Introduction: Anticholinergics, a common treatment for overactive bladder (OAB), are associated with new-onset dementia and their use for > 3 months was recently cautioned against in all age groups. Non-anticholinergic therapies, including sacral neuromodulation (SNM), should therefore be optimized; however, data on SNM in older or cognitively impaired (CI) populations are limited. The aim of this study was to assess cognitive impairment, technophilia, and device utilization in an older population undergoing SNM for refractory OAB. Methods: This is a secondary analysis of an ongoing IRB-approved prospective study on cognitive function and SNM outcomes, focusing on technophilia and device utilization. Patients aged =60 years undergoing test-phase SNM for refractory OAB were recruited. Cognitive function was assessed using the validated Montreal Cognitive Assessment (MoCA) tool, with scores <26/30 considered CI. Baseline functional status and technology comfort / use were assessed using a novel questionnaire, and OAB symptoms were assessed initially and at follow-up utilizing validated questionnaires (OAB-q SF, IIQ7, UDI-6, PGI-I). Patient device utilization, familiarity with communicator and ability to adjust amplitude / program were recorded at follow-up. Baseline technology use / comfort and post-implant device utilization were compared based on CI. Results: Fifty-eight patients underwent test-phase (36 PNE, 22 Stage 1). Mean age was 73±8 years and 95% were women. Mean MoCA score was 23.1±4.4, and 67% met CI criteria. Forty-nine (85%) had successful test-phase, of which 45 patients have undergone full implant and 38 have available follow-up data. At baseline, patients with CI had lower use and comfort levels with various technologies (Table). At mean 4.1±2 months follow-up, patients with CI were less involved in changing programs (p=0.004) or amplitudes (p=0.007) on their own, but patient-reported improvement did not differ (Table). Conclusions: Older patients presenting for SNM for OAB have a high incidence of CI. Despite lower baseline self-reported use / comfort with technology and lower SNM device utilization post-implant among those with CI, patient-reported outcomes appear similar over short-term follow-up. SOURCE OF Funding: Investigator initiated Medtronic research grant.
.jpg "Chen Shenhar, MD (she/her/hers) photo")
