Urinary Incontinence Associated with Dementia

Abstract

Urinary incontinence is common in patients with dementia and is more prevalent in demented than in nondemented older individuals. It occurs with equal or greater frequency in males than in females, and this contrasts with the female preponderance in community-based, general older populations. Since the etiology of incontinence in dementia is multifactorial, a comprehensive assessment of factors within and outside the lower urinary tract is essential. A careful clinical evaluation is sufficient to guide treatment in most cases. Further research is needed to determine the role of simple cystometry and more complex urodynamic investigation in these patients. Research on the management of urinary incontinence in demented patients has focused almost exclusively on toileting programs and drug treatments for detrusor hyperactivity. To date, anticholinergic and antispasmodic medications have not been shown to be effective in treating incontinence in demented persons. However, the few studies undertaken have been in the most severely mentally and physically deteriorated patients, and it is possible that these medications have greater efficacy in less impaired individuals. Prompted voiding regimens have been shown to reduce incontinence by an average of 32% and appear to be a useful approach in managing incontinence in some of these patients. However, unless staff management systems are employed, staff compliance with these programs diminishes with time and the labor costs involved may limit their applicability in nursing homes. Patients who are the most severely cognitively impaired, least mobile, and have the greatest frequency of incontinence derive the least benefit from toileting programs, and palliative measures may be more appropriate in these cases.

Assessment of urinary incontinence in the elderly using the InterRAI-AC instrument

“…Šveicarijos slaugos namuose atlikto tyrimo duomenimis, šlapimo nelaikymas buvo daž-nesnis tiriamiesiems, turėjusiems atminties ir judėjimo sutrikimų, o šlapimo nelaikymą mažino protinės ir fizinės veiklos pratimai (22). Demencija sergantys pagyvenusio amžiaus pacientai dažnai nelaikė šlapimo ir tokia situacija kėlė paciento globėjų stresą, slaugos ekonominių kaštų didėjimą (23,24).…”

Role of Urodynamics in the Evaluation of Elderly Voiding Dysfunction

“…It was therefore thought that DO explains UI in dementia patients. Different underlying mechanisms of UI are also expected however in this patient population [83,84].…”

“…Studies showed that in patients with cognitive impairment, cerebral dysfunction affects the frontal lobe control on the micturition reflex. This leads to involuntary detrusor contractions [83]. Involuntary detrusor contraction is interpreted in urodynamic studies as DO.…”

Managing the Elderly with Urinary Incontinence and Dementia

“…A full UDS for the elderly with dementia is difficult to perform and is invasive. Therefore, it should be considered only if other treatment modalities failed and the results have direct influence on treatment choices and outcome [3,23].…”

“…It is a common problem among the elderly, estimated to affect about 11-21% of community dwelling elderly in an Italian study and up to 77% of the residents in nursing homes [1,2]. Among the elderly with dementia, the prevalence is higher with 22% of the community dwelling elderly and 84% of nursing home residents reported to have UI [3]. Even though urinary incontinence is a common problem among the elderly, it should not be considered as synonymous with the normal ageing process.…”