Urinary incontinence and its functional anatomy in frontotemporal lobar degenerations.
OBJECTIVE
The frontal lobes play a crucial role in micturition control. However, no reports exist on the functional role of distinct frontal brain regions in urinary incontinence (UIC) in patients with a neurodegenerative damage of the frontal lobe. The aim of the present study was therefore to explore if functional brain lesions were associated with UIC in patients suffering from frontotemporal lobar degenerations (FTLD).


METHODS
Forty-four patients, including eight incontinent subjects, underwent cranial positron emission tomography scanning with (18)F-fluoro-2-deoxy-glucose ((18)F-FDG PET) to assess the relative metabolic rate of glucose (rCMRglc). Group comparisons of rCMRglc were conducted in SPM2 to identify brain regions where the group of incontinent patients (FTLD+UIC) had significant alterations compared with the group without UIC (FTLD-UIC).


RESULTS
At the stringent statistical threshold of p < 0.05, corrected for multiple comparisons according to the family-wise error rate, the statistical analysis revealed two significant right-hemispheric hypometabolic clusters located in the premotor/anterior cingulate cortex and the putamen/claustrum/insula. No hypermetabolic regions were found.


CONCLUSIONS
The present study is the first to provide evidence for brain functional alterations involved in the occurrence of UIC in FTLD. These results provide an important piece of evidence to the understanding of a particularly distressing autonomic nervous system symptom of dementia.
Perneczky
Robert
R
Department of Psychiatry and Psychotherapy, Technical University Munich Medical School, Munich, Germany. robert.perneczky@lrz.tum.de
Diehl-Schmid
Janine
J
Förstl
Hans
H
Drzezga
Alexander
A
May
Florian
F
Kurz
Alexander
A
D000368:Aged; D003704:Dementia / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics*; D005625:Frontal Lobe / Q000000981:diagnostic imaging* / Q000378:metabolism*; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014018:Tissue Distribution; D014549:Urinary Incontinence / Q000000981:diagnostic imaging* / Q000378:metabolism*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18