ABSTRACT
INTRODUCTION: Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA). METHODS: In this narrative review, we explore the dopaminergic hypothesis in the development of this combination of LUT signs and symptoms in older adults. RESULTS: DA is one of the neurotransmitters whose regulation and production is disrupted in aging. In synucleinopathies, altered DAergic activity is associated with the occurrence of LUTS and sleep disorders. Projections of DAergic neurons are involved in the regulation of sleep, diuresis, and bladder activity. The low dopamine hypothesis could explain the genesis of a set of LUT signs and symptoms commonly seen in this population, including elevated residual urine, Overactive bladder syndrome and Nocturia (discussed as the RON syndrome). This presentation is however also common in older patients without synucleinopathies or neurological disorders and therefore we hypothesise that altered DAergic activity because of pathological aging, and selective destruction of DAergic neurons, could underpin the presentation of this triad of LUT dysfunction in the older population. CONCLUSION: The concept of RON syndrome helps to better understand this common phenotypic presentation in clinical practice, and therefore serves as a useful platform to diagnose and treat LUTS in older adults. Besides recognizing the synucleinopathy "red flag" symptoms, this set of multi-causal LUT signs and symptoms highlights the inevitable need for combination therapy, a challenge in older people with their comorbidities and concomitant medications.
Subject(s)
Nocturia , Synucleinopathies , Urinary Bladder, Overactive , Urinary Retention , Humans , Aged , Urinary Bladder, Overactive/drug therapy , Nocturia/etiology , Dopamine/therapeutic use , Synucleinopathies/complications , Urinary Bladder , Urinary Retention/complicationsABSTRACT
BACKGROUND: As people age, urinary incontinence becomes more common. It is socially isolating and is often a factor in the move to residential care. OBJECTIVE: This article highlights the causes of incontinence in the elderly. DISCUSSION: With careful assessment, many elderly people can be cured, and the majority significantly helped. The implications of this for social and psychological health and the impact on the health and welfare dollar are considerable.
Subject(s)
Urinary Incontinence/etiology , Age Factors , Aged , Australia/epidemiology , Female , Humans , Incidence , Male , Medical History Taking , Prognosis , Quality of Life , Risk Factors , Urinary Incontinence/classification , Urinary Incontinence/epidemiology , Urinary Incontinence/therapyABSTRACT
BACKGROUND: As people age urinary incontinence is increasingly prevalent, socially isolating and is often a factor in the move to residential care. OBJECTIVE: To highlight the options in management. DISCUSSION: With careful assessment many elderly can be cured, and the majority significantly helped. The implications for social and psychological health and the impact on the health and welfare dollar are considerable.
Subject(s)
Urinary Incontinence/therapy , Aged , Australia , Female , Humans , Male , Prognosis , Quality of Life , Treatment Outcome , Urinary Incontinence/diagnosisABSTRACT
Urinary incontinence in the elderly is common. Up to 10 per cent of men and 15 per cent of women over 65 are incontinent. This rises to 30 per cent in acute care hospitals and 50 per cent in nursing homes. In many it is the cause of institutionalisation. It continues to be an 'iceberg' condition, with as few as 20 per cent of sufferers being known to health care professionals.
