Role of Brain in Bladder Control and Continence in Elderly Women

大脑在老年女性膀胱控制和节制中的作用

• 批准号: 8091358
• 负责人: Stasa Dusan Tadic
• 金额: $ 12.37万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8091358
• 关键词: Address; Affect; Age; Aging; Anterior; Arousal; Bladder; Bladder Control; Brain; Brain imaging; Brain region; Cerebrum; Clinical; Communities; Complex; Consult; Data; Defect; Development; Elderly; Elderly woman; Emotional; Esthesia; Extravasation; Failure; Financial compensation; Functional Magnetic Resonance Imaging; Imaging Techniques; Insula of Reil; Maps; Measures; Mentors; Methods; Monitor; Motor; Neurosciences; Pathway interactions; Patients; Prefrontal Cortex; Prevalence; Procedures; Public Health; Recruitment Activity; Research; Research Personnel; Role; Sampling; Severities; Signal Transduction; Societies; Structure; Supervision; Syndrome; Testing; Time; Training; Treatment Efficacy; Urge Incontinence; Urinary Incontinence; Urine; Urodynamics; Woman; Work; base; cingulate gyrus; design; executive function; frontal lobe; innovation; mind control; neglect; neuroimaging; new technology; novel; older women; prevent; programs; response; skills; statistics; therapeutic target; treatment strategy; volunteer; white matter

DESCRIPTION (provided by applicant): Urge urinary incontinence (Ul) is the most common form of geriatric Ul, with significant impact on patients' lives and on society as a whole. It is manifested by urgency to void and urine leakage, associated with involuntary bladder contraction (detrusor overactivity), implying failure of the brain to fulfill its role in controlling the bladder. Rapidly emerging neuroimaging data support this role, at least in healthy young volunteers. The candidate has been working with a team that has pioneered the study of brain control of bladder (functional brain imaging with simultaneous urodynamics). Together they have shown, in older women with urge Ul, a different response to bladder filling in 2 key brain regions involved in mapping and monitoring bladder afferent signals, combined with impaired response in frontal cortex (responsible for executive control of voiding) and recruitment of compensatory pathways to suppress urgency and prevent urine leakage. The present proposal is designed to provide the candidate with the additional skills needed to become an independent investigator capable of continuing to address the complex syndrome of geriatric Ul in an innovative, cross-disciplinary manner. Activities are structured in two major components: 1) academic, with further development of theoretical and practical expertise in neuroimaging, urodynamics and urinary incontinence, obtained by performing the relevant procedures and clinical consults under the direct supervision of designated mentors, and supported by coursework in neuroscience, statistics and imaging techniques; and 2) scientific, by carrying out a research plan based on hypotheses derived from previous observations. The proposed Research Plan is strongly oriented toward aging, as it aims: 1) to test existing preliminary observations in a larger sample of older urge incontinent subjects; and 2) to investigate the role of age-associated white matter hyperintensities (WMHI) in urge Ul, because of their known association with urge incontinence and detrusor overactivity and their negative effect on frontal cortex (executive) function. Relevance: geriatric urinary incontinence affects 15% of US elderly and thus represents an important public health issue for which therapeutic efficacy has advanced little in the past half century. The proposed training ill provide the candidate with academic development and a novel set of skills to use in investigating the potential causes of geriatric Ul and in developing new treatment strategies.

描述（由申请人提供）：急迫性尿失禁（Ul）是老年尿失禁的最常见形式，对患者的生活和整个社会产生重大影响。其表现为排尿急迫和漏尿，并伴有膀胱不自主收缩（逼尿肌过度活动），这意味着大脑未能发挥其控制膀胱的作用。快速出现的神经影像数据支持了这一作用，至少在健康的年轻志愿者中是这样。该候选人一直在与一个率先研究膀胱大脑控制（同步尿动力学的功能性大脑成像）的团队合作。他们共同发现，在患有尿急的老年女性中，参与映射和监测膀胱传入信号的两个关键大脑区域对膀胱充盈有不同的反应，同时额叶皮层（负责排尿的执行控制）反应受损，并招募补偿通路来抑制尿急并防止漏尿。本提案旨在为候选人提供成为独立研究者所需的额外技能，能够以创新、跨学科的方式继续解决老年 Ul 的复杂综合征。活动分为两个主要部分：1）学术，进一步发展神经影像学、尿动力学和尿失禁方面的理论和实践专业知识，通过在指定导师的直接监督下执行相关程序和临床咨询获得，并得到神经科学、统计学和成像技术课程的支持； 2）科学性，根据先前观察得出的假设来执行研究计划。拟议的研究计划强烈面向老龄化，因为它的目标是：1）在更大的老年急迫性失禁受试者样本中测试现有的初步观察结果； 2) 研究年龄相关性白质高信号 (WMHI) 在急迫性尿失禁中的作用，因为已知它们与急迫性尿失禁和逼尿肌过度活动相关，并且对额叶皮层（执行）功能产生负面影响。 相关性：老年尿失禁影响着 15% 的美国老年人，因此是一个重要的公共卫生问题，在过去的半个世纪中，其治疗效果几乎没有取得进展。拟议的培训将为候选人提供学术发展和一套新颖的技能，用于调查老年尿失禁的潜在原因和制定新的治疗策略。