Functional connectivity of the brain in older women with urgency urinary incontinence

被引:22
作者
Clarkson, Becky D. [1 ]
Karim, Helmet T. [2 ]
Griffiths, Derek J. [1 ]
Resnick, Neil M. [1 ]
机构
[1] Univ Pittsburgh, Div Geriatr Med, Suite 500,Kaufmann Bldg,3471 Fifth Ave, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Western Psychiat Inst & Clin, Dept Psychiat, Pittsburgh, PA 15213 USA
关键词
bladder; fMRI; functional connectivity; pelvic floor muscle therapy; urgency urinary incontinence; FMRI; ACTIVATION; TRACT;
D O I
10.1002/nau.23766
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
BackgroundMethodThe brain's role in continence is critical but poorly understood. Although regions activated during bladder stimulation have been identified, little is known about the interaction between regions. In this secondary analysis we evaluate resting state and effective connectivity in older women treated for urgency urinary incontinence (UUI). 54 women 60 years old with UUI and 10 continent women underwent fMRI scanning during provocation of urinary urgency, both before and after therapy. Response was defined by >50% reduction in leaks on bladder diary. Regions of interest (RoIs) were selected a priori: right insula, medial prefrontal cortex, and dorsal anterior cingulate cortex. Generalized psycho-physiological interaction (gPPI) was used to calculate effective connectivity between RoIs during urgency. We performed a one-way ANOVA pre-treatment between groups (continent/responders/non-responders), as well as a two-way mixed ANOVA between group and time (responders/non-responders; pre-/post-therapy) using false discovery rate (FDR) correction. Principal component analysis was used to assess the variance within RoIs. Exploratory voxel-wise connectivity analyses were conducted between each RoI and the rest of the brain. ResultsConclusion RoI-RoI connectivity analysis showed connectivity differences between controls, responders, and non-responders, although statistical significance was lost after extensive correction. Principal component analysis confirmed appropriate RoI selection. Voxel-wise analyses showed that connectivity in responders became more like that of controls after therapy (cluster-wise correction P<0.05). In non-responders, no consistent changes were seen. These data support the postulate that responders and non-responders to therapy may represent different subsets of UUI, one with more of a central etiology, and one without.
引用
收藏
页码:2763 / 2775
页数:13
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