Title:“Vascular Incontinence” and Normal-Pressure Hydrocephalus: Two Commonsources of Elderly Incontinence with Brain Etiologies
VOLUME: 7 ISSUE: 1
Author(s):Ryuji Sakakibara, Jalesh Panicker, Clare J. Fowler, Fuyuki Tateno, Masahiko Kishi, Yohei Tsuyusaki, Tomoyuki Uchiyama and Tatsuya Yamamoto
Affiliation:Neurology, Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285- 8741 Japan.
Keywords:Geriatric incontinence, white matter disease, normal-pressure hydrocephalus, overactive bladder, anticholinergic
drug
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.
