In Parkinson’s Disease (PD), the depletion of dopaminergic neurons in the basal ganglia leads to a "double-edged sword": the loss of inhibitory control over the micturition reflex—resulting in Neurogenic Detrusor Overactivity—and the simultaneous onset of bradykinesia and postural instability.
Clinically, this creates a high-risk "Motor-Urological" conflict: patients experience a sudden, intense urge to void but lack the explosive power and gait speed required to reach the toilet safely and in time. Despite its clinical importance, the correlation between physical frailty and urinary urgency is often assessed in silos.
This study aims to investigate the "Motor-Urological Axis" by examining how functional mobility—quantified by the Short Physical Performance Battery (SPPB)—correlates with the severity of lower urinary tract symptoms (LUTS) across different PD stages. We hypothesize that as PD progresses, the divergence between worsening urgency and declining mobility significantly escalates the risk of functional incontinence and falls.

A 16-week prospective intervention took place between August 15 and December 5, 2025. Seven individuals with PD (aged 52–74 years; disease duration ranging from 0.2 to 18 years) participated in a multidisciplinary PD program designed by Physical and Music Therapists, which involved weekly 120-minute sessions. The intervention combined core stabilization and lower-extremity strengthening to counter physical frailty, with Taiko-based rhythmic training using Rhythmic Auditory Stimulation (RAS) to compensate for impaired internal timing. Outcome measures included the Overactive Bladder Symptom Score (OABSS) to evaluate inhibitory control failure and the Urogenital Distress Inventory (UDI-6). Physical function was measured using the SPPB (assessing balance, gait speed, and lower-limb power) and the 30-Second Sit-to-Stand (STS) test, reflecting the essential "chair-to-toilet" transfer. Quality of life (QoL) was assessed using the Incontinence Impact Questionnaire (IIQ-7). Post-Intervention Satisfaction: A 10-point Likert scale assessed the perceived benefit of rhythmic elements (Taiko) on gait initiation and daily confidence, providing qualitative evidence of the intervention’s adherence and efficacy

The development of NLUTS demonstrated a clear positive relationship between disease duration and OABSS, rising from 1 in early-stage PD to 10 in advanced stages. Patient P4, who had an 18-year history of PD, experienced the heaviest symptom load, characterized by nocturia (three nightly episodes) and the highest urgency scores. Although early-stage patients showed preserved physical performance with perfect SPPB scores (12/12), functional capacity was substantially impaired in advanced PD (P4: SPPB = 5), primarily because of a markedly prolonged chair-stand time (25.74 s), illustrating the Motor–Urological dissociation. The QoL Impact measured by IIQ-7 increased markedly from 0 in the early stage to 17 in the late stage, with “urgency” (OABSS Q3) identified as the primary factor driving social distress. Satisfaction with the rhythmic intervention following therapy was high (mean > 8.7/10). Participants indicated that rhythmic cueing (Taiko) helped them “initiate gait rhythm” and promoted “body relaxation”.

The results indicate a parallel breakdown of dopaminergic pathways involved in both detrusor suppression and skeletal motor control. In advanced PD, marked mobility limitations (low SPPB) intensify the impact of NLUTS, as prolonged “chair-to-toilet” transfer times heighten the likelihood of urgency-related incontinence and falls. Rhythmic auditory stimulation using Taiko drumming may represent a new rehabilitation approach that circumvents disrupted internal timing processes in PD, thereby enhancing motor coordination of both the pelvis and limbs.

In Parkinson’s disease, the intensity of NLUTS is closely connected to motor function. To reduce the substantial fall risk linked to urinary urgency in more advanced stages of Parkinson’s, clinicians should use a dual-track strategy that integrates neuro-urological treatment with rhythmic physical therapy.

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