Abstract General Information

Title

BRAIN CORTEX MORPHOMETRY AND FUNCTIONAL CONNECTIVITY CORRELATES OF DAYTIME URINARY INCONTINENCE IN 9- TO 10-YEAR-OLDS IN THE US.

Introduction and objective

The brain plays an important role in control over micturition. Numerous studies indicate the sites where control of urination and sense of urgency are experienced in adults, but there is a lack of understanding of what regions and functional mechanisms are associated with daytime urinary incontinence in pre-adolescents. The aim of this structural and functional brain imaging study was to pinpoint brain regions and functional connections involved in bladder dysfunction and furthermore aid to the development of therapeutic strategies.

Method

We retrieved clinical and imaging data from the Adolescent Brain Cognitive Development (ABCD) Study that recruited over 11,000 9-to-10-year-olds across 21 sites to closely represent the US population. Children with daytime urinary incontinence according to the child behavioral checklist, but without symptoms of constipation, nocturnal enuresis, or encopresis were compared to healthy controls without any history of urinary incontinence, constipation or encopresis, mental health diagnoses as well as parental drug use and parental mental health issues. Univariate logistic regression models were used to compare multimodal magnetic resonance imaging (MRI) parameters known to be associated with voiding between groups. MRI variables of interest included thickness, volume, surface area and sulcus depth of 26 cortical regions, volume of 19 subcortical regions, functional coupling (FC) within and between 6 cortical networks (cingulo-opercular, salience, dorsal and ventral attention, default and fronto-parietal networks) as well as functional connectivity from 6 cortical to 19 subcortical regions. P-values were corrected for multiple testing using Benjamini and Hochberg. The significance level was set at p=0.05.

Results

Our final cohort included 32 children with incontinence (15 (46.9%) females, 17 (53.1%) males) and 488 controls (257 (52.7%) females and 231 (47.3%) males) at a mean age of 10.0 years (±0.6). After adjustment for multiple testing, we observed higher cortical thickness of the right rostral middle frontal gyrus in association with daytime urinary incontinence (p=0.028). Several other parcels of the prefrontal cortex such as the left rostral middle frontal gyrus, right pars triangularis and right precuneus (p=0.093 for all) did not reach the significance level.

Conclusion

Our multimodal MR imaging results showed higher thickness of the rostral middle frontal gyrus associated with daytime urinary incontinence. Thus, our results highlight the role of the prefrontal cortex in this voiding disorder.

Area

Enuresis