Correlation between overactive bladder symptom score and neuropsychological parameters in Alzheimer’s disease patients with lower urinary tract symptom

Vol. 43 (2): 256-263, March - April, 2017 ORIGINAL ARTICLE doi: 10.1590/S1677-5538.IBJU.2015.0664 Correlation between overactive bladder symptom score and neuropsychological parameters in Alzheimer’s disease patients with lower urinary tract symptom _______________________________________________ Ha Bum Jung 1, Don Kyoung Choi 1, Seong Ho Lee 1, Sung Tae Cho 1, Hae Ri Na 2, Moon Ho Park 3 Department of Urology, College of Medicine, Hallym University, Seoul, Korea Seoul, Korea; 2 Department of Neurology, Bobath Memorial Hospital, Seongnam-si, Korea; 3 Department of Neurology, College of Medicine, Korea University, Seoul, Korea 1 ABSTRACT ARTICLE INFO ______________________________________________________________ ______________________ Purpose: To examine an association between the overactive bladder symptom score (OABSS) and neuropsychological parameters. Moreover, we investigate the factors that affect each item in the questionnaire. Materials and Methods: A total of 376 patients (males: 184; females: 192) with probable Alzheimer’s disease (AD) were recruited. Cognitive testing was conducted using the Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR) scale, Global Deterioration Scale (GDS), and Barthel Activities of Daily Living (ADL). Lower urinary tract symptom (LUTS) was assessed using OABSS and voiding diary. Results: The prevalence of overactive bladder (OAB) (defined as OABSS ≥3 with an urgency score of ≥2) in patients with AD was 72.6%. Among the OAB subjects, the most common severity of symptom was moderate (72.6%), followed by mild (21.2%), and severe (5.8%). It was found that OABSS had a very high correlation with aging (r=0.75; p<0.001). When compared with neuropsychological parameters, it was found that OABSS was highly correlated with the CDR scores (r=0.446; p<0.001). However, no significant correlation was found between the changes in OABSS scores and those in other neuropsychological parameters. Based on the individual symptom scores, urgency incontinence was highly correlated with the CDR scores (r=0.43; p<0.001). Conclusions: OABSS is a useful tool in assessing AD patients with LUTS. There was a consistent positive association between OABSS severity, including urgency incontinence, and CDR scores. Keywords: Neuropsychological Tests; Urinary Bladder; Lower Urinary Tract Symptoms INTRODUCTION Overactive bladder (OAB) is a symptom complex, comprising urinary urgency with or without urgency and incontinence, usually with urinary frequency and nocturia (1); it represents the storage component of lower urinary tract symptoms (LUTS) (2). The incidence of OAB increases significantly with age. The mechanisms under- Int Braz J Urol. 2017; 43: 256-63 _____________________ Submitted for publication: November 17, 2015 _____________________ Accepted after revision: May 26, 2016 ________________________ Published as Ahead of Print: November 2, 2016 lying OAB in the elderly are multifactorial; the factors might include age-related changes in the bladder itself, or central nervous system changes innervating the bladder (3). Alzheimer’s disease (AD) is one of the most common neurodegenerative diseases and accounts for more than 80% of dementia patients among elderly people (4). The condition is associated with progressive memory loss, and impairment of cog- 256 ibju | Overactive Bladder in Alzheimer’s disease nitive function and functional independence. Many affected patients will also have problems with bladder and bowel control (5, 6). Both OAB and AD are common, often coexisting in older patients (7). Although AD is known to be an independent risk factor for OAB or urinary incontinence, few studies have been published with regard to research on OAB of elderly patients with AD (3, 8). As for the relationship between urinary incontinence and cognitive or functional measures in AD patients, we previously reported that severity of detrusor overactivity was linked to functional impairments, whereas there was no relationship between the Incontinence Questionnaire on Urinary Incontinence Short Form (ICIQ-UI) questionnaire and those (5). However, there has been a lack of study to investigate in detail the relationship between OAB with each symptom and cognitive or functional measures in AD patients with LUTS. Therefore, we assessed the OAB of patients with AD, examined the association between the Overactive Bladder Symptom Score (OABSS) questionnaire and neuropsychological parameters, and investigated the factors that affect each item of the questionnaire. MATERIALS AND METHODS Subjects who visited the dementia clinic were recruited sequentially. All patients met the National Institute of Neurological Communicative Disorders and Stroke (NINCDS) and the Alzheimer Disease and Related Disorders Association diagnostic criteria for probable AD. The diagnosis of probable AD was made by expert neurologists. Patients who were diagnosed with other dementia, including severe dementia in addition to behavioral disturbances, and inability to communicate were also excluded. All participants underwent an extensive evaluation that included physical and neurological examinations and laboratory test. Cognitive tests were performed using the Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR) scale, Global Deterioration Scale (GDS), and Barthel Activities of Daily Living (ADL), which have extensively been used in clinical and research settings to measure cognitive impairment. LUTS were assessed using the OABSS questionnaire and 3-day consecutive voiding diary with the Indevus Urgency Severity Scale (IUSS). OAB was defined as OABSS ≥3 with an urgency score of ≥2 (9, 10). In addition, scores on the OABSS of ≤5 were defined as mild, those of 6-11 as moderate, and those of ≥12 as severe (9, 10). The institutional review board approved the study protocol, and informed consent was obtained from all patients or legal guardians in accordance with the Declaration of Helsinki. Patients were asked to complete by themselves a questionnaire and voiding diary. However, if they were unable to complete them due to behavioral disturbances and inabilities, educated caregivers asked them the questions from the questionnaire and assisted them in filling out the required forms. Data are expressed as means and standard deviations. A p-value was calculated using the independent t-test, Pearson’s chi-squared test, and one-way analysis of variance. A Pearson correlation analysis was used to determine the correlations between the individual symptom scores of OABSS and neuropsychological parameters. All tests with a p-value of <0.05 were considered as statistically significant. The Statistical Package for the Social Sciences Version 18.0 (SPSS, Chicago, IL) was used to carry out all statistical analyses. RESULTS A total of 376 patients (male 184, female 192, 56-92 years old), with probable AD, were included in the analysis. Of 430 patients screened, 54 wer (...truncated)