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A systematic review of neurocognitive dysfunction with overactive bladder medications
Vi Duong1, Aya Iwamoto2, Jon Pennycuff3
1Department of Obstetrics and Gynecology, Medstar Washington Hospital Center/Georgetown University School of Medicine, 110 Irving St. NW, Washington, DC, 20010, USA. viduong414@gmail.com.
International Urogynecology Journal
|July 2, 2021
Summary
Antimuscarinic medications for overactive bladder, oxybutynin and tolterodine, may cause cognitive decline, especially in older adults. Trospium and darifenacin appear safer for cognitive function.
Area of Science:
- Neuroscience
- Pharmacology
- Geriatrics
Background:
- Overactive bladder (OAB) affects millions, with antimuscarinic medications being a primary treatment.
- Concerns exist regarding the cognitive side effects of these medications, particularly in vulnerable populations.
Purpose of the Study:
- To evaluate cognitive dysfunction associated with common antimuscarinic OAB medications.
- To compare these effects in patients with and without pre-existing neurological conditions.
Main Methods:
- Systematic literature review using Ovid MEDLINE, Embase, and PsycINFO (1998-2018).
- Included 18 studies: 5 randomized controlled trials and 13 observational studies.
- PRISMA guidelines were followed for study selection and data extraction.
Main Results:
- Cognitive decline reported with oxybutynin (5/8 studies) and tolterodine (4/7 studies).
- Oxybutynin linked to decline in Alzheimer's patients; solifenacin linked to dementia risk in diabetics.
- No cognitive decline linked to trospium (6 studies), darifenacin (3 studies), imidafenacin (2 studies), or fesoterodine (1 study).
Conclusions:
- Oxybutynin and tolterodine use may be associated with cognitive decline and warrant caution in adults over 65.
- Solifenacin, fesoterodine, and imidafenacin show mixed central nervous system effects.
- Trospium and darifenacin appear to have no association with cognitive decline in OAB patients.
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