Sacral Neuromodulation for Overactive Bladder in the Aging Population: Does Cognitive Impairment Impact Outcomes? A Prospective Clinical Trial.

Abstract

We evaluated the impact of cognitive impairment (CI) on sacral neuromodulation (SNM) outcomes in older patients, including progression to full implant, patient-reported outcome measures, and device utilization. This prospective trial recruited patients age ≥ 60 years scheduled for test-phase SNM for refractory overactive bladder (OAB). Screening for CI was completed and defined as Montreal Cognitive Assessment scores < 26/30.Patients underwent initial and follow-up assessments using validated questionnaires (Overactive Bladder Questionnaire, Short Form; Incontinence Impact Questionnaire, Short Form; Urinary Distress Inventory; Patient Global Impression of Improvement). Baseline functional status and technology comfort/use were assessed by novel questionnaire. The primary outcome of test-phase success (>50% improvement in baseline symptoms) was compared based on the presence of CI. Secondary outcomes included urinary questionnaire scores and device utilization. Of 92 patients recruited, 88 underwent test-phase SNM (mean age 73 ± 8 years, 89% female), and 63% had CI (Montreal Cognitive Assessment <26). Baseline patient-reported measures of OAB symptom severity and impact were not statistically different between groups. Patients with CI had lower baseline technology use and confidence. Overall test-phase success was 89% and did not differ based on CI (91% vs 87%, <i>P</i> = .7). At 1-month follow-up, patients with CI demonstrated lower rates of appropriate SNM controller use; however, patient-reported outcomes did not differ. Older patients with OAB presenting for SNM have a high incidence of CI, which is associated with reduced comfort using technology. However, there was no evidence that CI affected SNM test-phase success or short-term patient-reported outcomes.