Influence of antimuscarinic therapy on cognitive functions and quality of life in geriatric patients treated for overactive bladder

Esin, Ece; Ergen, Ali; Cankurtaran, Mustafa; Yavuz, Burcu Balam; Halil, Meltem; Ülger, Zekeriya; Yeşil, Yusuf; Kuyumcu, Mehmet Emin; Özcan, Münevver; Cankurtaran, Eylem Şahin; Arıoğul, Servet

doi:10.1080/13607863.2014.922528

Cited by 26 publications

(14 citation statements)

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“…We calculated the SMD of global cognitive decline for six studies [ 11 , 14 , 31 , 36 , 38 , 46 ]: five studies reported MMSE, while one calculated a composite score from 19 cognitive tests [ 38 ]. All but one study adjusted for some potential confounders [ 31 ]. Greater cognitive decline was consistently observed among patients taking anticholinergic drugs (SMD 0.15; 95% CI 0.09–0.21, I 2 = 3%) ( Figure 3 ).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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Background the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. Methods we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. Results twenty-six studies (including 621,548 participants) met our inclusion criteria. ‘Any’ anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I2 = 90%). ‘Any’ anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I2 = 0%). Conclusions anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…In two longitudinal studies involving older patients aged 65 and above, depression at baseline predicted new onset urgency incontinence at the 1-year follow up in one study and at the 6-year follow up in the second study [ 19 , 20 ]. Studies in the clinical OAB population showed that depression improved with successful treatment of OAB with anticholinergic medications, botulinum toxin A, and InterStim neuromodulation [ 21 – 23 ]. Collectively these studies suggested a causality relationship between depression and OAB/incontinence.…”

Section: Discussionmentioning

confidence: 99%

The relationship between depression and overactive bladder/urinary incontinence symptoms in the clinical OAB population

et al. 2016

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BackgroundTo investigate the relationship between depression and overactive bladder (OAB)/urinary incontinence symptoms among the clinical OAB population.MethodsPatients who were diagnosed with overactive bladder (OAB) and age-matched control subjects without OAB were enrolled. Depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS-D). OAB/incontinence symptoms were assessed using the validated questionnaires: ICIQ-UI, ICIQ-OAB, UDI-6, IIQ-7, and OAB-q.Results27.5 % of OAB patients in our study had depression (HADS ≥8), and 12 % of OAB patients had moderate to severe depression (HADS-D ≥11). OAB patients reported significantly higher HADS-D depression scores compared to age-matched controls (5.3 ± 3.9 versus 2.8 ± 3.9, p = 0.004). OAB patients with depression reported more severe incontinence symptoms (ICIQ-UI), greater bother and more impact on quality of life (UDI-6, IIQ-7) compared to OAB patients without depression (p = 0.001, 0.01, <0.001, respectively). However there were no differences in ICIQ-OAB and OAB-q. Among OAB patients, there were positive correlations between the severity of depression symptoms and OAB/incontinence symptoms (p-values <0.001 to 0.035).Conclusions27.5 % of OAB patients have depression. OAB patients with depression reported more severe urinary incontinence symptoms, greater bother and more impact on quality of life compared to those without depression. Future studies are needed to further examine the mechanistic links between depression and OAB/urinary incontinence.

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“…In vitro and radioligand binding studies have determined that tolterodine has a high potential for CNS penetration [ 55 , 56 ]. However, the results of a clinical study showed that the incidence of cognitive impairment was not significantly higher than that in the control group [ 65 ].…”

Section: Anticholinergicsmentioning

confidence: 99%

Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

2020

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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.

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Influence of antimuscarinic therapy on cognitive functions and quality of life in geriatric patients treated for overactive bladder

Abstract: Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

Cited by 26 publications

References 46 publications

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

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

The relationship between depression and overactive bladder/urinary incontinence symptoms in the clinical OAB population

Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

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