Behavioral therapy to treat urinary symptoms in Parkinson's disease

描述（由申请人提供） 据估计，40%的帕金森病（PD）患者患有下尿路症状（LUTS），其中超过25%的患者患有尿失禁（UI）。目前推荐抗胆碱能药物治疗的治疗指南是基于专家意见，因为迄今为止尚未在PD成人中完成任何LUTS（包括UI）治疗的随机对照试验。通常用于治疗泌尿系统症状的抗胆碱能药物可增加抗帕金森病治疗的抗胆碱能负担，从而增加疾病的认知和自主神经负担。与此同时，UI的行为干预-包括骨盆底肌肉锻炼（PFME）疗法-已在随机对照试验中证明有效，并且没有副作用。针对UI的基于练习的行为干预需要个体学习运动技能（PFME）并实施适应性策略。作为改善循证治疗指南的第一步，候选人发表了唯一已知研究的摘要，证明了使用基于运动的行为疗法治疗PD成人UI的可行性和潜在治疗益处。行为治疗的随机对照试验将提供一个合理的下一步，以优化护理的退伍军人与PD和LUTS。本提案的项目目标包括：1.采用随机对照试验设计，评价运动行为疗法治疗PD退伍军人LUTS的疗效。 2.探讨PD被试学习和实施运动行为策略的机制，作为一种利用内隐记忆的程序性学习的运动任务。 3.获得老化过程中的知识和专业知识，这些过程会影响学习和记忆事实知识和程序技能的能力。 4.了解植物神经功能失调及评估植物神经功能的技巧。 5.获得纵向数据分析的高级生物统计培训。指导：指导团队将教师与研究方法，PD患者的护理和排尿功能障碍的管理方面的专业知识相结合。导师包括：西奥多M。约翰逊，二，医学博士，公共卫生硕士（小学，老年病），凯瑟琳L。Burgio博士（行为心理学）和Jorge L.容科斯，医学博士（运动障碍）。顾问：Gerald McGwin博士（生物统计学）和Felicia Goldstein博士（神经心理学）。职业和研究计划：一项随机对照试验旨在评估以盆底肌肉运动为基础的行为疗法治疗PD成人LUTS的疗效。按照UI严重程度、PD严重程度和性别分层后，将60例受试者（每组30例）随机分组，接受8周的行为治疗或行为对照。计划对完成行为治疗干预的参与者进行为期6个月的随访。将使用7天膀胱日记测量主要结局（UI频率）。将在基线时对所有受试者进行程序性学习的运动任务（序列反应时间任务（SRTT））。探索性分析将评估SRTT的表现，作为实施基于运动的行为治疗以减少每周UI频率的成功预测因素。职业发展活动包括流行病学建模和纵向分析的高级生物统计课程。高级课程和定向阅读认知老化的建议。候选人将增加她的自主神经功能障碍的知识，通过定向阅读，课程和实践培训。候选人预计，拟议的职业和研究计划将使她准备申请Merit Review资助，以建立作为研究者的独立性，并提供必要的证据来支持PD退伍军人LUTS治疗指南。

DESCRIPTION (provided by applicant) An estimated 40% of Parkinson's disease (PD) patients suffer from lower urinary tract symptoms (LUTS) including more than 25% who have urinary incontinence (UI). Current treatment guidelines, that recommend treatment with anticholinergic drugs, are based on expert opinion, because no randomized controlled trials of any therapy for LUTS (including UI) have been completed to date in adults with PD. Anticholinergic medications typically used to treat urinary symptoms can add to the anticholinergic burden of antiparkinsonian therapy, and thus to the cognitive and autonomic burdens of the illness. Meanwhile, behavioral interventions for UI - including pelvic floor muscle exercise (PFME) therapy - have proven efficacy in randomized controlled trials and are free of side effects. Exercise-based behavioral interventions for UI require individuals to learn motor skills (PFME) and implement an adaptive strategy. As a first step in improving evidence-based treatment guidelines, the candidate published an abstract of the only known study demonstrating the feasibility and potential therapeutic benefit of using exercise-based behavioral therapy to treat UI in adults with PD. Randomized controlled trials of behavioral therapy would provide a logical next step to optimize the care of veterans with PD and LUTS. The project goals for this proposal include: 1. Evaluate the efficacy of exercise-based behavioral therapy to treat LUTS among veterans with PD using a randomized controlled trial design. 2. Explore the mechanism utilized by PD participants to learn and implement the exercise-based behavioral strategy as a motor task of procedural learning using implicit memory. 3. Gain knowledge and expertise in aging processes that affect the ability to learn and remember both factual knowledge and procedural skills. 4. Gain understanding of autonomic dysfunction and technical skill in evaluating autonomic function. 5. Gain advanced biostatistical training in the analysis of longitudinal data. Mentoring: The mentoring team combines faculty with expertise in research methodology, the care of persons with PD, and management of voiding dysfunction. Mentors include: Theodore M. Johnson, II, MD, MPH (Primary, geriatrics), Kathryn L. Burgio, PhD (behavioral psychology), and Jorge L. Juncos, MD (movement disorders). Advisors: Gerald McGwin, PhD (biostatistics) and Felicia Goldstein, PhD (neuropsychology). Career and Research Plan: A randomized controlled trial is proposed to assess the efficacy of pelvic floor muscle exercise-based behavioral therapy to treat LUTS in adults with PD. After stratification by UI severity, PD severity, and gender, a group of 60 subjects (30 in each group) will be randomized to receive behavioral therapy or a behavioral control over 8 weeks. A 6-month follow-up is planned among participants who complete the behavioral therapy intervention. The primary outcome (frequency of UI) will be measured using a seven-day bladder diary. A motor task of procedural learning (Serial Reaction Time Task (SRTT)) will be administered at baseline to all participants. Exploratory analyses will assess performance on the SRTT as a predictor of success in implementing exercise-based behavioral therapy to reduce weekly UI frequency. Career development activities include advanced biostatistical coursework in epidemiologic modeling and longitudinal analyses. Advanced coursework and directed readings in cognitive aging are proposed. The candidate will increase her knowledge of autonomic dysfunction through directed readings, coursework, and practical training. The candidate expects the proposed career and research plan will prepare her to apply for Merit Review funding to establish independence as an investigator and provide needed evidence to support guidelines for the treatment of LUTS in veterans with PD.