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Brain activity underlying impaired continence control in older women with overactive bladder
Author(s) -
Tadic Stasa D.,
Griffiths Derek,
Schaefer Werner,
Murrin Andrew,
Clarkson Becky,
Resnick Neil M.
Publication year - 2012
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.21240
Subject(s) - overactive bladder , medicine , sma* , urinary incontinence , supplementary motor area , urology , functional magnetic resonance imaging , magnetic resonance imaging , white matter , cohort , urinary urgency , prefrontal cortex , physical medicine and rehabilitation , pathology , cognition , psychiatry , alternative medicine , mathematics , combinatorics , radiology
Aims To identify, in subjects with overactive bladder (OAB), differences in brain activity between those who maintained and those who lost bladder control during functional magnetic resonance imaging (fMRI) of the brain with simultaneous urodynamics. Methods Secondary analysis of a cohort of older women (aged >60) with proven urgency urinary incontinence, who, in the scanner, either developed detrusor overactivity and incontinence (the “DO group”) or did not (the “no DO” group). A priori hypothesis: during urgency provoked by bladder filling, without DO, activity in regions related to continence control is diminished in the DO group; specifically (1a) less activation in supplementary motor area (SMA) and (1b) less deactivation in prefrontal cortex (PFC) and parahippocampal complex (PH). We also explored phenotypic (clinical and urodynamic) differences between the groups. Results During urgency preceding DO, the DO group showed stronger activation in SMA and adjacent regions (hypothesis 1a rejected), and less deactivation in PH but no significant difference in PFC (hypothesis 1b partially accepted). These subjects were older, with more changes in brain's white matter, decreased tolerance of bladder filling and greater burden of incontinence. Conclusions (1) In older women with OAB, brain activity in the SMA is greater among those with more easily elicitable DO, suggesting a compensatory response to failure of control elsewhere. (2) OAB is heterogeneous; one possible phenotype shows severe functional impairment attributable partly to age‐related white matter changes. (3) Functional brain imaging coupled with urodynamics may provide CNS markers of impaired continence control in subjects with OAB. Neurourol. Urodynam. 31:652–658, 2012. © 2012 Wiley Periodicals, Inc.