title: Urinary Incontinence, Incident Parkinsonism, and Parkinson's Disease Pathology in Older Adults.
abstract: OBJECTIVE
  To test the hypothesis that urinary incontinence (UI) is associated with incident parkinsonism in older adults.
  
  
  METHODS
  We used data from 2,617 older persons without dementia. Assessment included baseline self-report UI and annual structured exam which assessed parkinsonian signs, motor performances, cognitive function, and self-report disabilities. We used a series of Cox proportional hazards models to examine the association of UI with parkinsonism and adverse health outcomes and a mixed-effect model to examine the association of UI with the annual rate of cognitive decline. In decedents, regression models were used to examine if UI proximate to death was related to postmortem indices of neuropathologies.
  
  
  RESULTS
  At baseline, more than 45% of participants reported some degree of UI. Over an average of nearly 8 years of follow-up, UI was associated with incident parkinsonism (hazard ratio [HR] = 1.07, 95% CI = 1.02, 1.12), death (HR = 1.07, 95% CI = 1.03, 1.11), incident ADL disability (HR = 1.11, 95% CI = 1.07, 1.16), and incident mobility disability (HR = 1.07, 95% CI = 1.02, 1.13). UI was not related to incident MCI (HR = 1.02, 95% CI = 0.97, 1.07), incident AD dementia (HR = 1.00, 95% CI = 0.95, 1.05) or to the rate of cognitive decline (Estimate = -.002, standard error = .002, p = .167). In 1,024 decedents with brain autopsy, UI proximate to death was related to PD pathology (Lewy body pathology and nigral neuronal loss), but not Alzheimer's disease pathology or other age-related neuropathologies.
  
  
  CONCLUSIONS
  UI in older adults is associated with incident parkinsonism and may identify older adults at risk for accumulating PD brain pathology.
authors.affiliation: Hadassah Medical Center, Hebrew University Medical School, Jerusalem, Israel.
authors.forename: Noa M
authors.initials: NM
authors.lastname: Buchman
authors.affiliation: Rush Alzheimer's Disease Center.|Department of Neurological Sciences.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Leurgans
authors.affiliation: Rush Alzheimer's Disease Center.|Department of Family Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Raj J
authors.initials: RJ
authors.lastname: Shah
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Veronique
authors.initials: V
authors.lastname: VanderHorst
authors.affiliation: Rush Alzheimer's Disease Center.|Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Wilson
authors.affiliation: Department of Public Health, Ben Gurion University, Beer Sheva, Israel.
authors.forename: Yaacov G
authors.initials: YG
authors.lastname: Bachner
authors.affiliation: Department of Neurology, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.affiliation: Rush Alzheimer's Disease Center.|Department of Neurological Sciences.|Department of Pathology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schneider
authors.affiliation: Rush Alzheimer's Disease Center.|Department of Neurological Sciences.
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
authors.affiliation: Rush Alzheimer's Disease Center.|Department of Neurological Sciences.
authors.forename: Aron S
authors.initials: AS
authors.lastname: Buchman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D010300:Parkinson Disease / Q000453:epidemiology*; D020734:Parkinsonian Disorders / Q000453:epidemiology*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology*
keywords: Aging; Brain pathology; Cognition; Disability; Mortality; Urinary incontinence