Further Enhancing Non-Pharmacological Therapy for Incontinence

进一步加强失禁的非药物治疗

• 批准号: 8319436
• 负责人: NEIL M. RESNICK
• 金额: $ 47.76万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8319436
• 关键词: Address; Adult; Adverse effects; Age; Anterior; Area; Arousal; Behavior; Behavior Therapy; Biofeedback; Bladder; Bladder Control; Brain; Brain imaging; Brain region; Child Development; Clinical; Coupled; Data; Databases; Defect; Elderly; Emotional; Equipment; Esthesia; Evaluation; Extravasation; Failure; Functional Magnetic Resonance Imaging; Goals; Incontinence; Individual; Insula of Reil; Knowledge; Lead; Learning; Life; Lower urinary tract; Maps; Mediating; Motor; Neuraxis; Pathway interactions; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Phenotype; Physicians; Pilot Projects; Play; Prefrontal Cortex; Role; Scanning; Severities; Spasm; Sphincter; Testing; Time; Training; Urge Incontinence; Urinary Incontinence; Urine; Urodynamics; Work; base; cingulate gyrus; executive function; experience; improved; insight; mind control; novel therapeutics; older women; peer; prospective; research clinical testing; response; therapy design; trait; urinary

DESCRIPTION (provided by applicant): Urinary urge incontinence (UI) is involuntary leakage of urine that is accompanied by a sudden desire to urinate. Prevalent, morbid, and costly (nearly $20 billion annually in 2000), UI is a major problem for older adults. Although it is generally ascribed to bladder spasms (also known as detrusor overactivity [DO]), the actual causes of UI are unknown, and therapy remains inadequate and little improved over the last 50 years. The recommended first-line treatment behavioral therapy using biofeedback (BFB) is as successful as medications and safer, but it is rarely used because it requires equipment, expertise, and time that are not widely available. The goal of our ongoing study is to determine the factors that predict BFB response and, more importantly, how BFB works. Such understanding should allow physicians to further enhance its efficacy, streamline its delivery, and facilitate its more widespread application. However, this ongoing study is suggesting that the most important factors reside not in the lower urinary tract but rather in the way the brain controls it. While little is known about such brain control, our pilot studies suggest that the key areas can be identified, as can the connections between these areas, and that there are differences between the way these centers function in older people who remain in control of their bladder and in those who develop UI. To prove that these centers are the ones involved, the findings must be confirmed in a separate and larger group of older adults. In addition, if these data are correct, then the brain abnormalities in people who suffer from UI should improve in concert with the clinical response to BFB. Thus, the specific aims of this proposal are: (1) to confirm these pilot findings in a larger group of older women (>60 years old) with and without UI; and (2) to determine whether the abnormal brain findings in those with UI improve with BFB and whether such improvement parallels the clinical improvement. To address these aims, subjects will be studied before and after an 8 week course of BFB. The evaluation will include a clinical evaluation, detailed testing of lower urinary tract function, and non-invasive brain imaging using functional magnetic resonance imaging (fMRI). Findings after BFB will be compared with those before therapy and clinical improvement will be compared with change in the brain abnormalities. In addition, because some of these people will become continent even though their DO persists, their brain changes will be compared with those of their peers in whom the DO resolves. Knowledge from this study could shed important insights into the cause of UI in older adults, as well as the mechanisms that underlie its successful treatment. In turn, such knowledge should facilitate design of therapy that is simpler and more effective so that more people can benefit.Project Narrative The learning of bladder control is a milestone in child development, and the loss of bladder control as an adult can be a disastrous experience and one that often can compromise an independent and active life. The causes of this condition are not clear, and thus therapy is not very effective and is poorly targeted. Because biofeedback-assisted bladder training is the most promising and safest of available treatments, new knowledge of how it works could allow it to become even more effective and more widely available.

