Relationship between Lower Urinary Tract Dysfunction and Dementia

Abstract

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.

Pelvic floor muscle exercise and training for coping with urinary incontinence

“…However, initial management should be individualized and influenced by treatment goals, preferences, and estimated remaining life expectancy, as the most likely clinical diagnosis. In treating urinary incontinence of the frail elderly, PFME is considered as fist-line therapy (Na and Cho, 2020). In association with other conservative measures, it has a relevant role in the improvement of quality of life.…”

Rehabilitation in Dementia

“…LUTD is a distressing condition in persons with dementia and is associated with ADL impairment and poor quality of life. 129 LUTD refers to problems of either urinary storage or voiding. Storage symptoms include urinary urgency, frequency, nocturia, and urinary incontinence (UI), whereas voiding symptoms include hesitancy, poor flow, straining, a sensation of incomplete voiding, and urinary retention.…”

“…The caregiver may enquire at regular intervals (two hourly during daytime) and provide support during toileting. 129 , 134 , 135 Patients with low motivation and mobility issues can be trained for prompted and scheduled toileting. 133 …”

“…Timed voiding is preferably used for patients with relatively intact cognition with neurogenic bladder. 129 …”

“…By and large, the anus is contracted first as if raising the anus from the ground, and the pelvic muscles are contracted and relaxed alternatingly. 129 Supervised PFMT is an effective approach to prevent UI in the elderly with mild cognitive impairment. 137 It can be combined with auditory or visual biofeedback by recording biological signals (EMG activity) from the pelvic floor muscles to improve the therapeutic effect.…”