable slower performance on the TMT-B, suggesting that impaired executive function is associated with OAB.
Lower urinary tract symptoms, including urgency, urgency incontinence, frequency, and nocturia, are highly prevalent in older adults and are associated with significant morbidity and impairment in quality of life. When conservative measures such as bladder training fail to improve symptoms, pharmacological management is recommended by national and international guidelines. Mirabegron, an agonist of the β3 adrenergic receptor, demonstrates similar efficacy to the anticholinergic drugs without the risk of anticholinergic effects, but experience and evidence in the very elderly population are limited. This narrative review examines the current evidence base for mirabegron in very elderly adults.
Resilience is the ability to adapt and strive under adverse situations. Operational stressors linked to deployment such as isolation, increased workload, sleep deprivation and exposure to life-endangering situations, among others, can decrease resilience and thereby reduce cognitive capabilities of military personnel. We tested the cognitive functioning of Canadian Armed Forces (CAF) military troops (n = 85) using the Cambridge Neuropsychological Test Automated Battery prior to and during their deployment to Afghanistan in October 2013. The Attention Switching Task [AST] and Spatial Working Memory [SWM] tests measured executive functioning; the Stop Signal Task [SST]) assessed decision making and impulse control; whereas the Reaction Time [RTI] test measured reaction and movement time providing information about attention, focus, and fine motor control. Two tailed t-tests were performed to compare the performance before and during deployment. In general, participants improved their performance in all domains during deployment, as compared to the pre-deployment values. At both time points, compared to the literature data, the participants demonstrated higher scores in AST and RTI and sub-optimal performance in SWM and SST. The significant improvement in cognitive performance during deployment can be explained by strong soldiers' morale focusing on the success of the military mission. Nevertheless, in some cases, the enhanced cognitive performance had a negative impact on emotional stability; further analysis of the emotional cost of cognitive improvements is currently underway. Future research should also focus on biological stress-coping mechanisms and social support during deployment (Makhani et al, 2015).
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