Parkinson Disease Clinical Trial
Official title:
Randomized Controlled Study to Evaluate the Efficacy of a Cognitive Training Approach to Improve Urinary Dysfunction in Parkinson`s Disease
Idiopathic Parkinson's syndrome (IPS) is one of the most common neurodegenerative diseases.
The prevalence and significance of this disease is continuously increasing in the course of
demographic change. For many decades, the focus of diagnostics and therapy was on the motor
symptoms of IPS. Only in recent years, it has been recognized that Parkinson's patients also
suffer from a variety of non-motor symptoms. These have a decisive influence on the patient's
quality of life. As one of the most common non-motor symptoms, 55 to 80% of IPS patients
suffer from urinary dysfunction. This is associated with a very high impairment of quality of
life due to a high degree of stigmatization and impairment of social participation. In
clinical everyday life, Parkinson's patients regularly report the occurrence of a strong
imperative urge to urinate, which occurs suddenly and is usually triggered by a certain
external stimuli. Specific cognitive processing and reflection of these external stimuli
seems to help overcome the imperative urge to urinate. From this clinical observation, it can
be assumed that the imperative urge to urinate is subject to a certain cognitive control in
the sense of targeted inhibition.
The pharmacological therapy of urinary dysfunction in IPS patients is severely restricted and
characterized by insufficient proof of efficacy as well as a high potential for side effects.
In clinical practice, alpha-blockers and anticholinergics are frequently used, but the
evidence base for IPS is inadequate. In addition, there is a highly relevant risk for
Parkinson's patients of specific side effects such as orthostatic dysregulation or
deterioration of cognition up to psychoses and hallucinations. This greatly limits their use
especially in older IPS patients. While the use of dopaminergic medication is essential for
the treatment of motor symptoms in Parkinson's patients, a large number of studies have not
confirmed sufficient evidence for the efficacy of dopaminergic medication in urinary
dysfunction. In addition, non-pharmacological therapy options, in particular pelvic floor
training, are used to treat bladder dysfunction. Due to the lack of risk of side effects,
pelvic floor training is currently recommended as a first-line therapy option for IPS
patients. Initial studies have shown positive effects, but due to the lack of randomized
controlled trials, a sufficient evidence base for this has not yet been established.
The aim of the study is to examine whether a purely cognitive therapy approach is suitable to
improve subjective and objective symptoms of urinary dysfunction in IPS patients. This
therapeutic approach will be compared with the gold standard of pelvic floor training in
terms of efficacy.
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