Urinary Dysfunction in Progressive Supranuclear Palsy Compared with Other Parkinsonian Disorders

Abstract

BackgroundAutonomic urinary dysfunction affects patients with progressive supranuclear palsy (PSP); however, the severity and prevalence of urinary dysfunctions in these patients compared with those observed in patients with Parkinson’s disease (PD) and multiple system atrophy (MSA) are unknown.ObjectiveWe compared urinary dysfunction characteristics in patients with PSP, PD, and MSA.Patients and MethodsForty-seven patients who satisfied the probable or possible criteria of the National Institute for Neurological Diseases and Stroke and Society for PSP were assessed using the urinary symptoms questionnaire and the urodynamic study at Chiba and Toho Universities (n = 26 and 21, respectively). The results were compared with those of patients with PD and MSA (n = 218 and 193, respectively).ResultsThe mean disease duration of PSP and the mean age were 2.97 ± 0.26 and 71.4 ± 0.88 years, respectively. The mini-mental state examination and frontal assessment battery scores were 22.6 ± 0.70 and 10.7 ± 0.49, respectively. Urinary storage and voiding symptoms were observed in 57% and 56% of patients with PSP, respectively. Detrusor overactivity in the urodynamic study was detected in 81% of patients with PSP, which was slightly more than that found in patients with PD (69%) and MSA (67%); however, this was not statistically significant. Postvoid residual volume in patients with PSP was significantly more than that in patients with PD (P < 0.01), but was equivalent to that in patients with MSA.ConclusionsThe present study demonstrated that patients with PSP experienced various urinary dysfunctions. Urinary storage dysfunction in patients with PSP was not different from that in patients with PD or MSA, whereas urinary voiding dysfunction in patients with PSP was milder than that in patients with MSA and more severe than that in patients with PD. These features should be taken into account for the differentiation of PSP from PD and MSA.

Atypical globular glial tauopathy with a combination of types I and II pathology

“…The present patient also developed urinary dysfunction, which has been described in several previous cases of GGT . Urinary dysfunction is not uncommon in progressive supranuclear palsy (PSP), another similar tauopathy of GGT; about 60% of patients with clinically diagnosed PSP show urinary dysfunction in urodynamic studies . However, the lesions responsible for urinary dysfunction in GGT remain uncertain.…”

Association of autonomic symptoms with disease progression and survival in progressive supranuclear palsy

“…Another study described tau deposition in the Onuf’s nucleus, the structure responsible for bladder and sphincter control, in PSP patients with urinary symptoms and abnormality of sphincter muscles on electromyography 31. In addition, because cortico-subcortical structures are responsible for voluntary control of micturition,2 earlier urinary incontinence could reflect widespread involvement of the frontal lobe, although urinary symptoms were not associated with cognitive phenotypes in our study.…”

Neurogenic bladder in progressive supranuclear palsy: A comparison with Parkinson's disease and multiple system atrophy

“…Although urinary dysfunction is one of the major non‐motor symptoms in PSP, the number of studies on this topic is still sparse. Recently, urodynamic features of PSP were well compared with those of IPD or MSA . However, this study included PSP patients without urinary symptoms, so the results should be interpreted with caution.…”

“…Approximately 20 years ago, a mixture of dysfunctions in the storage and voiding phases with urodynamic profiles of six PSP patients has been reported . Recently, the urodynamic profiles of PSP patients were compared with those of PD or MSA patients; however, this study included subjects both with and without urinary dysfunction . Investigating the urodynamic profiles only in patients presenting urinary symptoms would provide a clearer comparison among PSP, IPD, and MSA.…”