title: Is overactive bladder a brain disease? The pathophysiological role of cerebral white matter in the elderly.
abstract: Small-vessel disease of the brain affecting the deep white matter characteristically manifests with neurological syndromes, such as vascular dementia and vascular parkinsonism. There is, however, compelling evidence to suggest that white matter disease can cause overactive bladder and incontinence, and in some patients these might be the initial manifestation. As white matter disease increases significantly with age, and preferentially affects the prefrontal deep white matter, white matter disease becomes an anatomical substrate in the brain etiology of overactive bladder. Treatment entails the management of small-vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood-brain barrier, to improve bladder control. In short, when caring for elderly overactive-bladder patients, we should look at both the brain and the bladder.
authors.affiliation: Neurology Division, Department of Internal Medicine, 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: Tsuyusaki
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yamanishi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Masashi
authors.initials: M
authors.lastname: Yano
mesh_terms: D000368:Aged; D006801:Humans; D056784:Leukoencephalopathies / Q000150:complications* / Q000503:physiopathology*; D053201:Urinary Bladder, Overactive / Q000209:etiology*
keywords: geriatric incontinence; overactive bladder; prefrontal cortex; vascular incontinence; white matter disease