Parkinson disease, while known for the motor symptoms such as tremor, slowness of movement and stiffness, is also associated with non-motor symptoms such as sleep disruption, constipation and urinary symptoms. The urinary symptoms in Parkinson’s are similar to overactive bladder and include urinary urgency, nocturia (awakening at night to urinate), frequent urination, and urinary incontinence (accidental loss of urine). Non-motor symptoms lead to more burden from Parkinson disease than the motor symptoms as the disease progresses. Additionally, people living with Parkinson disease are more susceptible to the potential side effects of commonly used drug therapy for urinary symptoms because Parkinson disease impacts brain function and other neurologic symptoms in the body. Behavioral treatments for urinary symptoms are well-studied in adults without Parkinson disease and could be an alternative to drug therapy in Veterans with Parkinson disease.
Dr. Vaughan’s research seeks to determine if behavioral treatment improves urinary symptoms in Veterans with Parkinson disease and ultimately to reduce or delay the use of drug therapy for urinary symptoms. Behavioral therapy involves learning to contract the pelvic floor muscles and use these muscles as part of a behavioral strategy called, “Freeze and Squeeze” to suppress urinary urgency. Funded by the VA, Dr. Vaughan’s research team published the first study showing the feasibility of behavioral therapy for urinary incontinence in the setting of Parkinson disease. She recently completed a second VA study demonstrating the behavioral therapy effectively treats urinary symptoms of overactive bladder. Now, the VA is funding Dr. Vaughan’s team to determine if behavioral therapy is as effective as drug therapy for urinary symptoms. This study involves three VA sites in Atlanta, Birmingham, AL, and Richmond, VA. Study participants will be randomly assigned to receive behavioral therapy or drug therapy with a commonly used drug for overactive bladder. After 12 weeks, the study team will determine the impact of treatment on overactive bladder symptoms, symptom bother and quality of life.
Results from Dr. Vaughan’s first study of behavioral therapy in Parkinson disease were published in the journal Neurology in 2011. She presented findings from her most recent study at annual meetings for the American Urological Association and the American Geriatrics Society (where she was selected as the best paper presented during the session).