Lower urinary tract function in dementia with Lewy bodies (DLB)

Tateno, Fuyuki; Sakakibara, Ryuji; Ogata, Tsuyoshi; Kusumoto, Masahiko; Tsuyusaki, Yohei; Takahashi, Osamu; Sugiyama, Megumi; Tateno, Akihiko

doi:10.1002/mds.25985

Cited by 43 publications

(28 citation statements)

References 39 publications

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“…Lower urinary tract function is known to be altered in patients with dementia, with severe nocturia being reported in up to 84% of Lewy body dementia and white matter lesions, respectively. 21,22 Evidence supports an increased risk of falls even in the early stages of dementia and confirms accompanying changes in gait, balance and fear of falling. 23 Thus, older patients with dementia are highly likely to have night toileting needs, even in the absence of nocturnal polyuria.…”

Section: Discussionmentioning

confidence: 90%

“…The prevalence of dementia did not differ significantly between individuals who fell while attempting to toilet at night and other patients who fell. Lower urinary tract function is known to be altered in patients with dementia, with severe nocturia being reported in up to 84% of Lewy body dementia and white matter lesions, respectively . Evidence supports an increased risk of falls even in the early stages of dementia and confirms accompanying changes in gait, balance and fear of falling .…”

Section: Discussionmentioning

confidence: 95%

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Toileting‐related falls at night in hospitalised patients: The role of nocturia

et al. 2019

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Objective The purpose of this study was to describe the prevalence and characteristics of toileting‐related falls in hospitalised older people. Methods Retrospective analysis of falls related to night‐time toileting in patients 60 years or over in a tertiary hospital during a one‐year period. Results Overall 34% of falls were related to toileting with at least 44% of these falls occurring during the night. Toilet‐related falls peaked between 11 pm and 1 am, a period that coincides with maximum supine‐induced diuresis. Almost half of night falls occurred at the bedside. In 80% of night toileting‐related falls, patients were mobilising without the recommended level of assistance. Half of all patients had no strategies for toileting documented in their care plan. Conclusion Findings support screening for nocturia in older inpatients and implementation of strategies to reduce both the need for toileting at night and risk factors for falling.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Toileting‐related falls at night in hospitalised patients: The role of nocturia

et al. 2019

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“…Some reports suggest an interdependence between autonomic and cognitive symptoms, which was shown for orthostatic hypotension and cognitive worsening (Heims et al, 2006). However, the association between PD-UU and cognition is only sparsely investigated despite a high prevalence rate of urinary urgency in some forms of dementia or late stages of PD (Del-Ser et al, 1996;McKeith et al, 2005;Ransmayr et al, 2008;Tateno et al, 2015). PD-UU can be caused by the neurodegenerative processes of the prefrontal cortex since the frontal cortex-basal ganglia circuit plays a prominent role not only in modulating EF and goal-directed behavior (Funahashi, 2001) but also in suppressing micturition (Winge, 2015).…”

Section: Discussionmentioning

confidence: 99%

Executive Function Is Related to the Urinary Urgency in Non-demented Patients With Parkinson’s Disease

Tkaczynska

Becker

Maetzler

et al. 2020

Front. Aging Neurosci.

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Introduction: Evidence suggests urinary urgency is associated with cognitive impairment in a subtype of Parkinson's disease (PD) patients. This study investigates if cognitive impairment independently predicts the presence of urinary dysfunction. Methods: We report data of 189 idiopathic PD patients, excluding those with concomitant diseases or medication interacting with bladder function. A standardized questionnaire was used to define the presence of urinary urgency. All patients underwent a comprehensive motor, cognitive non-motor and health-related quality of life (HRQoL) assessment. Multivariable linear regression analysis was performed to identify independent variables characterizing urinary urgency in PD (PD-UU), which were assigned as discriminant features to estimate their individual contribution to the phenotype of the PD-UU group. Results: Of 189 PD patients, 115 (60.8%) reported PD-UU. The linear regression analysis showed that among cognitive domains, executive function (EF; p = 0.04) had a significant negative association with PD-UU. In a second model, scores of the Montreal Cognitive Assessment (MoCA) significantly differentiated between study groups (p = 0.007) and also non-motor symptom (NMS) burden (p < 0.001). The third model consisted of reports of HRQoL, of which stigma was the only subscale of the Parkinson's Disease Questionnaire (PDQ-39) differentiating between patients with and without PD-UU (p = 0.02). The linear discriminant analysis provided evidence that the combination of EF, NMS burden, nocturia, and stigma discriminated between groups with 72.4% accuracy. Conclusion: In our large, non-demented PD cohort, urinary urgency was associated with executive dysfunction (EF), supporting a possible causative link between both symptoms. A combination of neuropsychological and non-motor aspects identified patients with PD-UU with high discriminative accuracy.

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“…urinary urgency/frequency) in DLB/PD is thought to be exaggerated micturition reflex . The net effect of the basal ganglia on micturition is inhibitory . Functional neuroimaging during bladder filling results in activation in the prefrontal cortex and the globus pallidus of normal volunteers .…”

Section: Discussionmentioning

confidence: 99%

Frontal executive function and the bladder: A study of dementia with Lewy bodies

Haruta

Sakakibara

Ogata

et al. 2018

Neurology & Clinical Neurosc

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Background: Pathophysiology of bladder dysfunction in dementia with Lewy bodies (DLB, a disease that shares pathology with Parkinson's disease [PD]) is disturbed prefrontal-basal ganglia pathway. Similarly, DLB/PD patients have frontal executive dysfunction by the same mechanism. Aim: To study the relationship between executive function and bladder autonomic function in patients with DLB. Methods: We recruited 45 patients with DLB (28 male, 17 female; age 73.3 years AE 6.8). Other neurologic, urologic, and systemic causes of cognitive and bladder dysfunctions were excluded. All patients underwent urodynamics tests and three sets of cognitive tasks (i.e. the mini-mental state examination [MMSE], Alzheimer's disease assessment scale cognitive [ADAScog; general cognitive tasks], and the frontal assessment battery [FAB; frontal executive tasks]). Results: The urinary questionnaire revealed urinary incontinence in 20 patients. Urodynamic testing revealed detrusor overactivity (DO) in 30 patients. Cognitive testing found patients' mean MMSE score to be 22.6 AE 4.8, while their mean FAB score was 11.5 AE 2.6. There was no relationship between DO and total MMSE score. However, our analysis revealed a significant relationship between DO and total FAB score (P < 0.05). Conclusion:The results showed that performance on the FAB test decreased in DLB patients with bladder dysfunction.

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Lower urinary tract function in dementia with Lewy bodies (DLB)

Abstract: LUT dysfunction is a common feature in DLB, attributable not only to dementia and immobility, but also to central and peripheral types of somato-autonomic dysfunction.

Cited by 43 publications

References 39 publications

Toileting‐related falls at night in hospitalised patients: The role of nocturia

Toileting‐related falls at night in hospitalised patients: The role of nocturia

Executive Function Is Related to the Urinary Urgency in Non-demented Patients With Parkinson’s Disease

Frontal executive function and the bladder: A study of dementia with Lewy bodies

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