Clinical features in Parkinson's disease: characterization of urinary symptoms according to Parkinson disease subtype

To evaluate whether lower urinary tract symptoms (LUTS) differ among clinical subtypes of PD and the association between urinary disorders and motor and non-motor features, quality of life (QoL), and disease variables.

Subjects underwent to the unified Parkinson's disease rating scale (UPDRS) motor section part III, Hoehn-Yahr (H&Y) scale and mini-mental state examination (MMSE) to evaluate motor symptoms, the stage of disease severity, and cognitive function, respectively. Patients were divided into tremor-dominant type (TDT), akinetic-rigid type (ART), and mixed type (MXT) PD subgroups. Urinary symptoms were evaluated with 3-day voiding diary, uroflowmetry, and the incontinence quality of life questionnaires (I-QoL); psychological status by Hamilton anxiety scale (HAM-A) and Hamilton depression scale (HAM-D).

52 patients were enrolled; mean (± SD) age: 66.5 ± 9.6 yrs. All patients complained about at least one LUTS: 92% had urgency, 83% had increased urinary frequency, and 77% had nocturia. Disease duration was positively related to an increase in urinary frequency (p = 0.06), nocturia (p = 0.03), and negatively related to Qmax (p = 0.01). The rate of urinary frequency increased with the increase of HAM-D score (p < 0.001). The number of nocturia episodes was expression of more severe disease, as expressed by UPDRS (p < 0.001) and worse scores in HAM-A (p = 0.01) and HAM-D scores (p = 0.04). A correlation was observed between urinary frequency and HAM-A scores (p = 0.01). No significant different was observed between the clinical subtypes.

Our results suggest that LUTS correlate with the severity of motor and non- motor impairment, demonstrating also that LUTS occurrence was irrespective to PD clinical features.