Frontal executive function and the bladder: A study of dementia with Lewy bodies

Abstract

Background: Pathophysiology of bladder dysfunction in dementia with Lewy bodies (DLB, a disease that shares pathology with Parkinson's disease [PD]) is disturbed prefrontal-basal ganglia pathway. Similarly, DLB/PD patients have frontal executive dysfunction by the same mechanism. Aim: To study the relationship between executive function and bladder autonomic function in patients with DLB. Methods: We recruited 45 patients with DLB (28 male, 17 female; age 73.3 years ± 6.8). Other neurologic, urologic, and systemic causes of cognitive and bladder dysfunctions were excluded. All patients underwent urodynamics tests and three sets of cognitive tasks (i.e. the mini-mental state examination [MMSE], Alzheimer's disease assessment scale cognitive [ADAScog; general cognitive tasks], and the frontal assessment battery [FAB; frontal executive tasks]). Results: The urinary questionnaire revealed urinary incontinence in 20 patients. Urodynamic testing revealed detrusor overactivity (DO) in 30 patients. Cognitive testing found patients’ mean MMSE score to be 22.6 ± 4.8, while their mean FAB score was 11.5 ± 2.6. There was no relationship between DO and total MMSE score. However, our analysis revealed a significant relationship between DO and total FAB score (P < 0.05). Conclusion: The results showed that performance on the FAB test decreased in DLB patients with bladder dysfunction.