Skelly J, Flint A J
Geriatric Psychiatry Program, Toronto Hospital, Canada.
J Am Geriatr Soc. 1995 Mar;43(3):286-94. doi: 10.1111/j.1532-5415.1995.tb07341.x.
Urinary incontinence is common in patients with dementia and is more prevalent in demented than in nondemented older individuals. It occurs with equal or greater frequency in males than in females, and this contrasts with the female preponderance in community-based, general older populations. Since the etiology of incontinence in dementia is multifactorial, a comprehensive assessment of factors within and outside the lower urinary tract is essential. A careful clinical evaluation is sufficient to guide treatment in most cases. Further research is needed to determine the role of simple cystometry and more complex urodynamic investigation in these patients. Research on the management of urinary incontinence in demented patients has focused almost exclusively on toileting programs and drug treatments for detrusor hyperactivity. To date, anticholinergic and antispasmodic medications have not been shown to be effective in treating incontinence in demented persons. However, the few studies undertaken have been in the most severely mentally and physically deteriorated patients, and it is possible that these medications have greater efficacy in less impaired individuals. Prompted voiding regimens have been shown to reduce incontinence by an average of 32% and appear to be a useful approach in managing incontinence in some of these patients. However, unless staff management systems are employed, staff compliance with these programs diminishes with time and the labor costs involved may limit their applicability in nursing homes. Patients who are the most severely cognitively impaired, least mobile, and have the greatest frequency of incontinence derive the least benefit from toileting programs, and palliative measures may be more appropriate in these cases.
尿失禁在痴呆患者中很常见，且在痴呆患者中比在非痴呆的老年人中更为普遍。在男性中发生的频率与女性相同或更高，这与以社区为基础的普通老年人群中女性占优势形成对比。由于痴呆患者尿失禁的病因是多因素的，因此对下尿路内外因素进行全面评估至关重要。在大多数情况下，仔细的临床评估足以指导治疗。需要进一步研究以确定简单膀胱测压法和更复杂的尿动力学检查在这些患者中的作用。对痴呆患者尿失禁管理的研究几乎完全集中在排尿训练计划和针对逼尿肌过度活动的药物治疗上。迄今为止，抗胆碱能和抗痉挛药物尚未被证明对治疗痴呆患者的尿失禁有效。然而，所进行的少数研究是针对精神和身体状况最差的患者，这些药物在受损较轻的个体中可能具有更大的疗效。定时排尿方案已被证明可使尿失禁平均减少32%，并且似乎是管理其中一些患者尿失禁的有用方法。然而，除非采用工作人员管理系统，否则工作人员对这些方案的依从性会随着时间而降低，并且所涉及的劳动力成本可能会限制其在养老院的适用性。认知障碍最严重、活动能力最差且尿失禁频率最高的患者从排尿训练计划中获益最少，在这些情况下姑息治疗措施可能更合适。
