Ana Catarina Santos

Purpose: To investigate the relationship between age‐related white matter hyperintensities (WMHs) and lower urinary tract symptoms (LUTS) in functionally independent older adults by integrating neurological and urological evaluations. Materials and Methods: This observational prospective cohort study (One Step Towards Overactive Bladder Phenotyping [OSTOAP Study]) included 59 community‐dwelling individuals aged ≥ 55 years with MRI evidence of cerebral small vessel disease. Participants underwent standardized neurological evaluation, Montreal Cognitive Assessment (MoCA), and WMH classification using the Fazekas scale. WMHs were categorized into mild (Fazekas 1) and moderate‐to‐severe (Fazekas 2–3). Urological assessment included validated questionnaires, a 3‐day bladder diary, uroflowmetry, and post‐void residual (PVR) measurement. Multivariable regression models identified predictors of LUT dysfunction. Results: Participants with moderate‐to‐severe WMHs had more urgency episodes (median [IQR]: 3 [1–4] vs. 1 [0–2], p = 0.001) and higher PVR volumes (median [IQR]: 50 [0–90] vs. 0 [0–20], p = 0.012). WMH burden independently predicted urgency (OR = 3.51; p = 0.014) and PVR ≥ 50 mL (OR = 3.25; p = 0.014), after adjusting for age, MoCA, and comorbidities. Questionnaire scores and prostate volume did not differ significantly. Increasing age was associated with reduced maximum voided volume ( β = −0.516, p < 0.001). Conclusions: Moderate‐to‐severe WMHs are independently associated with urgency and impaired bladder emptying. These findings suggest that cerebral small vessel disease may contribute to LUT dysfunction in older adults and support the inclusion of neurological screening in their evaluation, reinforcing the value of integrative phenotyping in future studies.

Cognitive impairment and cerebrovascular pathology are both frequent with ageing. Cognitive impairment due to vascular pathology of the brain, termed vascular cognitive impairment (VCI), is one of the most frequent causes of cognitive impairment in elderly subjects. Thus far, VCI has no specific pharmacological treatment. Recent observational studies have suggested a protective effect of physical activity in cognition, but adequate randomised controlled trials (RCT) are lacking. AFIVASC is a multi-centre randomised controlled trial, with a 6-month intervention treatment and an additional follow-up of 6 months, that aims to estimate the impact of 6 months of moderate intensity physical activity on cognition (the primary outcome) at 6 and 12 months in subjects with VCI. Participants are community dwellers with criteria for VCI without dementia or who have had previous stroke or transient ischaemic attack (TIA). Patients may be self-referred or referred from a medical appointment. After confirming the inclusion criteria, a run-in period of 1 month is conducted to access adherence; only after that are subjects randomly assigned (using a computerised program blinded to clinical details) to two groups (intervention group and best practice usual care group). The intervention consists of three physical activity sessions of 60 min each (two supervised and one unsupervised) per week. The primary outcome is measured by the presence or absence of decline in cognitive status. Secondary outcomes include changes in neuro-cognitive measures, quality of life, and functional and motor status. Primary and secondary outcomes are evaluated at 6 and 12 months by investigators blinded to both intervention and randomisation. A required sample size of 280 subjects was estimated. Statistical analyses will include regression analysis with repeated measures. The study was approved by the Ethics Committee for Health of Centro Hospitalar de Lisboa Norte (ref. no. 1063/13) and by the Ethics Committee for Health of Centro Hospitalar do Porto CHP (ref. no. 2016.055(049-DEFI/048-CES)). We aim to show whether or not moderate physical activity has a beneficial impact on cognition, quality of life, motor, and functional status in people with vascular cognitive impairment, and to generate new insights on the applicability of implementing physical activity in this specific population. ClinicalTrials.gov, NCT03578614 July 6, 2018.

Anger is a frequent neuropsychiatric symptom after stroke, which can disrupt treatment and recovery, in particular by affecting adherence behaviour to treatment and health care education. This study aimed to follow-up a cohort of stroke patients 12 months after their stroke to describe the presence of anger, compare levels and profile of acute and post-acute anger and analyse its impact on the adherence to treatment and beliefs about stroke. We followed (13.3 months mean follow-up) 91 stroke patients with a standardized protocol, using State-Trait Anger Expression Inventory-2 (STAXI-2) to assess the frequency and profile of anger and its components and one questionnaire to measure adherence to treatment and health education (meaning on the treatment) (Adh-T). We used as explanatory variables socio-demographic, clinical, stroke type and location information collected during the acute phase. Anger-state was detected in 15 (17%) patients, while anger-trait was present in 7 (8%) patients. The best regression model revealed that trait-anger, stroke location (posterior infarcts), and impact of stroke sequels were independent predictive factors for anger (R ² = 43%). Patients with higher levels of anger expression had lower adherence rates, independently of the adherence dimension. In the chronic phase after stroke anger was related with posterior lesions, the impact of stroke consequences and anger as a personality trait. The detection and monitoring of anger could eventually prevent the negative impact of anger in care, especially in adherence to rehabilitation and secondary prevention.