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Dual treatment of incontinence and dementia associated with functional decline
May 01, 2008WINSTON-SALEM, N.C. - Older nursing home residents who took medications for dementia and incontinence at the same time had a 50 percent faster decline in function than those who were being treated only for dementia, according to a study from researchers at Wake Forest University School of Medicine and colleagues.
"It is likely that the oppositional effects of the drugs contributed to the accelerated decline," said Kaycee M. Sink, M.D., M.A.S., lead author. "Over a year's time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity."
The combination of drugs affected older adults who started out with higher levels of function in activities of daily living such as dressing, personal hygiene, toileting, transferring, bed mobility, eating and being able to get around the unit. The results were published online by the Journal of the American Geriatrics Society and will appear in a future print issue.
The two most common medical conditions among nursing home residents are dementia and urinary incontinence and they often coexist. The study involved 395 nursing home residents in Indiana who were taking medications for both conditions and 3,141 who were taking only a dementia medication.
Residents included in the analysis were age 65 and older and had had at least two consecutive prescriptions for cholinesterase inhibitors, a family of drugs used to treat dementia. Examples include donepezil (Aricept®), galantamine (Razadyne®), rivastigmine (Exelon®), and tacrine (Cognex®). These drugs are designed to increase levels of acetylcholine, a chemical that enhances communication between nerve cells in the brain.
About 10 percent of the residents were also taking either oxybutynin or tolterodine, the two most commonly prescribed drugs for urinary incontinence. These drugs are known as anticholinergic agents and are designed to block acetylcholine.
"The two drugs are pharmacological opposites, which led us to hypothesize that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs," said Sink, an assistant professor of internal medicine-gerontology.
She said the finding of the more rapid decline among residents taking both types of drugs represents a significant public health problem because an estimated 33 percent of people with dementia also take a drug for incontinence.
"Until now, the clinical dilemma for managing incontinence and dementia has been largely theoretical. This research suggests it may lead to worse outcomes, which is the opposite intention of therapy for dementia."
The researchers also measured whether the residents taking both drugs also experienced a decline in mental function, but there was no difference between the two groups, possibly because the test was not sensitive enough. Sink said that similar research should be extended to community-dwelling older adults with dementia and that more sensitive measures for cognition should be used. Previous studies have shown that the bladder medications are associated with cognitive decline and that people with dementia are especially sensitive to this side effect.
"The results suggest that clinicians should continue to try non-drug management strategies for incontinence before beginning therapy with one of these common drugs," said Sink.
She noted that the study was conducted in 2003 and 2004, before newer incontinence medications were introduced that may have less effect on acetylcholine in the brain.
Wake Forest University Baptist Medical Center
The two most common medical conditions among nursing home residents are dementia and urinary incontinence and they often coexist. The study involved 395 nursing home residents in Indiana who were taking medications for both conditions and 3,141 who were taking only a dementia medication.
Residents included in the analysis were age 65 and older and had had at least two consecutive prescriptions for cholinesterase inhibitors, a family of drugs used to treat dementia. Examples include donepezil (Aricept®), galantamine (Razadyne®), rivastigmine (Exelon®), and tacrine (Cognex®). These drugs are designed to increase levels of acetylcholine, a chemical that enhances communication between nerve cells in the brain.
About 10 percent of the residents were also taking either oxybutynin or tolterodine, the two most commonly prescribed drugs for urinary incontinence. These drugs are known as anticholinergic agents and are designed to block acetylcholine.
"The two drugs are pharmacological opposites, which led us to hypothesize that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs," said Sink, an assistant professor of internal medicine-gerontology.
She said the finding of the more rapid decline among residents taking both types of drugs represents a significant public health problem because an estimated 33 percent of people with dementia also take a drug for incontinence.
"Until now, the clinical dilemma for managing incontinence and dementia has been largely theoretical. This research suggests it may lead to worse outcomes, which is the opposite intention of therapy for dementia."
The researchers also measured whether the residents taking both drugs also experienced a decline in mental function, but there was no difference between the two groups, possibly because the test was not sensitive enough. Sink said that similar research should be extended to community-dwelling older adults with dementia and that more sensitive measures for cognition should be used. Previous studies have shown that the bladder medications are associated with cognitive decline and that people with dementia are especially sensitive to this side effect.
"The results suggest that clinicians should continue to try non-drug management strategies for incontinence before beginning therapy with one of these common drugs," said Sink.
She noted that the study was conducted in 2003 and 2004, before newer incontinence medications were introduced that may have less effect on acetylcholine in the brain.
Wake Forest University Baptist Medical Center
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New finding suggests prostate biopsy is not always necessary
Researchers at Wake Forest University School of Medicine and the University of Wisconsin-Madison have discovered that some elevated prostate-specific antigen (PSA) levels in men may be caused by a hormone normally occurring in the body, and are not necessarily a predictor of the need for a prostate biopsy.
Psychiatric disorders and sexual trauma are associated with lower urinary tract symptoms
Depression, anxiety disorders and sexual trauma have all been implicated as risk factors in lower urinary tract symptoms (LUTS) such as incontinence and overactive bladder.
Pelvic floor muscle exercises can help manage urinary incontinence in older women
Researchers at Rush University Medical Center have found that a program of pelvic floor muscle exercises, combined with pelvic health education, can be an effective way to manage urinary incontinence in elderly women.
UNC expert: Better decision support tools needed for prostate cancer screening choice
Although screening for prostate cancer with the Prostate Specific Antigen (PSA) test in men ages 50-70 can detect the cancer before it becomes symptomatic, knowing whether screening is beneficial for these men is uncertain.
PET/CT scans may help detect recurring prostate cancer earlier
A new study published in the September issue of The Journal of Nuclear Medicine shows that positron emission tomography (PET)/computer tomography (CT) scans with the imaging agent choline could detect recurring prostate cancer sooner than conventional imaging technologies in some patients who have had their prostates surgically removed.
Study finds no link between cognitive decline, socioeconomic status in elderly
New UCLA research suggests that for seniors age 70 and older, socioeconomic status does not play a major role in the brain's continued ability to function.
Study shows seed implants a suitable prostate cancer treatment option for men of all ages
Men diagnosed with prostate cancer have a number of treatments to choose from, but it's a daunting task to figure out the right mix of therapies for an individual patient.
Some neural tube defects in mice linked to enzyme deficiency
Women of childbearing age can reduce the risk of having a child born with a neural tube defect such as spina bifida by eating enough folate or folic acid. However, folate prevents only about 70 percent of these defects.
Uterus sparing surgery is a safe and effective treatment for pelvic organ prolapse
Researchers presented data at the 104th Annual Scientific Meeting of the American Urological Association (AUA) showing that uterus sparing surgery is an effective and safe treatment for women who want to preserve the integrity of vaginal function after pelvic organ prolapse.
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Urinary & Fecal Incontinence: Current Management Concepts by Dorothy B. Doughty MN RN CWOCN FAAN (Author) Completely updated to reflect current practice, the 3rd edition of this comprehensive resource provides a multi-disciplinary, in-depth review of the physiology of continence, the pathologic mechanisms producing incontinence, and current treatment options for the various types of incontinence. Assessment, behavioral therapies, and multidisciplinary care are emphasized as key elements in the treatment and management of incontinence. In addition to the life-span content discussed throughout the book, an entire chapter is devoted to bowel and bladder management in children. Authored and contributed by leaders in the Wound, Ostomy and Continence Nurses Society (WOCN). Provides an in-depth review of the physiology of continence, the pathologic mechanisms producing incontinence, and... |
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