Association of urodynamic function and brain neuropathology in elderly institutionalized patients

In order to examine the association between intracerebral lesions and urinary dysfunction in incontinent nursing home patients, cystometric studies were compared with postmortem brain examinations. Nine cases were identified which had both cystometric studies during life and postmortem neuropathological examination of the brain (mean age=87.6 years; eight females, one male). Cystometric studies revealed involuntary bladder contractions in all of the cases. On neuropathological examination, neurofibrillary tangle and senile plaque formation were found in eight of the nine subjects. There was evidence of old infarction in three subjects. There was no clear association between the degree of plaque and tangle formation and the characteristics of the involuntary bladder contractions (volume at which contraction occurs, contraction pressure, duration of contraction). While there is an understanding of the association of cerebral infarction and detrusor instability, the role of neurofibrillary tangles and senile plaques in urinary dysfunction is not well understood. Functional disability probably is an important contributor to urinary problems in patients with intracerebral lesions.