Do Older Adults with Overactive Bladder Demonstrate Impaired Executive Function Compared to Their Peers Without OAB?

Abstract

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.

Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report

“…In addition, lower urinary tract (LUT) symptoms, such as urinary incontinence (UI) and OAB, have been associated with dementia in administrative database studies 13,23 . Lower performance in executive control and division of attention has been demonstrated in cross sectional studies of community dwelling adults with OAB and urgency urinary incontinence (UUI) when compared with those without urgency (stress UI or healthy controls) 24,25 . Given the association between incontinence and dementia, recognition of other modifiable risk factors in women presenting to clinicians with OAB symptoms might provide an opportunity for dementia risk reduction.…”

“…The OAB and UUI in older women may be associated with strength, balance and mobility impairment, 54,55 and/or cognitive impairment (executive function) 24,25 . Interestingly, new conservative management trials for mixed UI and UUI in women involve a more holistic approach of PFMT, to consider cognitive, gait, and balance deficits 56–60 .…”

“…[50][51][52][53] The OAB and UUI in older women may be associated with strength, balance and mobility impairment, 54,55 and/or cognitive impairment (executive function). 24,25 Interestingly, new conservative management trials for mixed UI and UUI in women involve a more holistic approach of PFMT, to consider cognitive, gait, and balance deficits. [56][57][58][59][60] In an earlier cohort study, Elliott studied a PFMT+ cognitive, gait, and balance training program for mixed UI in older women, which showed a reduction in leakage frequency and amount and improvement in gait stability during a concurrent cognitive task.…”

Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment

“…This article synthesizes the presentations and discussions with multiple stakeholders at the 2021 SOS Conference. Overactive bladder in older adults is associated with frailty; multimorbidity 2,5,9–11 ; and functional, physical, and cognitive impairments 32–39 . The multifactorial nature of OAB creates challenges for health care professionals, patients, and their care partners in many settings across the continuum of OAB health care delivery.…”

The effect of oral medications on fMRI brain activation: A randomized, double blind, controlled pilot trial of older women with overactive bladder

“…Longitudinal studies have associated dementia with lower urinary tract symptoms such as urinary incontinence [ 5 , 6 ]. In cross-sectional studies of community-dwelling older adults, those with OAB demonstrate inferior performance on tests of executive function [ 7 , 8 ] compared to their peers with stress incontinence or no urinary complaints.…”