Functional connectivity of the brain in older women with urgency urinary incontinence

Clarkson, Becky; Karim, Helmet T.; Griffiths, Derek; Resnick, Neil M.

doi:10.1002/nau.23766

Cited by 24 publications

(24 citation statements)

References 28 publications

(50 reference statements)

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“…They could demonstrate that the patients show lower, more diffuse activation than the healthy volunteers and recommended to study a larger population of those patients to identify areas of interest for future interventions. Clarkson et al analyzed the interaction between activated regions in urge incontinent women before and after therapeutical interventions and concluded that responders and nonresponders to therapy may represent different subsets of urge urinary incontinence. In another study, Tadic et al showed that the activity of brain regions involved in the control of continence is related to clinical measures of incontinence severity and could be used to evaluate therapy.…”

Section: Discussionmentioning

confidence: 99%

Functional MRI in patients with detrusor sphincter dyssynergia: Is the neural circuit affected?

Seseke

Leitsmann

Hijazi³

et al. 2019

Neurourology and Urodynamics

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Aims In recent years, the human brain‐bladder control network has been visualized in different functional magnetic resonance imaging (fMRI) studies. The role of the brainstem and suprapontine regions has been elucidated. Especially the pontine region and the periaqueductal gray, as the central structures of the micturition circuit, were demonstrated. Detrusor sphincter dyssynergia (DSD) is a common problem in patients with neurological diseases. Residual urine and consecutive urinary tract infections with the risk of kidney damage remain a problem. In the present study, we used fMRI of the brain to compare the activation sites of patients with DSD with those of our previously published healthy controls with special emphasis on the brainstem region. Methods fMRI was performed in 11 patients with DSD who had an urge to void due to a filled bladder. In a nonvoiding model, they were instructed to contract or to relax the pelvic floor muscles repetitively. Results In patients with DSD, we could reproduce the activation sites found in healthy subjects, showing the regions in the brainstem as well as the other micturition‐related areas. The activation of the pontine region was more rostral/dorsal compared with the healthy volunteers. Conclusion Interestingly, we detected the well‐known activation in the pontine region in the patients in the dorsal/rostral part compared with the more ventral activation in the healthy volunteers, suggesting that the L‐region of the pontine micturition center is more prominent in cases of DSD.

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Section: Discussionmentioning

confidence: 99%

Functional MRI in patients with detrusor sphincter dyssynergia: Is the neural circuit affected?

Seseke

Leitsmann

Hijazi³

et al. 2019

Neurourology and Urodynamics

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“…Together, these studies suggest at least two phenotypes of UUI with differential response to brain-targeted therapy such as biofeedback-assisted pelvic floor muscle training. Additional analysis of these data looking at functional connectivity of responders versus non-responders to biofeedback-assisted pelvic floor muscle training further supports the theory of different UUI phenotypes, one with a more brain-centric etiology 31 .…”

Section: Abnormal Brain Region Activitymentioning

confidence: 54%

Understanding overactive bladder and urgency incontinence: what does the brain have to do with it?

Smith

2018

F1000Res

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Understanding the pathophysiologic mechanisms responsible for overactive bladder (OAB) and urgency urinary incontinence (UUI) is critical to advancing the treatment options available to men and women with this prevalent and bothersome condition. Development of novel technologies and advanced functional neuroimaging modalities has provided us with new information to support and refine existing mechanistic theories. Emerging research on central pathophysiologic mechanisms of OAB from functional magnetic resonance imaging may provide new targets for therapeutic interventions and opens the door for novel treatment strategies. Several regions of interest—specifically the anterior cingulate gyrus, insula, and frontal cortices—have been implicated as areas of activation in women with OAB, suggesting a neural correlate of the experience of urgency. The cerebellum and parietal lobe have demonstrated increased activation during inhibition of voiding, and increased connectivity between the cerebellum and parietal lobe and the right insula and anterior cingulate gyrus has been demonstrated in women with UUI compared with controls. Evolving literature is beginning to shed light on the prerequisite effective connections between regions of interest in the healthy bladder and negative connectivity in OAB and UUI. Precision medicine with individualized care pathways may better select available treatment modalities for rightful recipients, thus improving efficacy with prescribed treatment approaches and adherence to therapy.

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“…β3a medication is assumed by many clinicians to not affect cognitive abilities; however, there are no studies of higher neural effects of this medication. Changes in rsFC and activation on fMRI have been seen with therapies for OAB which do not likely cross the blood-brain barrier [ [31] , [32] , [33] , [34] ]. This is the first study to compare the effects of two types of oral medication therapy for idiopathic OAB on rsFC and activation during a cognitive task.…”

Section: Background and Rationalementioning

confidence: 99%

Protocol for a multicenter randomized, double blind, controlled pilot trial of higher neural function in overactive bladder patients after anticholinergic, beta-3 adrenergic agonist, or placebo

High

Danford

Shi

et al. 2020

Contemporary Clinical Trials Communications

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Introduction Overactive bladder (OAB) syndrome has a negative impact on quality of life and prevalence increases with advanced age. Anticholinergics (AC) and beta-3 adrenergic agonists (β3a) are commonly prescribed medications for treatment of OAB. AC medication has been associated with dementia in population studies and with cortical atrophy in imaging studies. Higher neural effects of both classes of OAB medications have not been evaluated with functional neuroimaging. Longitudinal clinical assessments of cognition after OAB therapy with AC has produced conflicting results. β3a medication is has not been associated with dementia in clinical studies; however, higher neural effects are unknown. Our multicenter, double blind, randomized, placebo-controlled trial uses functional magnetic resonance imaging (fMRI) and cognitive testing to evaluate the effects of AC and β3a on brain functional connectivity in females with non-neurogenic OAB. Methods and Analysis and analysis: Female patients with OAB symptoms ages 50–90 years old without baseline cognitive impairment, moderate to severe depression or anxiety, neurologic disorders, or significant incomplete bladder emptying are invited to participate. Subjects are randomized to one of three interventions for 29 ± 1 day: AC (Solifenacin succinate, Teva), β3a (Mirabegron, Myrbetriq, Astellas), or placebo. Functional neuroimaging data at baseline and post-intervention will be analyzed accordingly. Clinical cognitive assessments will be compared from baseline to post-intervention. Ethics All qualifying patients are properly consented before enrolling in this study that has been approved by the Institutional Review Board of participating institutions.

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Functional connectivity of the brain in older women with urgency urinary incontinence

Abstract: These data support the postulate that responders and non-responders to therapy may represent different subsets of UUI, one with more of a central etiology, and one without.

Cited by 24 publications

References 28 publications

Functional MRI in patients with detrusor sphincter dyssynergia: Is the neural circuit affected?

Functional MRI in patients with detrusor sphincter dyssynergia: Is the neural circuit affected?

Understanding overactive bladder and urgency incontinence: what does the brain have to do with it?

Protocol for a multicenter randomized, double blind, controlled pilot trial of higher neural function in overactive bladder patients after anticholinergic, beta-3 adrenergic agonist, or placebo

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