title: Vascular incontinence: incontinence in the elderly due to ischemic white matter changes.
abstract: This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.
authors.affiliation: Neurology Department, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan;
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sakakibara
authors.forename: Jalesh
authors.initials: J
authors.lastname: Panicker
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Tateno
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kishi
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tsuyuzaki
authors.forename: Emina
authors.initials: E
authors.lastname: Ogawa
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
keywords: geriatric incontinence; overactive bladder; vascular incontinence.; white matter change