Poststroke urinary incontinence: one-year outcome and relationships with measures of attentiveness.
OBJECTIVE
To investigate the prognostic effect of poststroke urinary incontinence (UI) on 1-year outcome in relation to measurements of attention and mental processing speed.


METHODS
Prospective observational study.


METHODS
Geriatric department (stroke and rehabilitation unit) in a university hospital.


METHODS
Two hundred thirty-five previously continent patients (median age 78) with an acute stroke.


METHODS
Clinical stroke syndromes, subtypes of UI, pre- and poststroke cognitive function and activities of daily living, computerized assessment of attention and processing speed for 110 of the participants, mortality and accommodation at 1 year.


RESULTS
One hundred seventy patients remained continent, and 65 developed UI (27 with urge UI, 38 with UI with impaired awareness of the need to void (IA-UI). Patients with urge UI had poorer power of attention and speed of memory than continent patients but similar continuity of attention (P<.001, .001, and .07, respectively). Patients with IA-UI performed poorer in all categories than continent and patients with urge UI (all P<.01). In regression analyses, IA-UI was the strongest predictor of mortality and nursing home residence after 1 year (odds ratio=15.7, 95% confidence interval=3.6-69.7). When deaths were excluded, IA-UI and continuity of attention remained independent risk factors.


CONCLUSIONS
Patients with poststroke UI are less attentive than continent patients. Those with IA-UI perform poorest. Sustained attention seems important for outcome and should be taken more into account in the rehabilitation process. In patients who recognize their incontinence, attention-focused training might be the most effective measure of reestablishing bladder control.
Pettersen
Renate
R
Department of Geriatric Medicine, Ullevaal University Hospital, University of Oslo, Oslo, Norway. rrpettersen@yahoo.no
Saxby
Brian K
BK
Wyller
Torgeir Bruun
TB
D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D011379:Prognosis; D012047:Rehabilitation Centers; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D014549:Urinary Incontinence / Q000209:etiology*