Nocturia in Parkinson's Disease: Why Does It Occur and How to Manage?

Abstract

Background: Nocturia is one of the commonest nonmotor symptoms in Parkinson's disease (PD) and has a significant impact on quality of life both for patients and their carers. There exists a relation between nocturia and poor sleep quality, falls, and institutionalization. Nocturia may manifest as a result of reduced functional bladder capacity or nocturnal polyuria; however, most often the cause is multifactorial. Disorders of circadian rhythm regulation are known to occur with sleep disturbances in PD may also contribute to nocturia. Methods and Results: In this review, an overview of the assessment and management of nocturia in patients with PD is presented. History taking, medication review, and a bladder diary form the cornerstone of the evaluation. Urinalysis, ultrasonography, and urodynamic studies help to assess the cause for lower urinary tract symptoms and exclude concomitant pathologies, such as bladder outlet obstruction. Antimuscarinic medications are the first-line treatment for the overactive bladder; however, caution is needed when using these medications in individuals predisposed to cognitive impairment. Desmopressin is effective for managing nocturnal polyuria. Conclusions: An individualized approach is recommended to optimize the management of nocturia in PD.Parkinson's disease (PD) is characterized predominantly by motor complaints, consisting of bradykinesia, rigidity, and rest tremor and gait disturbances. However nonmotor symptoms (NMS) commonly accompany these motor symptoms.1 Lower urinary tract (LUT) symptoms are common in PD and include storage symptoms (urinary urgency, increased daytime frequency, and nocturia, with or without incontinence) and voiding symptoms (urinary hesitancy, interrupted or poor stream, and double voiding). 2,3 The prevalence of LUT symptoms varies between 38% and 71%, 4,5 and its severity increases with progression of PD, paralleling other manifestations of autonomic dysfunction. 6Urinary symptoms are an important cause for morbidity in PD, having a devastating impact on quality of life, and have been recognized by Parkinson's UK as one of the top 10 priority areas for research in PD. 7Using a standardized validated questionnaire of NMS, the NMS Quest, nocturia was found to be the most common LUT symptom, reported by more than 60% of participants.8 Nocturia was, in fact, reported to be the commonest NMS reported in this study. The cause for nocturia in PD is poorly understood; however, it is likely to be multifactorial. [9][10][11] We review the pathophysiology of nocturia in PD and principles for management. Prevalence of Nocturia in PDQuestionnaire based studies generally report a high prevalence of nocturia, with figures ranging between 76% 12 and 86%, 13,14 though one study reported a prevalence of only 34.6%. 15 In a study of 115 PD patients using a questionnaire on pelvic organ functions, Sakakibara et al. reported nocturia (or nighttime frequency) in 53% of men and 63% of women with PD.16

International Continence Society consensus on the diagnosis and treatment of nocturia

“…Sleep disruption and deprivation are associated with low dopamine levels in the central nervous system . Both Parkinson’s disease and restless legs syndrome are associated with NP and a reduced bladder capacity due to OAB and sphincter dysfunction . However, a recent study suggested that the prevalence of NP in Parkinson’s disease is no higher when compared with a control population, indicating some uncertainty in this regard .…”

“…39 Both Parkinson's disease and restless legs syndrome are associated with NP and a reduced bladder capacity due to OAB and sphincter dysfunction. [40][41][42] However, a recent study suggested that the prevalence of NP in Parkinson's disease is no higher when compared with a control population, indicating some uncertainty in this regard. 43 The diagnosis of a brain-or sleep-related cause of nocturia is made clinically, and when suspected, patients need to be referred to neurologists or sleep specialists.…”

SURINPARK: Safinamide for Urinary Symptoms in Parkinson’s Disease

“…Nocturia is the most common urinary symptom in PD, with important consequences in the quality of sleep and, thus, daily functioning [ 8 ]. In our sample, nocturia episodes more than halved by mean (56% reduction), which, despite the lack of a proper multimodal assessment in our study, probably had a more global functional improvement in these patients through sleep quality improvement.…”

“…Among dysautonomic problems, urinary symptoms are very common across different PD stages and tend to worsen as disease progresses, although some authors have suggested a late decline in frequency [ 8 , 9 ]. The range is wide, from 24 to 96% [ 10 , 11 ].…”

Genitourinary Dysfunction Prevalence in Parkinson Disease Patients

“…Specifi c therapy for the management of the OAB are currently available, even only partially eff ective: antimuscarinic agents, botulinum toxin, sacral nerve modulation and percutaneous tibial nerve stimulation; incomplete bladder emptying can be relieved using α-adrenoceptor blockers or intermittent catheterization and nocturnal polyuria responds to desmopressin or late afternoon diuretic (13).…”