Griffiths D J, McCracken P N, Harrison G M, Moore K N
Department of Applied Sciences in Medicine, University of Alberta, Edmonton, Canada.
Scand J Urol Nephrol Suppl. 1994;157:83-8.
Recent research has shown that urge incontinence is common in the elderly and is often combined with reduced bladder sensation. It is associated with cognitive impairment and with underperfusion of the frontal lobes of the cortex. To test for an expected preferential association with particular aspects of cognitive function, 47 incontinent patients (25 men and 22 women, median age 78 y) underwent cognitive testing, 24-hour monitoring of bladder function and videourodynamics. Median CAMCOG score was 72/107. Median urine loss in 24 h was 36 g (range 11-1347 g). 17 patients had urodynamic proof of urge incontinence, 8 with normal and 9 with reduced bladder sensation. Impaired orientation in time was more strongly associated with proven urge incontinence than overall cognitive impairment; it was the only significant predictor (P < 0.00005). Praxis, calculation ability, abstract thinking or recent memory were less closely involved. Thus dysfunction of the frontal cortical lobes and impairment of temporal orientation appear to constitute a "brain factor" underlying geriatric urge incontinence, particularly in combination with reduced bladder sensation.
近期研究表明，急迫性尿失禁在老年人中很常见，且常伴有膀胱感觉减退。它与认知障碍以及皮质额叶灌注不足有关。为了测试其与认知功能特定方面预期的优先关联，47例尿失禁患者（25名男性和22名女性，中位年龄78岁）接受了认知测试、膀胱功能24小时监测及影像尿动力学检查。CAMCOG评分中位数为72/107。24小时尿失禁量中位数为36克（范围11 - 1347克）。17例患者有急迫性尿失禁的尿动力学证据，其中8例膀胱感觉正常，9例膀胱感觉减退。与整体认知障碍相比，时间定向障碍与已证实的急迫性尿失禁关联更强；它是唯一显著的预测因素（P < 0.00005）。运用、计算能力、抽象思维或近期记忆与之关系不那么密切。因此，额叶皮质功能障碍和时间定向障碍似乎构成了老年急迫性尿失禁的“脑因素”，尤其是在合并膀胱感觉减退的情况下。
