Pd59-12 Does Cognitive Impairment Impact Sacral Neuromodulation Success in Older Adults?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neuromodulation (PD59)1 May 2024PD59-12 DOES COGNITIVE IMPAIRMENT IMPACT SACRAL NEUROMODULATION SUCCESS IN OLDER ADULTS? Chen Shenhar, Howard B. Goldman, Jacquelyn Booher, Lauren Gleich, Omer Anis, Tyler Trump, Emily Emily, Bradley Gill, and Jacqueline Zillioux Chen ShenharChen Shenhar , Howard B. GoldmanHoward B. Goldman , Jacquelyn BooherJacquelyn Booher , Lauren GleichLauren Gleich , Omer AnisOmer Anis , Tyler TrumpTyler Trump , Emily EmilyEmily Emily , Bradley GillBradley Gill , and Jacqueline ZilliouxJacqueline Zillioux View All Author Informationhttps://doi.org/10.1097/01.JU.0001009544.34256.8a.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) and cognitive impairment (CI) are both increasingly prevalent with age. Concern regarding the cognitive safety of anticholinergic OAB medications has highlighted the importance of optimizing alternative safe and effective therapies in older patients with OAB, including those with cognitive impairment (CI). The objective of this study is to assess the impact of cognitive function on sacral neuromodulation (SNM) outcomes in older patients. METHODS: This is an IRB-approved prospective study. Patients aged ≥60 years scheduled for test-phase (peripheral nerve evaluation (PNE) or stage 1) SNM for refractory OAB were recruited. Cognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) tool, with scores <26/30 considered CI. Patients underwent initial and follow-up assessments utilizing validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Baseline functional status and technology comfort/use were assessed with a novel questionnaire. The primary outcome of test-phase success (>50% improvement in baseline symptoms) was compared based on presence of CI. Secondary outcomes included urinary questionnaire scores and device utilization. RESULTS: 92 patients were recruited, of which 88 underwent test-phase (60 PNE, 28 Stage 1). Mean age was 73±8 years and the majority were female (89%). Mean MoCA score was 23.7±4.1 (range 13 -30), and 63% met criteria for CI (MoCA <26). Patients with CI had lower baseline technology use and confidence. Patient reported measures of OAB symptom severity and impact were similar across the 2 groups. Overall test-phase success was 89% and did not differ based on CI (91% vs 87%, p=0.60). At a mean follow-up of 35±19 days, while patients with CI demonstrated lower rates of appropriate SNM controller use and amplitude changes, the reported symptom and impact outcomes did not differ. CONCLUSIONS: Older patients presenting for SNM testing for OAB have a high incidence of mild and moderate cognitive impairment, also associated with reduced comfort with technology. Test-phase success and short-term patient-reported outcomes after implant were not impacted by cognitive impairment, though long-term results are still unknown. Source of Funding: Investigator initiated Medtronic research grant © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1225 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Chen Shenhar More articles by this author Howard B. Goldman More articles by this author Jacquelyn Booher More articles by this author Lauren Gleich More articles by this author Omer Anis More articles by this author Tyler Trump More articles by this author Emily Emily More articles by this author Bradley Gill More articles by this author Jacqueline Zillioux More articles by this author Expand All Advertisement PDF downloadLoading ...