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Lower urinary tract symptoms in dementia with Lewy bodies, Parkinson disease, and Alzheimer disease

From the Department of Neurology (G.N.R., W.P.), the Neurourology Unit of the Department of Neurology (S.H., K.S., H.M., G.K.), and the Department of Biostatistics (M.D.), Innsbruck Medical University; and the Departments of Neurology and Psychiatry (G.N.R.) and Urology (H.H.), Linz General Hospital, Austria.

Address correspondence and reprint requests to Dr Ransmayr, Department of Neurology and Psychiatry, Krankenhausstraße 9, Linz General Hospital, A-4020 Linz, Austria gerhard.ransmayr{at}akh.linz.at

Objective: The present study sought to investigate lower urinary tract symptoms and urodynamic and cystometric findings in Parkinson disease (PD), dementia with Lewy bodies (DLB), and Alzheimer disease (AD).

Methods: Included were patients with frequency, urgency, incontinence, and nocturia, without major bladder outflow obstruction. The protocol comprised physical examination, urine analysis, prostate specific antigen, 24-hours frequency of micturition, mean voided volume (MVV), free flow before instrumentation (Qmax_before), post-void residual volume (PVR), and cystometry.

Results: Fifteen patients with DLB and PD and 16 patients with AD were examined. MVV, PVR, Qmax_before and with transurethral catheter, cystometric bladder capacity, and detrusor pressor at maximum flow were similar in the three groups and corresponded to values of the general elderly population. Urge episodes and urge incontinence were observed in 93 and 53% of the patients with DLB, 53 and 27% of the patients with PD, and 19 and 12% of the patients with AD, and detrusor overactivity in 92% of the patients with DLB, 46% of the patients with PD, and 40% of the patients with AD.

Conclusions: Urgency and urge incontinence suggest detrusor overactivity, which was more prevalent in dementia with Lewy bodies than in Parkinson disease and Alzheimer disease, whereas mean voided volume, free flow, cystometric bladder capacity, and detrusor pressor were similar in the groups. Frequency of micturition could not be reliably assessed in patients with dementia.

Abbreviations: AChE-I = acetylcholinesterase inhibitor; AD = Alzheimer disease; aNL = atypical neuroleptics; DA = dopamine agonist; DLB = dementia with Lewy bodies; EMG = electromyography; ICS = International Continence Society degree of infravesical obstruction; KW ANOVA = Kruskal-Wallis analysis of variance; LD = levodopa; LUTS = lower urinary tract symptoms; MF = mean frequency of micturition; MMSE = Mini-Mental State Examination; MSA = multiple system atrophy; MVV = mean voided volume; MW-U = Mann-Whitney U test; PD = Parkinson disease; PVR = post-void residual volume.

Disclosure: The authors report no conflicts of interest.

Received January 23, 2007. Accepted in final form July 2, 2007.