“Vascular Incontinence” and Normal-Pressure Hydrocephalus: Two Commonsources of Elderly Incontinence with Brain Etiologies

Ryuji      Sakakibara; Jalesh      Panicker; Clare      J. Fowler; Fuyuki      Tateno; Masahiko      Kishi; Yohei      Tsuyusaki; Tomoyuki      Uchiyama; Tatsuya      Yamamoto

Abstract

This paper reviewed two common sources of elderly incontinence with brain etiologies, “vascular incontinence” (a disorder of bladder control resulting from cerebral white matter disease) and normal-pressure hydrocephalus (NPH), from a neurological point of view. Both diseases manifest with gait disturbance, dementia, and urinary incontinence. Urinary frequency/ urgency (overactive bladder, OAB) often precedes urinary incontinence in both diseases, and in some patients may be the initial manifestation. While NPH is less common than vascular incontinence, at approximately one-tenth the prevalence, it is important because the symptoms can be reversed by shunt surgery or endoscopic third ventriculostomy. For vascular incontinence, early identification of risk factors and initiation of secondary prevention are necessary. Detrusor overactivity due to frontal hypofunction may underlie the bladder disorder in both diseases. Treatment options for urinary incontinence include anticholinergics, which do not easily penetrate the blood-brain barrier, or newer drugs that act on the adrenergic beta-3 receptor and other receptors.

Keywords: Geriatric incontinence, white matter disease, normal-pressure hydrocephalus, overactive bladder, anticholinergic drug

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