Differential Effects of the Antimuscarinic Agents Darifenacin and Oxybutynin ER on Memory in Older Subjects

Kay, Gary G.; Crook, Thomas H.; Rekeda, Ludmyla; Lima, Raul; Ebinger, Ursula; Arguinzoniz, Miguel; Steel, Michael

doi:10.1016/j.eururo.2006.03.057

Cited by 261 publications

(176 citation statements)

References 26 publications

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“…Uma metanálise 4 demonstrou que o efeito dos anticolinérgicos é bastante discutível frente aos placebos (efeito comparativo apenas 1,4 vezes melhor). Informações recentes em adultos atentam para defeitos intelectivos pelo uso de anticolinérgicos (o efeito prejudicial da oxibutinina nos mecanismos de memó-ria corresponderia em média a 10 anos de envelhecimento) 5 e síndromes demenciais Alzheimer-like, reversíveis com a retirada das drogas 6 . Não há estudos de boa qualidade técnica analisando os efeitos destas drogas sobre o cérebro humano infantil em processo de maturação.…”

Section: Discussionunclassified

O uso da neuromodulação no tratamento das disfunções de eliminações

Jesus

Nery

2007

Rev. Col. Bras. Cir.

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RESUMO: Objetivo: Apresentar a experiência clínica com o uso de neuromodulação através de eletroestimulação transcutânea no tratamento das disfunções de eliminação. Métodos: Foram analisados retrospectivamente seis pacientes com disfunções de eliminação submetidos à neuromodulação através de eletroestimulação percutânea peri-sacral. Todos os pacientes incluídos eram refratários ao tratamento clínico convencional e a eletroestimulação foi utilizada como terapia de resgate. As sessões terapêuticas eram semanais e o seguimento mínimo foi de seis meses. Resultados: Todos os pacientes obtiveram melhora clínica. Quatro pacientes não necessitaram de mais medicação. Todos aceitaram bem o tratamento e referiram melhora da qualidade de vida. Conclusão: A eletroestimulação percutânea mostrou-se útil no tratamento das disfunções do assoalho pélvico e da musculatura vesical (Rev. Col. Bras. Cir. 2007; 34(6): 392-397 INTRODUÇÃOOs últimos 20 anos trouxeram grandes mudanças conceituais com relação aos distúrbios funcionais da musculatura pelvi-perineal. A correlação fisiopatológica entre os distúrbios vesicais e os da evacuação foi fundamental: o funcionamento integrado (neuro-muscular) do assoalho perineal representou uma explicação satisfatória para a associação freqüente entre constipação crônica e problemas urológicos, a seguir denominada síndrome da disfunção das eliminações Koff et al ¹.Novas linhas de pesquisa sugeriram um papel fundamental, previamente ignorado, das informações neurais aferentes na coordenação dos tratos urinário e intestinal distais. O urotélio tem um papel integrativo, atuando como um sincício funcional com funções proprioceptivas.Exames ´in vivo´ com PET-scan demonstraram a existência de modulação funcional do aparelho urinário e assoalho pélvico em vários níveis do sistema nervoso central.A alta frequência de efeitos colaterais sérios com drogas anticolinérgicas e a relativa ineficácia do tratamento com laxativos, técnicas funcionais e drogas moduladoras da atividade vesical determinaram a busca de novas táticas terapêuticas.Apresentamos a nossa experiência clínica com o uso de eletroestimulação percutânea (EP) semanal perisacra no tratamento de uma coorte selecionada de portadores de distúrbios graves das funções de eliminação, previamente refratários ao tratamento clínico durante longos períodos. MÉTODOSForam analisados os prontuários de seis pacientes cujas idades variavam entre 5 e 14 anos que apresentavam disfunções de eliminação e foram submetidos à eletroestimulação percutânea (EP) peri-sacra (S2 -S4) e torácica (T11 -L2). A EP foi aplicada uma vez por semana com duração de 40 minutos cada uma durante 10 semanas.O tratamento foi ministrado por um cirurgião pediatra, responsável pela análise e seguimento clínico dos casos e um médico acupunturista, responsável pela aplicação da EE e análise clínica dos pacientes durante as sessões. Em todos os pacientes aqui apresentados a eletroestimulação foi utilizada como terapia de resgate. Foram excluídas da análise todas as crianças que apresentavam d...

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Section: Discussionunclassified

O uso da neuromodulação no tratamento das disfunções de eliminações

Jesus

Nery

2007

Rev. Col. Bras. Cir.

