title: Brain activity measured by functional magnetic resonance imaging is related to patient reported urgency urinary incontinence severity.
abstract: OBJECTIVE
  We investigated the relationship between experimental neuroimaging and self-reported urinary incontinence measures.
  
  
  METHODS
  We evaluated 14 functionally independent, community dwelling women older than 60 years with moderate to severe urgency urinary incontinence. All underwent detailed clinical assessment (3-day bladder diary, 24-hour pad test and quality of life assessment), urodynamic testing and functional brain scanning. Brain activity during reported urgency was assessed using a method that combines functional magnetic resonance imaging with simultaneous urodynamic monitoring during repeat bladder filling/emptying cycles. We used the statistical parametric mapping program SPM2 (http://www.fil.ion.ucl.ac.uk/spm/spm2.html) to correlate brain activity with relevant clinical covariates, including the number of urgency incontinent episodes, amount of urine leakage and psychological burden as assessed by the Urge Impact Scale questionnaire.
  
  
  RESULTS
  Activity in rostral and subgenual anterior cingulate gyrus, insula, inferior frontal gyrus, orbitofrontal cortex, dorsal and posterior cingulate gyrus, parahippocampus, cuneus and parts of parietotemporal lobe correlated positively with daytime incontinence frequency and urine loss. Different brain regions correlated with the psychological burden and the associations were inverse, that is precuneus/cuneus and posterior cingulate gyrus, and superior temporal, supramarginal and transverse gyrus.
  
  
  CONCLUSIONS
  As provoked by bladder filling, regional brain activity in the setting of self-reported urgency correlates significantly with incontinence severity in daily life and the associated psychological burden. Thus, observations made under experimental conditions correlate with patient real-life experience and suggest neural correlates of urgency incontinence symptoms that could serve as potential targets for future investigations.
authors.affiliation: Division of Geriatric Medicine and Gerontology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. std45@pitt.edu
authors.forename: Stasa D
authors.initials: SD
authors.lastname: Tadic
authors.forename: Derek
authors.initials: D
authors.lastname: Griffiths
authors.forename: Werner
authors.initials: W
authors.lastname: Schaefer
authors.forename: Cathy I
authors.initials: CI
authors.lastname: Cheng
authors.forename: Neil M
authors.initials: NM
authors.lastname: Resnick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012720:Severity of Illness Index; D014549:Urinary Incontinence / Q000503:physiopathology*