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Poststroke Urinary Incontinence: One‐Year Outcome and Relationships with Measures of Attentiveness
Author(s) -
Pettersen Renate,
Saxby Brian K.,
Wyller Torgeir Bruun
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01396.x
Subject(s) - medicine , urinary incontinence , observational study , stroke (engine) , odds ratio , rehabilitation , confidence interval , activities of daily living , physical therapy , cognition , surgery , psychiatry , mechanical engineering , engineering
OBJECTIVES: To investigate the prognostic effect of poststroke urinary incontinence (UI) on 1‐year outcome in relation to measurements of attention and mental processing speed. DESIGN: Prospective observational study. SETTING: Geriatric department (stroke and rehabilitation unit) in a university hospital. PARTICIPANTS: Two hundred thirty‐five previously continent patients (median age 78) with an acute stroke. MEASUREMENTS: Clinical stroke syndromes, subtypes of UI, pre‐ and poststroke cognitive function and activities of daily living, computerized assessment of attention and processing speed for 110 of the participants, mortality and accommodation at 1 year. RESULTS: One hundred seventy patients remained continent, and 65 developed UI (27 with urge UI, 38 with UI with impaired awareness of the need to void (IA‐UI). Patients with urge UI had poorer power of attention and speed of memory than continent patients but similar continuity of attention ( P <.001, .001, and .07, respectively). Patients with IA‐UI performed poorer in all categories than continent and patients with urge UI (all P <.01). In regression analyses, IA‐UI was the strongest predictor of mortality and nursing home residence after 1 year (odds ratio=15.7, 95% confidence interval=3.6–69.7). When deaths were excluded, IA‐UI and continuity of attention remained independent risk factors. CONCLUSION: Patients with poststroke UI are less attentive than continent patients. Those with IA‐UI perform poorest. Sustained attention seems important for outcome and should be taken more into account in the rehabilitation process. In patients who recognize their incontinence, attention‐focused training might be the most effective measure of reestablishing bladder control.