描述（由申请人提供）：急迫性尿失禁（UI）是伴有突然排尿欲望的尿液不自主渗漏。流行，病态和昂贵（2000年每年近200亿美元），UI是老年人的主要问题。虽然它通常归因于膀胱痉挛（也称为逼尿肌过度活动[DO]），但UI的实际原因尚不清楚，并且在过去50年中治疗仍然不足且几乎没有改善。推荐的一线治疗 生物反馈行为疗法 它和药物一样成功，而且更安全，但很少使用，因为它需要设备，专业知识和时间，而这些都不是广泛可用的。我们正在进行的研究的目标是确定预测BFB反应的因素，更重要的是，BFB如何工作。这样的理解应该使医生能够进一步提高其疗效，简化其交付，并促进其更广泛的应用。然而，这项正在进行的研究表明，最重要的因素不在于下尿路，而在于大脑控制它的方式。虽然人们对这种大脑控制知之甚少，但我们的试点研究表明，可以识别关键区域，也可以识别这些区域之间的联系，并且这些中枢在控制膀胱的老年人和患尿失禁的老年人中的功能存在差异。为了证明这些中心是相关的，必须在一个单独的更大的老年人群体中证实这些发现。此外，如果这些数据是正确的，那么患有UI的人的大脑异常应该与对BFB的临床反应一致地改善。因此，本提案的具体目的是：（1）在较大的老年女性（>60岁）中证实这些初步发现，无论是否患有UI;（2）确定UI患者的异常脑发现是否在BFB治疗后得到改善，以及这种改善是否与临床改善平行。为了实现这些目标，受试者将在为期8周的BFB课程之前和之后进行研究。评估将包括临床评估，下尿路功能的详细测试，以及使用功能性磁共振成像（fMRI）的非侵入性脑成像。将BFB后的结果与治疗前的结果进行比较，并将临床改善与脑异常的变化进行比较。此外，由于这些人中的一些人即使他们的DO持续存在，也会变得自制，因此他们的大脑变化将与DO解决的同龄人进行比较。这项研究的知识可以揭示老年人UI的原因以及成功治疗的机制。反过来，这样的知识应该有助于设计更简单，更有效的治疗，使更多的人可以受益。项目叙述膀胱控制的学习是儿童发育的一个里程碑，作为一个成年人失去膀胱控制可能是一个灾难性的经历，往往可以妥协的独立和积极的生活。这种情况的原因尚不清楚，因此治疗不是很有效，并且针对性很差。由于生物反馈辅助膀胱训练是最有前途和最安全的可用治疗方法，因此有关其工作原理的新知识可以使其变得更有效和更广泛。

项目成果

Brain responses to bladder filling in older women without urgency incontinence.

• DOI: 10.1002/nau.22320
• 发表时间: 2013-06
• 期刊: Neurourology and urodynamics
• 影响因子: 2
• 作者: Tadic SD;Tannenbaum C;Resnick NM;Griffiths D
• 通讯作者: Griffiths D

Brain activity measured by functional magnetic resonance imaging is related to patient reported urgency urinary incontinence severity.

• DOI: 10.1016/j.juro.2009.08.155
• 发表时间: 2010-01
• 期刊: The Journal of urology
• 作者: Tadic SD;Griffiths D;Schaefer W;Cheng CI;Resnick NM
• 通讯作者: Resnick NM

Brain activity during bladder filling is related to white matter structural changes in older women with urinary incontinence.

• DOI: 10.1016/j.neuroimage.2010.03.016
• 发表时间: 2010-07-15
• 期刊: NEUROIMAGE
• 影响因子: 5.7
• 作者: Tadic, Stasa D.;Griffiths, Derek;Murrin, Andrew;Schaefer, Werner;Aizenstein, Howard J.;Resnick, Neil M.
• 通讯作者: Resnick, Neil M.

What predicts and what mediates the response of urge urinary incontinence to biofeedback?

• DOI: 10.1002/nau.22347
• 发表时间: 2013-06
• 期刊: Neurourology and urodynamics
• 影响因子: 2
• 作者: Resnick NM;Perera S;Tadic S;Organist L;Riley MA;Schaefer W;Griffiths D
• 通讯作者: Griffiths D

Brain activity underlying impaired continence control in older women with overactive bladder.

• DOI: 10.1002/nau.21240
• 发表时间: 2012-06
• 期刊: NEUROUROLOGY AND URODYNAMICS
• 影响因子: 2
• 作者: Tadic, Stasa D.;Griffiths, Derek;Schaefer, Werner;Murrin, Andrew;Clarkson, Becky;Resnick, Neil M.
• 通讯作者: Resnick, Neil M.