Poststroke urinary incontinence: One-year outcome and relationships with measures of attentiveness

OBJECTIVES: To investigate the prognostic effect of poststroke urinary incontinence (UI) on 1-year outcome in relation to measurements of attention and mental processing speed. DESIGN: Prospective observational study. SETTING: Geriatric department (stroke and rehabilitation unit) in a university hospital. PARTICIPANTS: Two hundred thirty-five previously continent patients (median age 78) with an acute stroke. MEASUREMENTS: Clinical stroke syndromes, subtypes of UI, pre- and poststroke cognitive function and activities of daily living, computerized assessment of attention and processing speed for 110 of the participants, mortality and accommodation at 1 year. RESULTS: One hundred seventy patients remained continent, and 65 developed UI (27 with urge UI, 38 with UI with impaired awareness of the need to void (IA-UI). Patients with urge UI had poorer power of attention and speed of memory than continent patients but similar continuity of attention (P <.001, .001, and .07, respectively). Patients with IA-UI performed poorer in all categories than continent and patients with urge UI (all P <.01). In regression analyses, IA-UI was the strongest predictor of mortality and nursing home residence after 1 year (odds ratio=15.7, 95% confidence interval=3.6-69.7). When deaths were excluded, IA-UI and continuity of attention remained independent risk factors. CONCLUSIONS: Patients with poststroke UI are less attentive than continent patients. Those with IA-UI perform poorest. Sustained attention seems important for outcome and should be taken more into account in the rehabilitation process. In patients who recognize their incontinence, attention-focused training might be the most effective measure of reestablishing bladder control.