Nocturia in Patients With Parkinson's Disease

Abstract

Background: Waking up from sleep more than once to pass urine, known as nocturia, is an important nonmotor symptom in Parkinson's disease (PD). Very little is known about the cause for nocturia. The aim of this work was to evaluate lower urinary tract (LUT) symptoms in patients with PD reporting nocturia using standardized validated questionnaires and bladder diaries and to assess the impact of nocturia on quality of life and sleep. Methods: Twenty-three consecutive patients with PD (17 males, 6 females; mean age: 68.5 years; range, 50-85) referred to a specialist uro-neurology clinic reporting nocturia according to the International Continence Society definition were included. Patients measured their daily fluid intake, urinary output per void, and recorded these with the timing of voids on a 3-day bladder diary. Standardized questionnaires were used to assess LUT symptoms (Urinary Symptom Profile, International Prostate Symptom Score, and Qualiveen Short Form) and sleep quality (Parkinson's Disease Sleep Scale). Results: Mean duration of PD was 10.1 years, and mean severity on H & Y scale was 3.0 (range, 1.0-5.0). Median duration of LUT symptoms was 6.0 years. Mean night-time urinary frequency was 3.5 (range, 1.0-7.3), and mean nocturnal maximum voided volume was 242 mL. Mean Nocturnal Polyuria Index (NPi) was 0.4 (range, 0.13-0.75), and 13 patients (56.5%) had nocturnal polyuria (NPi > 0.33). Patients with nocturnal polyuria reported more-severe LUT symptoms that impacted quality of life and sleep. Conclusions: In this preliminary study, nocturnal polyuria seems to be common in patients with PD reporting nocturia and appears to affect quality of life and sleep, though this was not statistically significant. The bladder diary is an essential tool in the assessment of nocturia in patients with PD.Parkinson's disease (PD) is the second-most common neurodegenerative condition. Although predominantly a disorder of motor control, PD is commonly associated with nonmotor symptoms. Lower urinary tract (LUT) symptoms are common in PD, with nocturia being present in up to 60% of patients who completed the standardized, validated Non-Motor Symptoms questionnaire.1 Nocturia is considered as one of the commonest nonmotor symptoms. Mean prevalence of nocturia in PD is 63.2%, but ranges widely (35-78%) between studies. Nocturia has an immense impact on quality-of-life measures, health-related costs, and is associated with the need for early institutionalisation. 2The causes for nocturia in PD are poorly understood. 3-5Most often, nocturia may result from reduced nocturnal bladder capacity owing to an overactive bladder (OAB). Symptoms of OAB-urinary urgency, increased daytime and night-time frequency, and incontinence-are common in PD and reported in 33% to 54% of patients. 6,7 Urodynamic investigations in PD patients reporting OAB symptoms demonstrate detrusor overactivity in most patients (43-93%), 8 but nocturia may also be the result of nocturnal polyuria, which is characterized by increased nocturnal urine pro...

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

“…In line with previous findings using either questionnaires or urodynamic tests, our PD population presented a high prevalence of PD-UU (Araki et al, 2000;McDonald et al, 2017;Picillo et al, 2017). No differences were observed in our study groups regarding sleep problems or fluctuation of levodopa response, which could influence the subjective perception of a discomfort related to urinary tract symptoms (Campos-Sousa et al, 2003;Uchiyama et al, 2003Uchiyama et al, , 2011Breen and Drutyte, 2013;Smith et al, 2015). Sexual symptoms were reported in 31% of all patients (Sakakibara et al, 2011), but the distribution did not differ among our study groups.…”

“…In this study presence of PD-UU was associated with longer disease duration, a higher dosage of LEDD, which has been previously reported (Liu et al, 2015;Winge, 2015), but neither to age nor gender. We found nocturia to be reported as in previous studies-about 60% prevalence rate (Yeo et al, 2012;Smith et al, 2015;Winge, 2015). The PD-UU patients reported nocturia significantly more often than PD-NUU patients, showing that both, nocturia and urgency are associated with disease duration (Araki et al, 2000).…”

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

“…There are several causes for nocturia (Table ). The commonest causes are reduced functional bladder capacity and nocturnal polyuria; however, these are not mutually exclusive and often occur concurrently in the same patient, known as mixed nocturia …”

Genitourinary Dysfunction Prevalence in Parkinson Disease Patients

“…The causes for nocturia in PD are still debated: most often attributed to reduced nocturnal bladder capacity due to an overactive bladder, nocturia may also be the result of nocturnal polyuria, which is characterized by increased nocturnal urine production, more than 20% to 33% of the entire 24 hour volume (7,8). Other symptoms of an overactive detrussor, as urinary urgency, increased daytime and night time frequency, and incontinence are reported in 33% to 54% of patients (3,7).…”

“…Patients with nocturia reported more severe lower urinary tract symptoms that impacted quality of life and sleep (7).…”