Association between different anticholinergic drugs and subsequent dementia risk in patients with diabetes mellitus

Abstract

BackgroundThe effects of oxybutynin, solifenacin and tolterodine on dementia risk in patients with diabetes mellitus (DM) remain unknown. We investigated the effects of oxybutynin, solifenacin and tolterodine on dementia risk in patients with DM.MethodsWe conducted a cohort study by using the diabetes dataset of the Taiwan National Health Insurance Research Database from 1 January, 2002 to 31 December, 2013. We included 10,938 patients received one type of oxybutynin, solifenacin, or tolterodine, while 564,733 had not. We included a comparable number of patients not receiving oxybutynin, solifenacin, or tolterodine as controls through systematic random sampling matching by age, gender, and the year of the index date with 1 to 1 ratio. The dementia risk was estimated through multivariate Cox proportional hazard regression after adjustment for several confounding factors.ResultsThe dementia event rates were 3.9% in the oxybutynin group, 4.3% in the solifenacin group, 2.2% in the tolterodine group and 1.2% in the control group (P<0.001). The adjusted HRs compared to nonusers of anticholinergic drugs were 2.35 (95% CI, 1.96 to 2.81), 2.16 (95% CI, 1.81 to 2.58), and 2.24 (95% CI, 1.85 to 2.73), respectively, for patients receiving oxybutynin, solifenacin, or tolterodine.ConclusionOur study indicates an association between taking oxybutynin, solifenacin and tolterodine and the subsequent diagnosis of dementia in DM patients. Moreover, the patients using oxybutynin had highest risk. The impact of these three drugs on risk of dementia in non-diabetic populations is warrant.

Are Anticholinergic Medications Associated With Increased Risk of Dementia and Behavioral and Psychological Symptoms of Dementia? A Nationwide 15-Year Follow-Up Cohort Study in Taiwan

“…Several previous studies have reported the association between antidepressant usage and the risk factor for dementia (Lee et al, 2016;Then et al, 2017); nevertheless, our study revealed no such association between antidepressants with anticholinergic effects (most tricyclic antidepressants) and the risk of dementia. In addition, one study using the NHIRD database reported the association between antimuscarinics for an overactive bladder (OAB) and the subsequent dementia risk in patients with diabetes mellitus (Yang et al, 2017). However, in our study, the usage of urological drugs (antimuscarinics, such as oxybutynin, solifenacin, and tolterodine) was not associated with the risk of dementia.…”

Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis

“…Some studies reported an increasing dementia risk with greater exposure to anticholinergic drugs, consistent with a causal link [ 9 , 10 , 26 ]. However, few studies excluded drug exposure in the period just prior to dementia [ 9 , 10 , 41 ], and so drugs may have been prescribed for early symptoms of dementia. Two large UK studies report differences in dementia risk according to anticholinergic drug class, inconsistent with a causal link [ 9 , 55 ].…”

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

“…Two studies independently exploring the effects of anticholinergic burden and gabapentin on cognition found limited evidence of adverse reactions relating to the use of these medications in patients with SCI [44,45]. These results are in contrast to a sizable body of evidence of negative associations between anticholinergic medication-use and cognitive impairment in able-bodied individuals [62][63][64][65][66] and individuals comprising other illness samples [67][68][69][70][71], and may relate to inadequate length of follow-up, insufficient statistical power to detect effects, and/or use of measures that lack sensitivity to detect cognitive decline.…”