July 5, 2012 — Does Alzheimer's disease lead to incontinence? Not necessarily, asserts a University of Virginia researcher.

A new $428,269 grant from the National Institutes of Health will help School of Nursing professor Karen Rose determine whether people living with Alzheimer's are incontinent because of the disease, or whether their incontinence and nighttime agitation – common symptoms of the progressive brain disease – are connected and might be, therefore, better and more thoughtfully managed.

"People assume that incontinence is part of the disease, that 'that's the way it goes,' but that may not be, in fact, true," said Rose, who will lead the two-year study. "The answer isn't necessarily just putting a diaper on someone."

Between 70 percent and 90 percent of those living with Alzheimer's are cared for by family members in their homes, and many who are treated for agitation – another common occurrence among this population – are given sedating medication which may have an effect on their continence. Roughly 53 percent of Alzheimer's patients suffer from incontinence, Rose said.

Nearly 5.5 million Americans, including one in eight people 65 and older, are living with the degenerative brain disease, which robs victims of memory, cognitive function and physical control.

Urinary incontinence, common in Alzheimer's patients, often means families feel cornered into sending their loved ones into a nursing home. The study's goal, Rose said, is to offer solutions to families caring for their loved ones.

"It's very intimate, very personal, these things," Rose said, "and it can be a tipping point for institutionalization."

Rose, along with UVA School of Engineering and Applied Science colleagues and professors John Stankovic and John Lach, and collaborator Janet Specht from the University of Iowa, will study a group of 50 local individuals with Alzheimer's who are at least 65 years old who receive care at UVA's Memory and Aging Care Clinic. Those with Alzheimer's will wear a wrist actigraph at night – a device created by Lach and Stankovic that measures physical movement and agitation – and will sleep on beds with wetness sensors. They will also be recorded for verbal agitation between the nighttime hours of 9 p.m. and 7 a.m. Data will be collected over five days and nights, and tabulated to see whether physical and verbal agitation precedes bed-wetting and whether there are timing issues to consider – whether a person is incontinent early in the evening or in the morning, for example – that might help families better keep ahead of the problem.

Rose said the study could ultimately inform the way families manage incontinence by offering a template for home study of Alzheimer's patients and their continence patterns. Enabling more people with this disease to be cared for by their families will, she said, help to lessen the strain on the already overtaxed federal Medicare program, which currently spends some $200 billion a year on managing the disease. The amount is expected to exceed $1 trillion by 2050.

"From a financial perspective, this disease is set to break the bank for Medicare, so figuring out how to keep people at home longer helps all around," Rose said. "And most importantly, people want to stay home, be cared for by their families."

She said her study will bring a difficult topic better into the light.

"There's a stigma attached to all of this – the disease, the incontinence, the burden on families," Rose said. "But we still don't know whether some very basic things are linked. We don't know that urinary incontinence is just part of the disease. Are they agitated because they're incontinent? Are there things we can do to relieve that?"

Rose, an associate professor of nursing and director of the Bachelor of Science in Nursing program, has taught acute and specialty care courses at the school since 2006.