Anticholinergic medications and risk of dementia in older adults: Where are we now?

Chatterjee, Satabdi; Talwar, A.; Aparasu, Rajender R.

doi:10.1080/14740338.2020.1811227

Cited by 15 publications

(12 citation statements)

References 57 publications

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“…5,6 It is not clear if newer anticholinergics have the same risk of dementia as oxybutynin since previous studies linking dementia and bladder antimuscarinics often group the whole class of medications together. 16 Each anticholinergic differs in their ability to passively penetrate the BBB and the extent to which they are transported out by proteins such as P-glycoprotein and multidrug associated proteins. 3 Medications that are smaller and more lipophilic, such as oxybutynin, can more readily pass the BBB.…”

Section: Discussionmentioning

confidence: 99%

“…In 2017, there were 8.8 million claims for OAB medications amounting to $1.6 billion in medication expenditures, a 15% increase in claims and a 58% increase in cost from 2013. Over the study period, oxybutynin remained the most commonly prescribed OAB medication (representing 51%À 54% of all claims), while mirabegron claims increased by 16.5%, making it the second most commonly prescribed medication in 2017.…”

Section: Discussionmentioning

confidence: 99%

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Yearly Trends of Overactive Bladder Medication Usage

et al. 2021

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Introduction: Anticholinergics are associated with cognitive side effects and dementia. Agents such as trospium, fesoterodine and darifenacin have been shown to be less likely to cross the blood-brain barrier. Furthermore, in 2012, mirabegron was approved by the U.S. Food and Drug Administration as the first beta-3 adrenoreceptor agonist to treat overactive bladder (OAB). This study aims to examine prescribing patterns of OAB medications in the United States over time. Methods:The 2013e2017 Medicare Part D Public Use File was used to identify prescribers of OAB medications including oxybutynin, tolterodine, trospium, darifenacin, solifenacin, fesoterodine and mirabegron. The number of claims and total annual expenditure for each medication for all prescribers, nonurologists and urologists were analyzed from 2013 to 2017.Results: Oxybutynin was consistently the most prescribed OAB medication each year, comprising 53.9% of all OAB medication prescriptions in 2017. From 2013 to 2017, mirabegron claims increased from 140,401 to 1,617,439, making it the second most prescribed OAB medication. Solifenacin usage decreased each year. Trospium, darifenacin and fesoterodine were the least prescribed agents each year. These trends were similar for those !65 years old. Total annual expenditure for mirabegron increased yearly, and it had the highest total expenditure of OAB medications, with $658.6 million in 2017.Conclusions: Oxybutynin was consistently the most prescribed OAB medication every year. Mirabegron utilization steadily increased each year. Anticholinergic medications associated with fewer cognitive adverse effects, such as trospium, darifenacin and fesoterodine, were among the least prescribed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Yearly Trends of Overactive Bladder Medication Usage

et al. 2021

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“…33,34 Finally, the 1-year follow-up time does not allow for the assessment of longterm costs and outcomes, including the advancement to more aggressive treatments, the occurrence of a prescribing cascade, and the implications of anticholinergic burden. 35,36 5 | CONCLUSIONS…”

Section: Discussionmentioning

confidence: 99%

Mirabegron and antimuscarinic use in frail overactive bladder patients in the United States Medicare population

Johnson

Walker

Lockefeer

et al. 2022

Neurourology and Urodynamics

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Introduction Overactive bladder (OAB) and frailty are independently associated with patient burden. However, economic burden and treatment‐taking behavior have not been well characterized among frail patients with OAB, which, given the varying safety and tolerability profiles of available treatments, is crucial. Objectives To assess costs, health care resource utilization, treatment‐taking behavior (persistence and adherence) to OAB medication in older, frail OAB patients. Methods This was a retrospective cohort study using international business machines MarketScan Medicare Supplemental claims data. Eligible frail patients (per Claims‐based Frailty Index score) initiating mirabegron were 1:2 propensity score matched (based on age, sex, and other characteristics) with those initiating antimuscarinics and were followed up to 1 year. All‐cause, per‐person, per‐month costs, health care encounters, persistence (median days to discontinuation assessed using Kaplan−Meier methods) and adherence (≥80% of proportion of days covered at Day 365) were compared. Results From 2527 patients with incident mirabegron (21%) or antimuscarinic (79%) dispensations, 516 incident mirabegron users (median age: 82 years, 64% female) were matched to 1032 incident antimuscarinic users (median age: 81 years, 62% female). Median cost was higher in mirabegron group ($1581 vs. $1197 per month); this was primarily driven by medication cost. There was no difference in medical encounters. Adherence (39.1% vs. 33.8%) and persistence (103 vs. 90 days) were higher in mirabegron users. Conclusions Among frail older adults with OAB, mirabegron use was associated with higher costs and potential improvements in treatment‐taking behaviors, particularly with respect to treatment adherence, versus those initiating antimuscarinics.

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“…The anticholinergic burden has been related to the risk of cognitive impairment both in elderly subjects and in subjects with schizophrenia ( 78 , 79 , 228 – 230 ). Several large and well-conducted studies have shown an association between the use of drugs with anticholinergic properties (some antipsychotics and anticholinergic drugs) and poor cognitive performance, with the anticholinergic burden increasing cognitive impairment in specific domains (e.g., processing speed, attention, language, problem solving, and psychomotor performance) ( 78 , 123 – 125 , 127 , 231 – 235 ).…”

Section: Cognitive Dysfunctionsmentioning

confidence: 99%

Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature

Giordano

Brando²,

Pezzella³

et al. 2022

Front. Psychiatry

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The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.

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Anticholinergic medications and risk of dementia in older adults: Where are we now?

Cited by 15 publications

References 57 publications

Yearly Trends of Overactive Bladder Medication Usage

Yearly Trends of Overactive Bladder Medication Usage

Mirabegron and antimuscarinic use in frail overactive bladder patients in the United States Medicare population

Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature

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