Receipt of Overactive Bladder Drugs and Incident Dementia: A Population-based Case-control Study

An Analysis of Stated Insurance Coverage and Estimated Patient-Incurred Costs of Treatments for Lower Urinary Tract Symptoms

“…Antimuscarinics demonstrate treatment efficacy for OAB but have frequent adverse effects (dry mouth, constipation) that lower persistence. As OAB prevalence increases with age, 16 recent studies detailing increased dementia risk 17–19 and dose-dependent associations with brain atrophy, cognitive impairments, and clinical decline with anticholinergics are concerning 17 . Oxybutynin, a nonselective anticholinergic, is the only option covered by all plans at low price, but many health care providers are reticent to prescribe it for fear of cognitive sequelae, particularly in older patients 20 .…”

Overactive Bladder Management: Cognitive Risk With Anticholinergics and Alternative Management Options for the General Practitioner

“…17 Darifenacin and solifenacin are more selective toward M3 over M1, whereas oxybutynin and tolterodine are less selective, suggesting the latter are more likely to exert central nervous system side effects. 18 However, a case-control study by Matta et al 9 showed there was an increased odds of developing dementia in those taking solifenacin and darifenacin in the 6 months before diagnosis of dementia and those taking solifenacin, darifenacin, tolterodine, or fesoterodine in the year before diagnosis of dementia compared with those receiving mirabegron. 9 This association was not found with trospium or oxybutynin, which they attribute to protopathic bias.…”

“…Recent evidence shows an increased risk of dementia in patients taking anticholinergics for greater than or equal to 3 months. [7][8][9][10] A meta-analysis by Dmochowski et al 10 calculates an increased risk of dementia by 46% with use of anticholinergics for greater than or equal to 3 months compared with nonuse. OAB anticholinergic use for more than 3 months (ie, darifenacin, fesoterodine, flavoxate, oxybutynin, solifenacin, tolterodine, propiverine, and trospium) was associated with an increased risk of dementia with odds ratios (ORs) ranging from 1.21 to 1.35 8 and 1.35 to 1.65.…”

“…Recent data have emerged showing a significant association between long-term use of anticholinergic medication and increased risk of cognitive impairment and dementia. [5][6][7][8][9][10] Given these new data, a focus on alternative oral medication treatments has emerged, including use of selective M2/M3 antagonists such as trospium and β-3 adrenergic agonists mirabegron and vibegron. [11][12][13] The American Geriatrics Society recently updated the Beers Criteria to include anticholinergic medications as a risk Overactive bladder (OAB) is a symptomatic condition characterized by urinary urgency, with or without incontinence, and is often associated with nocturia and increased frequency.…”

“…Second-line management has historically relied heavily on oral anticholinergic medications. Recent data have emerged showing a significant association between long-term use of anticholinergic medication and increased risk of cognitive impairment and dementia 5–10. Given these new data, a focus on alternative oral medication treatments has emerged, including use of selective M2/M3 antagonists such as trospium and β-3 adrenergic agonists mirabegron and vibegron 11–13.…”