Nocturia in patients with cognitive dysfunction: a systematic review of the literature

Haddad et al. BMC Geriatrics (2020) 20:230 https://doi.org/10.1186/s12877-020-01622-8 RESEARCH ARTICLE Open Access Nocturia in patients with cognitive dysfunction: a systematic review of the literature Rebecca Haddad1,2*† , Thomas F. Monaghan1,3†, Charles Joussain4,5, Véronique Phé6, Wendy Bower7, Saskia Roggeman1, Gilberte Robain2 and Karel Everaert1 Abstract Background: The objective of this study is to evaluate current literature on the association between cognitive dysfunction and nocturia. Methods: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was conducted through MEDLINE, EMBASE and COCHRANE databases and completed in November 2019. Randomized and non-randomized studies were included if they assessed the association between cognitive dysfunction and nocturia in older participants with or without neurological diseases. The quality of included studies was evaluated using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS). Results: A total of 8 cross-sectional studies conducted in older patient populations met the criteria for inclusion. A statistically significant association was identified in 6 studies on univariate analysis, which persisted in 2 studies after controlling for confounding factors. The association between cognitive dysfunction and nocturia was positive for all 6 significant analyses. The overall risk of bias was unclear. Conclusion: A significant positive association between cognitive dysfunction and nocturia was identified. However, research has been limited to cross-sectional studies, which precludes identification of causality between cognitive dysfunction and nocturia. Heightened awareness of the complex interplay between cognition and nocturia would allow professionals involved in the care of cognitively impaired patients with concomitant nocturia to more effectively manage these symptoms. Keywords: Nocturia, Lower urinary tract symptoms, Cognitive dysfunction, Systematic review, Epidemiology * Correspondence: † Rebecca Haddad and Thomas F. Monaghan contributed equally to this work. 1 Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium 2 GRC 001 GREEN Neuro-Urology Research Group, Sorbonne Université Rothschild Academic Hospital AP-HP, F-75012 Paris, France Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Haddad et al. BMC Geriatrics (2020) 20:230 Background Nocturia, defined as the act of waking to void during the hours of intended sleep, is among the most common and bothersome lower urinary tract symptoms (LUTS) [1, 2]. Although nocturia is a pervasive complaint across different patient populations, older people are disproportionally affected, with clinically-significant symptoms reported in up to 60% of patients over 70 years of age [3]. Nocturia has been associated with significant morbidity and mortality [4] and shown to have a direct adverse effect on sleep architecture [5, 6]. Among older patient populations, nocturia confers an increased risk of both falls and hip fractures [7, 8], and it stands to reason that this effect may be more pronounced in the setting of concomitant cognitive impairment [9]. Notably, there exists a robust association between cognitive dysfunction - which refers to deficits in attention, verbal and nonverbal learning, short-term and working memory, visual and auditory processing, problem solving, processing speed, motor functioning - and other LUTS, particularly urinary incontinence [10–12]. Moreover, current literature has identified a diverse array of risk factors common to both nocturia and cognitive dysfunction, including aging, comorbidities [13], brain lesions - particularly those affecting the hypothalamicpituitary axis [14], and sleep disturbances [15]. However, relative to other LUTS, the relationship between nocturia and cognitive dysfunction remains poorly characterized. Increased awareness of the complex interplay between cognition and nocturia would facilitate the evaluation and management of cognitively impaired patients with concomitant nocturia. The objective of this systematic review was to evaluate available evidence on the association between cognitive dysfunction and nocturia. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [16]. Eligibility criteria Types of studies Original studies including randomized controlled trials (RCTs), non-RCTs, single-arm cohort studies, casecontrol studies, cross-sectional studies, and case series were included. Review articles and meta-analyses were not included, but references from these studies were reviewed, and eligible articles were subsequently retrieved. Population Only studies involving adults were selected. No limits on gender, ethnicity or setting were applied. The presence Page 2 of 9 of nocturia had to have been reported in participants, regardless of the method of assessment or the threshold used to define nocturia. Cognitive dysfunction had to have been assessed by either a validated neuropsychological test or defined via formal diagnosis of a neurocognitive disorder. Outcomes The primary outcome was the association between cognitive dysfunction with neurodegenerative disorders of aging and nocturia. Measurement of this association was specified by an effect size indicator and/or a statistical significance level. Search strategy and information sources The MEDLINE, EMBASE, COCHRANE and CENTRAL databases were used with specific keywords (MeSH or Emtree terms) combined with Boolean operators. The complete search strategy is available as supplementary data (Additional File 1). The search was completed in November 2019 and no date limits were applied. No limit of language was applied. References cited in systematic reviews or (...truncated)