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a Department
of Neurology, b Department of Urology, Chiba University School
of Medicine, 1-8-1 Inohana Chuo-ku, Chiba 260-8670 Japan
Correspondence to: Dr R Sakakibara, Neurology Department Chiba University, 1-8-1 Inohana Chuo-Ku, Chiba 260-8670 Japan. Telephone 0081 43 226 2129; fax 0081 43 226 2160; email sakaki{at}med.m.chiba-u.ac.jp
Received 16 November
1998 and in revised form 2 March 1999;
Accepted 7 April
1999
OBJECTIVES
To
investigate urinary function in the elderly with and without white
matter lesion (leukoaraiosis) in relation to cognitive and gait function.
METHODSSixty three
subjects were examined, with mean age 73 (range 62 to 86 years).
Subjects with brainstem stroke or with large hemispheric lesions were
excluded. Spin echo 1.5 T MRI images were graded from 0 to 4 for
severity of white matter lesions. Urinary function was assessed by
detailed questionnaire and urodynamic studies were performed in 33 of
the subjects, including measurement of postmicturition residuals, water
cystometry, and sphincter EMG. A mini mental state examination (MMSE)
and examination of gait was also performed and compared with urinary function.
RESULTSUrodynamic
studies showed subjects with grade 1-4 white matter lesions to have
detrusor hyperreflexia more commonly (82%) than those with grade 0 white matter lesions (9%) (p<0.05), indicating that leukoaraiosis was
a factor associated with geriatric urinary dysfunction. Postmicturition
residuals, low compliance, detrusor-sphincter dyssynergia, and
uninhibited sphincter relaxation were also more common in grade 1-4
than in grade 0 white matter lesions, though the difference was not
significant. In grade 1 white matter lesions urinary dysfunction (urge
urinary incontinence) was more common than cognitive (MMSE<19)
(p<0.05) and gait disorders (slowness, short step/festination, and
loss of postural reflex) (p<0.05), which increased together with the
grade of white matter lesions (p<0.05).
CONCLUSIONSUrinary
dysfunction is common and probably the early sign in elderly people
with leukoaraiosis on MRI.
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