Overactive bladder (OAB) and cognitive impairment (CI) are both highly prevalent in the aging population. Anticholinergics, a common treatment for OAB, are associated with new-onset dementia, and long-term (>3 months) use has been cautioned against in all populations (1). As the medical community is moving away from anticholinergic medications (2), optimization of non-anticholinergic therapies, including sacral neuromodulation (SNM), becomes key. however, study of SNM in the older population and in patients with CI is limited. Specifically, perceived difficulties with technology utilization (3) are a possible barrier for widespread use of SNM in these patients.
The aim of this study was to assess the relationship between cognitive impairment, technophilia, and device utilization, in treatment effect of SNM for refractory OAB in an older population.

This is a secondary analysis of an ongoing IRB-approved prospective study assessing cognitive function and SNM outcomes, with focus on technophilia and device utilization. Patients aged ≥60 years scheduled for test-phase SNM for refractory OAB were recruited. Cognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) tool, with scores <26/30 considered CI. Baseline functional status and technology comfort / use were assessed with a novel questionnaire. Patients underwent initial and follow-up assessments utilizing validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Device utilization, determined by patient ability to perform amplitude / program adjustments and appropriate device use (i.e., familiarity with communicator / programmer) were recorded at follow-up. Baseline technology use / comfort and post-implant device utilization were compared based on CI.

Fifty-eight patients underwent test-phase (36 PNE, 22 Stage 1). Mean age was 73±8 years and most were women (95%). Mean MoCA score was 23.1±4.4, and 67% met CI criteria with MoCA<26. Forty-nine (85%) had successful test-phase, of which 45 patients have undergone full implant and 38 have available follow-up data. At baseline, patients with CI had lower use and comfort levels with various technologies (Table). At mean 4.1±2 months follow-up, patients with CI were less involved in changing programs (p=0.004) or amplitudes (p=0.007) on their own, but patient-reported improvement did not differ (table).

Older patients presenting for SNM for OAB have a high incidence of CI. Patients with CI demonstrated lower baseline self-reported use / comfort with technology and lower SNM device utilization post-implant. Despite this, patient-reported outcomes appear similar over short-term follow-up.

Despite lower baseline technophilia and lower utilization of SNM controller, patients with CI undergoing SNM for OAB had comparable short-term clinical efficacy to those without CI.

Zillioux J, Welk B, Suskind AM, Gormley EA, Goldman HB. SUFU white paper on overactive bladder anticholinergic medications and dementia risk. Neurourology and Urodynamics. 2022 Sep 6;nau.25037.
Menhaji K, Cardenas-Trowers OO, Chang OH, Hall EF, Ringel NE, Falk KN. Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk. Int Urogynecol J. 2021 Oct 1;32(10):2819–26.
Guzman-Parra J, Barnestein-Fonseca P, Guerrero-Pertiñez G, Anderberg P, Jimenez-Fernandez L, Valero-Moreno E, et al. Attitudes and Use of Information and Communication Technologies in Older Adults With Mild Cognitive Impairment or Early Stages of Dementia and Their Caregivers: Cross-Sectional Study. J Med Internet Res. 2020 Jun 1;22(6):e17253.

Continence 7S1 (2023) 100936
DOI: 10.1016/j.cont.2023.100936