Investigation of urinary storage symptoms in Parkinson's disease utilizing structural MRI techniques

Abstract

Background Lower urinary tract symptoms occur in 27% to 86% of patients with Parkinson's disease (PD), however, the mechanisms responsible for bladder dysfunction are not fully understood. This study utilized magnetic resonance imaging (MRI) to test the hypothesis that key brainstem bladder control areas (including the pontine micturition center and the pontine continence center (PCC) and their links with the basal ganglia are important in the development of urinary storage symptoms in PD. Methods Seventeen patients with PD completed a “bladder symptom questionnaire” and underwent diffusion‐weighted MRI (1.5 T). Storage symptom severity and MRI measures of white matter microstructural integrity were correlated using tract‐based spatial statistics. Results Mean diffusivity in the ventral brainstem correlated significantly with the bladder symptom severity in areas close to the predicted anatomical co‐ordinates of the PCC. Tracts seeded from these regions passed via areas involved in pelvic floor musculature control and urinary voiding including the cerebellum, pallidum, and precentral gyrus. Conclusion We used diffusion‐weighted MRI to investigate the role of the brainstem and its structural connections in the development of urinary storage symptoms in PD. Our data suggest that the brainstem degenerative change in the vicinity of the PCC may be implicated in the pathogenesis of storage symptoms in these patients.

Neurosonological Findings Related to Non-Motor Features of Parkinson’s Disease: A Systematic Review

“…Moreover, there was a greater number of OAB patients suffering from dysthymia or major depressive disorder. In line with these data, in a recent study by Roy et al, mean MRI diffusivity in the ventral brainstem, in areas close to the pontine micturition center and the pontine continence center, correlated significantly with the bladder symptom severity in PD patients [52].…”

Autonomic Dysfunction in Parkinson's Disease

“…Although reports estimating the prevalence of bladder dysfunction in PD vary widely, ranging between 27 and 86%, there certainly is a consensus that it occurs frequently and that it can have a significant effect on quality of life for affected individuals [131][132][133][134][135][136]. In a survey of 545 PD patients using the NMSQuest, the most frequently reported nonmotor symptoms were urinary urgency in 56% and nocturia in 62% [137].…”

Neuroimaging in Neuro-Urology

“…Diffusion-weighted imaging in PD patients showed that mean diffusivity (MD) in areas close to the pontine continence center (PCC) correlated with bladder symptom severity. This result suggests that degenerative changes in the area of the PCC may be involved in the pathogenesis of LUT symptoms (LUTS) in PD [9]. MD is an unspecific but sensitive marker for the impairment of barriers that restrict the movement of water molecules in tissue such as axonal or neuronal membranes.…”

“…Despite these rather disillusioning considerations, there are still many lessons to be learned, and consequently there is much room for improvement with the chance to make neuroimaging more meaningful and useful in neuro-urology. This primarily [9] sMRI (1. includes optimization of imaging protocols with adaption to specific, well-defined patient populations. Furthermore, it is encouraging that in other disciplines and context, fMRI has already been demonstrated to be clinically useful for patients [13].…”