Antimuscarinic Drugs: Review of the Cognitive Impact When Used to Treat Overactive Bladder in Elderly Patients

Abstract

The blockade of muscarinic receptors in the management of overactive bladder (OAB) symptoms provides beneficial as well as adverse effects. The cognitive changes observed are caused by the drugs' ability to cross the blood-brain barrier and bind to muscarinic receptors within the central nervous system (CNS). To date, while not specifically testing for CNS side effects, most of the controlled efficacy trials of multiple OAB medications have not shown significant adverse effects on cognitive function. However, elderly individuals, in whom OAB is more prevalent, often are excluded from these studies. The few trials that have performed cognitive testing in healthy elderly people taking antimuscarinics have clearly shown that oxybutynin can adversely affect cognition. Darifenacin, trospium, solifenacin, and tolterodine appear to have little to no risk of causing CNS side effects in this population. However, caution needs to be used in elderly patients with preexisting dementia.

Urinary Incontinence and Pelvic Organ Prolapse

“…Anticholinergics should be used with caution in patients with Alzheimer's disease or in those taking an acetylcholinesterase inhibitors because of risk of acute worsening of dementia and delusions. 22 Additionally, caution should be exercised in elderly patients with elevated postvoid residual (PVR) urine volume. There is no well-established PVR above which initiating an anticholinergic medication is absolutely contraindicated, although caution should be exercised when PVR is greater than 150 mL.…”

Pharmacologic Management of Overactive Bladder and Urge Incontinence: A Review of New and Old Treatment Options

“…However, immediate release oxybutynin has the highest incidence of adverse effects and the highest rate of discontinuation of all the anticholinergics in its class [7]. In particular, oxybutynin crosses the blood brain barrier and may cause cognitive impairment especially in the elderly [8]. Dosing multiple times daily may also be complicated for some patients who struggle with adherence.…”

Neurourologische Funktionsstörungen des unteren Harntraktes bei Erkrankungen des ZNS

“…MS-Patienten berichten über verstärkte Müdigkeit unter antimuskarinerger Therapie. Bei Patienten mit bereits eingeschränkter kognitiver Funktion sollte zudem besonders auf die ZNS-Nebenwirkungen der Antimuskarinika wie Reduktion der Gedächtnisleistung und Verwirrtheit geachtet werden [53]. Hier empfiehlt sich die Verwendung von Trospiumchlorid als quartäres Amin, das die Blut-Hirn-Schranke weniger stark penetriert, wobei diese bei älteren Patienten bereits nicht mehr vollständig intakt sein kann [65].…”