Behavioral therapy may help improve overactive bladder symptoms among patients with Parkinson disease, based on a randomized trial of 77 participants across 4 US Veterans Affairs health systems.
The 12-week trial compared pelvic floor muscle exercise–based behavioral therapy with solifenacin, an antimuscarinic drug that is commonly prescribed for overactive bladder (OAB). The primary outcome was symptom reduction as measured by the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) score.
A movement disorder neurologist diagnosed Parkinson disease (PD), and patients reported significant urinary symptoms at baseline (ICIQ-OAB scores of 7 or higher). All had Montreal Cognitive Assessment (MOCA) scores of at least 18.
Patients were randomly assigned to behavioral therapy (n = 36) or solifenacin (n = 41). The drug group began with 5 mg daily, though titration to 10 mg was allowed at week 6 if symptom control was inadequate. By week 12, both groups had significant improvements in symptoms.
The mean ICIQ-OAB score in the drug group decreased from 9.1 to 5.8, and in the behavioral group from 8.5 to 5.5. The between-group difference met the prespecified noninferiority margin of 15%. Both groups also showed reductions in patient-reported bother and improved quality of life. The mean bother score declined from 28.7 to 17 in the solifenacin group and from 27.8 to 17 in the behavioral group. Quality of life scores improved from 69 to 59 in the drug group and from 74 to 60 in the behavioral group.
Eight participants in the drug group discontinued treatment due to adverse effects but remained in the trial for assessment. Dry mouth occurred in 24 of 41 participants (59%) in the solifenacin group compared with 9 of 36 (25%) in the behavioral group (P = .002). Six participants in the drug group reported falls during the study and one patient experienced a hip fracture as a result. No falls occurred in the behavioral group. Other treatment-emergent adverse effects included dry skin or eyes, headache, fatigue, decreased urinary frequency, pain or burning with urination, and nausea or heartburn.
Four participants withdrew entirely, all from the drug group, but only one of these patients reported adverse effects as their reason for dropout. No participants dropped out of the behavioral therapy group.
Behavioral therapy was administered by trained nurse practitioners and included pelvic floor muscle training, urge suppression techniques, and bladder habit education. Sessions were delivered in person or by telehealth. Adherence remained high throughout the trial.
The study sample had a mean age of 71.3 years and included mostly men (84%). Mean duration of PD was 6.6 years. Baseline MOCA scores averaged 23.9 in the drug group and 24.8 in the behavioral group. While limitations included the short-term follow-up period and a mostly male sample, the authors noted that the duration is typical for similar studies, and that clinical guidelines recommend behavioral therapy for both men and women because "behavioral therapy is feasible among persons with PD, including those with evidence of cognitive impairment, and is associated with a high level of adherence compared with drug therapy."
“This study builds on the emerging literature suggesting behavioral therapy may have utility as an initial therapy for the most common urinary symptoms affecting persons with PD," noted lead author Camille P. Vaughan, MD, of Emory University and the Atlanta VA Health Care System, and colleagues. They concluded that their findings may help guide treatment decisions for urinary symptoms in PD.
Disclosures can be found in the study.
Source: JAMA Neurology