title: Localization of brain white matter hyperintensities and urinary incontinence in community-dwelling older adults.
abstract: BACKGROUND
  Because white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) may be linked to geriatric syndromes involving mobility, cognition, and affect, we postulated that involvement of areas critical to bladder control could influence urinary incontinence (UI).
  
  
  METHODS
  One hundred community-dwelling individuals (75-89 years) were recruited into three groups stratified by age and gender reflecting normal and mildly and moderately impaired mobility. Baseline incontinence status and related symptoms were evaluated in 97 individuals using validated instruments (3IQ, Urinary Incontinence Severity Index, Urogenital Distress Inventory, Incontinence Impact Questionnaire). Regional WMH was measured using an MRI brain imaging segmentation pipeline and WM tract-based parcellation atlas.
  
  
  RESULTS
  Sixty-two (64%) of the participants were incontinent, mostly with urgency (37; 60%) and moderate-severe symptoms (36; 58%). Incontinent individuals were more likely to be women with worse scores for depression and mobility. WMH located in right inferior frontal regions predicted UI severity, with no significant relationship with incontinence, incontinence type, bother, or functional impact. As regards WM tracts, WMH within regions normally occupied by the anterior corona radiata predicted severity and degree of bother, cingulate gyrus predicted incontinence and severity, whereas cingulate (hippocampal portion) and superior fronto-occipital fasciculus predicted severity.
  
  
  CONCLUSIONS
  Presence of WMH in right inferior frontal regions and selected WM tracts predicts incontinence, incontinence severity, and degree of bother. Our observations support the findings of recent functional MRI studies indicating a critical role for the cingulum in bladder control, while also suggesting potential involvement of other nearby WM tracts such as anterior corona radiata and superior fronto-occipital fasciculus.
authors.affiliation: UConn Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-5215, USA. kuchel@uchc.edu
authors.forename: George A
authors.initials: GA
authors.lastname: Kuchel
authors.forename: Nicola
authors.initials: N
authors.lastname: Moscufo
authors.forename: Charles R
authors.initials: CR
authors.lastname: Guttmann
authors.forename: Neer
authors.initials: N
authors.lastname: Zeevi
authors.forename: Dorothy
authors.initials: D
authors.lastname: Wakefield
authors.forename: Julia
authors.initials: J
authors.lastname: Schmidt
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Dubeau
authors.forename: Leslie
authors.initials: L
authors.lastname: Wolfson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000502:physiology; D003337:Corpus Callosum / Q000502:physiology; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009778:Occipital Lobe / Q000502:physiology; D015995:Prevalence; D014549:Urinary Incontinence / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D014554:Urination / Q000502:physiology