Management of lower urinary tract symptoms in Parkinson's disease in the neurology clinic

Madan, Arina; Ray, Sudeshna; Burdick, Daniel; Agarwal, Pinky

doi:10.1080/00207454.2017.1327857

Cited by 14 publications

(10 citation statements)

References 75 publications

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“…Urgency can be decreased by a strengthened core and pelvic floor for which exercise is recommended or by delaying the voiding by distraction techniques [89]. Scheduled toileting can be beneficial as well [91]. Bedside commodes and flasks can address frequency, especially for people with limited mobility [90].…”

Section: Self-help Management Fluid Intake In the 4 H Priormentioning

confidence: 99%

Non-motor complications in late stage Parkinson’s disease: recognition, management and unmet needs

Rukavina

Batzu

Boogers

et al. 2021

Expert Review of Neurotherapeutics

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Introduction:The burden of non-motor symptoms (NMS) is a major determinant of health-related quality of life in Parkinson's disease (PD), particularly at its late stage. Areas covered: The late stage is usually defined as the period from unstable advanced to the palliative stage, characterized by a combination of emerging treatment-resistant axial motor symptoms (freezing of gait, postural instability, falls and dysphagia), as well as both non-dopaminergic and dopaminergic NMS: cognitive decline, neuropsychiatric symptoms, aspects of dysautonomia, pain and sleep disturbances (insomnia and excessive day-time sleepiness). Here, the authors summarize the current knowledge on NMS dominating the late stage of PD and propose a pragmatic and clinically focused approach for their recognition and treatment. Expert opinion: The NMS progression pattern is complex and remains under-researched. While dopamine-dependent NMS may improve with dopamine replacement therapy, non-dopamine dependent NMS worsen progressively and culminate at the late stages of PD. Furthermore, some PD specific features could interact negatively with other comorbidities, multiple medication use and frailty -the evaluation of these aspects is important in the creation of personalized management plans in the late stage of PD.

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Section: Self-help Management Fluid Intake In the 4 H Priormentioning

confidence: 99%

Non-motor complications in late stage Parkinson’s disease: recognition, management and unmet needs

Rukavina

Batzu

Boogers

et al. 2021

Expert Review of Neurotherapeutics

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“…Urinalysis is essential to investigate pyuria and bacteriuria suggesting urinary tract infection, hematuria suggesting malignancy and glucosuria or ketonuria suggesting diabetes. 19 …”

Section: Evauationmentioning

confidence: 99%

“…However, antimuscarinics are associated with cognitive worsening, due to the blockade of M1 muscarinic receptor, especially in patients with dementia who have already reduced brain acetylcholine activity. 1 19 In general, antimuscarinic-induced cognitive impairment is reversible when antimuscarinic therapy is withdrawn. However, some studies suggest that antimuscarinics may be associated with an increased risk of dementia.…”

Section: Treatmentmentioning

confidence: 99%

“…It activates the beta-3 adrenergic receptors in the detrusor muscle, resulting in direct bladder relaxation and increased bladder capacity, resulting in similar therapeutic effect as existing antimuscarinics. 19 Its mechanism of action differs from that of antimuscarinics, and thus avoids the anticholinergic adverse effects in the elderly patients. Treatment with mirabegron over 12 weeks had no adverse impact on cognitive function in older patients at risk of or concerned with cognitive impairment, based on the Montreal Cognitive Assessment.…”

Section: Treatmentmentioning

confidence: 99%

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Relationship between Lower Urinary Tract Dysfunction and Dementia

Cho

2020

Dement Neurocogn Disord

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Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition. Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy. Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.

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“…From a physiological perspective, the pathogenesis of PD is closely related to the developing mechanisms of urinary dysfunctions 13. The most prominent pathological changes in patients with PD are the degeneration or loss of pigmented neurons localized in the basal ganglia and brainstem, with the most significant loss of the dopaminergic neurons occurring in the pars compacta of the substantia nigra.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical study of the effects of deep brain stimulation on urinary dysfunctions in patients with Parkinson’s disease</p>

Zong

Meng

Zhang

et al. 2019

CIA

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Purpose: To evaluate the effect of deep brain stimulation (DBS) on urinary dysfunctions in Parkinson’s patients. Patients and methods: A total of 416 patients, diagnosed with Parkinson’s disease (PD) based on the UK Parkinson’s Disease Society Brain Bank Diagnostic Criteria, were enrolled in the study, including 307 males and 109 females. The effects of DBS treatment on urinary functions during urination and bladder storage of these patients were evaluated using testing and assessment scales, such as the American Urological Association Symptom Index (AUA-SI), Overactive Bladder Symptom Scores (OAB-SS), Quality Of Life Scale (QOL), and urodynamic tests. The data were statistically analyzed with the chi-square test and both independent-samples t -test and paired-samples t -test were used in this study. Results: Symptoms of urinary dysfunctions, such as urinary frequency, urgency, and incontinence, in the patients with PD were notably relieved by DBS treatment ( P <0.05), and the OAB-SS and bladder storage problems were greatly improved as well ( P <0.05). Compared with those in male patients, DBS surgery significantly improved the AUA-SI, urinary symptom scores, and QOL in female PD patients ( P <0.05), as well as other functional indicators related to the urinary tract, including the maximum urinary flow rate, detrusor pressure at peak flow, and residual urine volume in female PD patients ( P <0.05). Conclusion: DBS surgery is effective in improving urinary functions in PD patients, as primarily reflected by the alleviation of urinary symptoms such as urinary frequency, urgency, and incontinence. Female PD patients displayed better urinary function outcomes from DBS treatment than did male patients.

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Management of lower urinary tract symptoms in Parkinson's disease in the neurology clinic

Cited by 14 publications

References 75 publications

Non-motor complications in late stage Parkinson’s disease: recognition, management and unmet needs

Non-motor complications in late stage Parkinson’s disease: recognition, management and unmet needs

Relationship between Lower Urinary Tract Dysfunction and Dementia

<p>Clinical study of the effects of deep brain stimulation on urinary dysfunctions in patients with Parkinson’s disease</p>

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