Bladder antimuscarinics and cognitive decline in elderly patients

Area of Science:

• Gerontology
• Neuroscience
• Pharmacology

Background:

• Evidence regarding the effect of bladder antimuscarinic initiation on cognitive function in older adults remains inconsistent.
• Antimuscarinic medications are frequently prescribed for overactive bladder symptoms in the elderly population.

Purpose of the Study:

• To investigate the association between the initiation of bladder antimuscarinics and cognitive decline in adults aged 65 and older.
• To determine if antimuscarinic use increases the risk of cognitive decline in an elderly cohort.

Main Methods:

• Retrospective analysis of data from the National Alzheimer's Coordinating Center (NACC) cohort.
• Matched new users of antimuscarinics with nonusers based on enrollment year and cohort duration.
• Cognitive decline defined using the NACC Uniform Data Set 2.0 battery; analyses employed inverse probability of treatment weighting.

Main Results:

• The study included 698 antimuscarinic users and 7037 nonusers.
• Antimuscarinic initiation was associated with a 40% increased odds of cognitive decline on the Mini-Mental State Examination (MMSE) (OR 1.4, 95% CI 1.19-1.65).
• Increased odds of decline were also observed for Clinical Dementia Rating, semantic memory/language, and executive function, with higher risk in those with pre-existing cognitive impairment.

Conclusions:

• Initiation of bladder antimuscarinics is significantly associated with cognitive decline in older adults.
• The findings raise concerns regarding the use of antimuscarinics, especially in elderly individuals with existing cognitive impairment.
• Further research is warranted to explore alternative treatments and risk mitigation strategies.