Griffiths D J, McCracken P N, Harrison G M, Gormley E A, Moore K, Hooper R, McEwan A J, Triscott J
Urodynamics Unit, Edmonton General Hospital, Alberta, Canada.
Age Ageing. 1994 May;23(3):246-50. doi: 10.1093/ageing/23.3.246.
We have examined 73 elderly incontinent patients (mean age 79 years) and 27 continent subjects (mean age 78 years) of similar cognitive status. Among the incontinent patients, 20 were shown objectively to have urge incontinence with normal bladder filling sensation, 14 had objectively demonstrated urge incontinence with reduced bladder sensation, and 39 had other types of incontinence. We compared cognitive function (by Mini-mental State Examination: MMSE) and regional brain perfusion (by SPECT scanning) in these four groups. Patients with objectively demonstrated urge incontinence and reduced bladder sensation stood out as being different from the rest: their mean MMSE score was significantly lower than that of any of the other three groups; perfusion of the frontal cortex was significantly poorer than that in the continent and other incontinent groups; global cortical perfusion was significantly poorer than in the other incontinence groups. This was not found in patients with urge incontinence and normal bladder sensation. The observations support the hypothesis that in elderly people urge incontinence with reduced bladder sensation can be a consequence of cortical neuropathy, especially in the frontal lobes.
我们研究了73名老年失禁患者（平均年龄79岁）和27名认知状态相似的非失禁受试者（平均年龄78岁）。在失禁患者中，客观显示有20例为尿急失禁且膀胱充盈感觉正常，14例客观显示为尿急失禁且膀胱感觉减退，39例有其他类型的失禁。我们比较了这四组患者的认知功能（通过简易精神状态检查表：MMSE）和局部脑灌注（通过单光子发射计算机断层扫描：SPECT扫描）。客观显示为尿急失禁且膀胱感觉减退的患者表现出与其他患者不同：他们的平均MMSE评分显著低于其他三组中的任何一组；额叶皮质的灌注明显比非失禁组和其他失禁组差；全脑皮质灌注明显比其他失禁组差。而尿急失禁且膀胱感觉正常的患者未发现这种情况。这些观察结果支持了这样一种假说，即老年人中膀胱感觉减退的尿急失禁可能是皮质神经病变的结果，尤其是在额叶。
