Executive Function Is Related to the Urinary Urgency in Non-demented Patients With Parkinson’s Disease

Abstract

Introduction: Evidence suggests urinary urgency is associated with cognitive impairment in a subtype of Parkinson's disease (PD) patients. This study investigates if cognitive impairment independently predicts the presence of urinary dysfunction. Methods: We report data of 189 idiopathic PD patients, excluding those with concomitant diseases or medication interacting with bladder function. A standardized questionnaire was used to define the presence of urinary urgency. All patients underwent a comprehensive motor, cognitive non-motor and health-related quality of life (HRQoL) assessment. Multivariable linear regression analysis was performed to identify independent variables characterizing urinary urgency in PD (PD-UU), which were assigned as discriminant features to estimate their individual contribution to the phenotype of the PD-UU group. Results: Of 189 PD patients, 115 (60.8%) reported PD-UU. The linear regression analysis showed that among cognitive domains, executive function (EF; p = 0.04) had a significant negative association with PD-UU. In a second model, scores of the Montreal Cognitive Assessment (MoCA) significantly differentiated between study groups (p = 0.007) and also non-motor symptom (NMS) burden (p < 0.001). The third model consisted of reports of HRQoL, of which stigma was the only subscale of the Parkinson's Disease Questionnaire (PDQ-39) differentiating between patients with and without PD-UU (p = 0.02). The linear discriminant analysis provided evidence that the combination of EF, NMS burden, nocturia, and stigma discriminated between groups with 72.4% accuracy. Conclusion: In our large, non-demented PD cohort, urinary urgency was associated with executive dysfunction (EF), supporting a possible causative link between both symptoms. A combination of neuropsychological and non-motor aspects identified patients with PD-UU with high discriminative accuracy.

Classifying Parkinson’s Disease Patients With Syntactic and Socio-emotional Verbal Measures

“…Note that similar classification accuracies have been reported by previous studies using cognitive measures in PD and other neurodegenerative diseases (Bennett et al, 2006;García et al, 2016;Tkaczynska et al, 2020). Indeed, our classification results are even higher than those of a recent study (Zimmerer et al, 2020) using linguistic measures to classify syndromes which primarily impair language (i.e., primary progressive aphasia).…”

Pattern of prefrontal cortical activation and network revealed by task-based and resting-state fNIRS in Parkinson’s disease’s patients with overactive bladder symptoms

“…Our data showed that PD patients with higher OABSS presented significantly lower FAB scores and MoCA total scores, especially in visuospatial/executive, attention and orientation-related domains, which was well-aligned with previous reports. In a cohort of 189 non-demented PD subjects, urinary urgency was found to be associated with executive dysfunctions, in combination with NMS burden, nocturia, and stigma ( Tkaczynska et al, 2020 ). Xu et al (2019) have also identified that H-Y staging, FAB scoring, and RBD were accompanying etiological factors for OAB.…”

“…Recent investigations have highlighted that alteration of the D1 dopaminergic (DA) neuronal circuitry in the frontal-basal ganglion could be the major inducer of OAB in PD patients ( Kitta et al, 2015 ; Mito et al, 2018 ). To date, only a few studies have elaborated on the pathological connection between PFC disturbances with OAB onset in PD from the neuropsychiatric perspective ( Xu et al, 2019 ; Tkaczynska et al, 2020 ). However, there is still a lack of verification from functional neuroimaging examinations.…”

Prevalence of lower urinary tract symptoms, urinary incontinence and retention in Parkinson's disease: A systematic review and meta-analysis

“…LUTS were demonstrated to be correlated with putamen/caudate ratio and the degeneration of nigrostriatal dopaminergic neurons in PD patients with severe LUTS, suggesting that LUTS was associated with the degeneration of the caudate nucleus in patients with severe bladder dysfunction (Winge et al, 2005 ). Besides, there were potential associations between frontal executive dysfunction and LUTS or its subtypes in PD (Tkaczynska et al, 2017 , 2020 ; Xu et al, 2019 ). PD dementia (PDD) and dementia with Lewy bodies were diseases with high prevalence of LUTS and characterized by cognitive impairment.…”