Nocturia in patients with cognitive dysfunction: a systematic review of the literature

Abstract

Background: The objective of this study is to evaluate current literature on the association between cognitive dysfunction and nocturia. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted through MEDLINE, EMBASE and COCHRANE databases and completed in November 2019. Randomized and non-randomized studies were included if they assessed the association between cognitive dysfunction and nocturia in older participants with or without neurological diseases. The quality of included studies was evaluated using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). Results: A total of 8 cross-sectional studies conducted in older patient populations met the criteria for inclusion. A statistically significant association was identified in 6 studies on univariate analysis, which persisted in 2 studies after controlling for confounding factors. The association between cognitive dysfunction and nocturia was positive for all 6 significant analyses. The overall risk of bias was unclear. Conclusion: A significant positive association between cognitive dysfunction and nocturia was identified. However, research has been limited to cross-sectional studies, which precludes identification of causality between cognitive dysfunction and nocturia. Heightened awareness of the complex interplay between cognition and nocturia would allow professionals involved in the care of cognitively impaired patients with concomitant nocturia to more effectively manage these symptoms.

Urinary dysfunction in patients with vascular cognitive impairment

“…In studies of nocturia in community-dwelling older patients, the results of a multivariate analysis suggested that a higher MMSE score was a protective factor against nocturia in older men ( Burgio et al, 2010 ; Lee et al, 2012 ). One review of eight cross-sectional studies suggested that nocturia and cognitive impairment are causal and share many risk factors ( Haddad et al, 2020 ). Furthermore, in one clinical study of brain and urinary tract function in older patients with urinary incontinence, 128 patients with urinary incontinence (mean age, 79 years) and 27 continent controls were enrolled; 24-h voiding monitoring, cognitive function monitoring, video urodynamics, and single-photon emission computed tomography (SPECT) were performed ( Griffiths, 1998 ).…”

“…After stroke, OAB is the most frequently reported urinary disturbance ( Pettersen and Wyller, 2006 ; Williams et al, 2012 ). A systematic review highlighted a significant association between nocturia and cognitive dysfunction ( Haddad et al, 2020 ). Urinary incontinence includes any involuntary leakage of urine ( Abrams et al, 2002 ) and is common in older adults ( Goepel et al, 2010 ; Milsom and Gyhagen, 2019 ).…”

Sleep Disorders in Older People with Special Focus on Parkinson’s Disease

“…It is argued, by some, that OSA is not a clinically relevant concern with PD [51], claiming that excessive daytime sleepiness may be more related to nocturia and cognitive impairment which also increase with advancing years [54]. Personal clinical experience suggests that there is a significant increase in OSA amongst those with PD although detailed analysis, within a controlled study, suggested that PD patients had: lower sleep efficiency; shorter REM stage; and that the expression of excessive daytime sleepiness (EDS) is multifactorial and responds to clonazepam [50] resulting in less fatigue for PD patients [50], despite sleepiness being a recognised adverse effect of clonazepam therapy [35].…”

Urogenital dysfunction following neurotrauma

“…Expression of toilet needs, comprehension on how/where to use the toilet, or the ability to locate the toilet may be impaired. Executive dysfunction has been found to be significantly associated with overactive bladder symptoms [13]. Apathy and depression may result in poor motivation to maintain continence.…”