Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

Abstract

Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

Approach to Cognitive Impairment in Parkinson's Disease

“…Oxybutynin, an anticholinergic medications used for treatment of overactive bladder, should not be prescribed as first line in patients with PD, as it has been shown to distribute to the CNS and cause cognitive impairment in some patients [99]. Alternatives exist, including anticholinergics with less CNS distribution and beta-3 agonists (mirabegron) [100]. Additionally, nonprescription medications should be screened for, such as over the counter sleep aids containing diphenhydramine, which also have anticholinergic properties [101].…”

Efficacy and Tolerability of Solifenacin Fumarate with Overactive Bladder Patients: A Multicenter Observational Study

“…Muscarinic receptors play an important role in cognitive functions, such as memory and learning [16]. Because the muscarinic receptor is in the central nervous system, cognitive impairment can occur as a side effect of anticholinergic agents, particularly in older people.…”

A Review of Aging and the Lower Urinary Tract: The Future of Urology

“…However, recent physical function decline in walking speed significantly increased the risk of UI even after adjusting for variables (daily 3%, weekly 22%, monthly 42%, P = 0.002 for the linear trend) [66]. Cognitive decline was associated with disruptive incontinence after adjusting for variables such as the baseline frequency of incontinence and baseline cognitive function [66,67].…”