VAS-COG: Incontinence with Impaired Awareness Linked to Mortality Risk after Stroke

SAN ANTONIO, July 16 -- Patients who had post-stroke urinary incontinence and were unaware of the urge to void had a significantly higher risk of mortality and nursing-home placement.
Those patients were nearly 16 times more likely than continent patients or patients with simple urge incontinence to have died or been placed in a nursing home one year post-stroke (odds ratio 15.7; 95% confidence interval 3.6-69.7), according to results of a multivariate analysis presented at the International Society for Vascular Behavioral and Cognitive Disorders meeting here.
When mortality was removed from consideration, incontinence with impaired awareness and continuity of attention remained independent predictors of poorer outcome, according to Brian Saxby of CDR Ltd., a cognitive function testing firm in Goring, England.
"Patients with post-stroke urinary incontinence are less attentive compared with continent patients," said Saxby. "Those with urinary incontinence associated with impaired awareness perform the poorest [on tests of attention]. This should be taken more into account in the rehabilitation process."
Some evidence suggests that new onset post-stroke incontinence with impaired awareness, but not urge incontinence, predicts worse stroke outcomes, he said, including death and nursing-home confinement. Attention deficits also occur frequently after stroke and are associated with poorer outcome.
So Saxby and colleagues in Norway explored whether aspects of attention and mental processing affect the risk of post-stroke urinary incontinence at one year.
From a cohort of hospitalized stroke patients, the researchers identified 235 patients who remained incontinent and 75 who developed urinary incontinence within 10 days after their stroke. The incontinent group consisted of 27 patients with urge incontinence and 38 with incontinence and impaired awareness. The median age of the patients was 78. All were fully conscious, free of delirium, clinically stable, and free of sensory aphasia.
The patients underwent a battery of tests to assess functional and cognitive abilities before and after stroke. A subset of 110 patients also completed an automated assessment that provided the basis for composite scores related to power of attention, continuity of attention, and speed of memory. The subset consisted of 80 continent patients, 13 with urge urinary incontinence, and 17 with incontinence and impaired awareness.
As compared with the continent patients, both groups of incontinent patients had significant impairment in power of attention (P=0.008 to P<0.001) and speed of memory (P<0.001). However, only the incontinent patients with impaired awareness of the need to void differed significantly from continent patients with respect to continuity of attention (P=0.002).
Sustained attention appears to play a major role in outcome and should be taken into consideration during rehabilitation, the researchers said.
In patients who recognize their incontinence, attention-focused training might be the most effective measure in order to re-establish bladder control, they concluded.
The investigators declared no conflicts of interest or outside funding sources for the study.Primary source: International Society for Vascular Behavioral and Cognitive DisordersSource reference: BK Saxby et al. "Post-stroke urinary incontinence: one-year outcome and relationships with measures of attentiveness." International Society for Vascular Behavioral and Cognitive Disorders. July 11-14, San Antonio. Final Program. Abstract P-57.