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“…Despite the short duration of the study, it does show that older patients with pharmacological steady state plasma levels of oxybutynin ER may have an increased risk of impaired cognitive function relative to those in steady state taking darifenacin. 31 Contrary to the relatively high dose oxybutynin ER used in previous study, Lackner reported a randomized, placebocontrolled trial of the cognitive effect, safety and tolerability of 5mg daily dosage of oxybutynin ER in a population of cognitively impaired nursing home residents with urge incontinence. The authors cite that OAB is undertreated in this population due to the fear that the frail older patient is more susceptible to anticholinergic associated adverse reactions.…”

Section: Special Populations and Other Trialsmentioning

confidence: 99%

Oxybutynin extended release for the management of overactive bladder: a clinical review

Arisco¹,

Brantly

Kraus³

2009

DDDT

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Overactive bladder (OAB) is a common condition which negatively impacts the quality of life of afflicted patients. This can result in alterations in social interactions at home, in the workplace and in the community, often leading to depression and poor self esteem as well as loss of productivity. Traditional mainstays of treatment include both behavioral therapy and pharmacotherapy. Oxybutynin immediate release (IR) represents the first such medication approved by the FDA specifically for treatment of OAB in 1975. Nevertheless, bothersome side effects in addition to thrice daily dosing often led to treatment cessation which raised the question that patients may actually prefer to live with their OAB symptoms rather than incur side effects or complex dosing schemes. Pharmacological advances ultimately led to development of a long-acting formulation of oxybutynin in the form of oxybutynin extended release (ER) with the hope that this drug would maintain efficacy while decreasing bothersome side effects and improve compliance with the convenience of once daily dosing regimen. This paper will review the major clinical studies involving oxybutynin ER as well as its role in different patient populations and potential concerns with its use.

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“…The newer antimuscarinics for OAB -darifenacin, fesoterodine, solifenacin, tolterodine, and the quaternary ammonium compound, trospium chloride -do not appear to adversely affect cognition. [18][19][20][21][22] Oxybutynin transdermal gel similarly appears to have no demonstrable adverse effect on cognition. 23 There are, as yet, no data on the use of these medications in older people who are cognitively at risk, those with mild cognitive impairment, dementia, Parkinson's disease and the like.…”

Section: Antimuscarinics: Effect On Cognitionmentioning

confidence: 99%

Treating overactive bladder in the elderly

Wagg

2011

CUAJ

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The prevalence of the overactive bladder (OAB) symptom complex increases with age. Older people also appear to experience more severe incontinence syndromes, including OAB, than their younger counterparts. Older patients are more likely than younger individuals to ask for medication for bladder problems and to require higher doses of medication. Conventional treatment for OAB with conservative and lifestyle measures in combination with antimuscarinic pharmacotherapy is effective in older people. Although there is a theoretical potential for cognitive impairment with antimuscarinic agents, the newer antimuscarinics are cognitively safe in cognitively intact older people.T he overactive bladder (OAB) symptom complex, much like all lower urinary tract symptoms, is increasingly prevalent in association with increasing age.1,2 This brief review outlines the epidemiology of these symptoms in later life and discusses the particular changes that occur in the aging lower urinary tract. In addition, the use of antimuscarinic agents in older patients is reviewed, including a discussion of the potential for the antimuscarinic effects to have a detrimental impact on cognitive function. Changes in the urinary tract associated with agingNatural changes in the urinary tract may account for some of the apparent increase in lower urinary tract symptoms with increasing age. The sensation of bladder filling is reduced and bladder capacity falls, leading to an older person having less time to respond to the call to urinate and perhaps explaining why many older people complain of severe urge, rather than urgency, as defined by the International Continence Society.3 However, older people also experience a more severe degree of incontinence, including OAB, than their younger counterparts.2,4 For older sufferers with OAB, bladder sensation appears to be heightened, bladder capacities much lower, and urethral resistance rises in association with the onset of the condition, although the mechanism underlying this is unknown. Underlying mechanismsUrinary urgency in older people may be a result of both bladder and intracerebral lesions. Severity of urinary urgency and of incontinence per se have been associated with increased white matter hyperintensities (WMH) on MRI scanning of older people, suggesting that increasing ischemic insults in association with aging may impair higher centres of influence on the maintenance of continence, manifesting as severe urge, urgency and urgency incontinence. 5,6 Treatment of OAB in older patientsConventional treatment for OAB with conservative and lifestyle measures in combination with antimuscarinic pharmacotherapy is effective in older people. In direct contradiction to the usual geriatric paradigms of prescribing, older people: are more likely than young to require, and ask for, medication for their bladder problem; 7 appear to require higher doses of medication; 8,9 and, despite higher reported rates of adverse events, are more adherent to their medication than younger users. 10 Antimuscarinic...

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Differential Effects of the Antimuscarinic Agents Darifenacin and Oxybutynin ER on Memory in Older Subjects

Cited by 261 publications

References 26 publications

O uso da neuromodulação no tratamento das disfunções de eliminações

O uso da neuromodulação no tratamento das disfunções de eliminações

Oxybutynin extended release for the management of overactive bladder: a clinical review

Treating overactive bladder in the elderly

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