[Lower urinary tract dysfunction and degenerative brain disease]

Although lower urinary tract dysfunction and dementia are classically associated, some patients with advanced dementia do not experience incontinence. Management of these patients must be based on careful assessment of the respective roles of ageing of the urinary tract and dementia in the pathogenesis of incontinence. It is also important to distinguish those dementia syndromes that are inevitably accompanied by urinary incontinence (such as normal pressure hydrocephalus) and those in which urinary incontinence is a late phenomenon (such as Alzheimer's disease). The diagnostic and therapeutic strategy must then be based on a stepwise approach, by eliminating all simple causes of lower urinary tract dysfunction and preferring the most conservative treatments possible.