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Pharmacotherapy for overactive bladder syndrome and the risk of incident dementia

David Sheyn1, Jennifer Murphy2, Abhimanyu Mahajan3

  • 1Urology Institute, University Hospitals, Cleveland, OH, USA. David.d.sheyn@gmail.com.

World Journal of Urology
|April 4, 2025
PubMed
Abstract

Insights

Most anticholinergic drugs and mirabegron increase dementia risk in overactive bladder patients. Fesoterodine showed no increased dementia risk compared to untreated individuals.

Area of Science:

  • Gerontology
  • Pharmacology
  • Neurology

Background:

  • Overactive bladder (OAB) pharmacotherapy involves anticholinergic medications and mirabegron.
  • Concerns exist regarding the potential neurocognitive side effects of these OAB treatments.

Purpose of the Study:

  • To compare the risk of incident dementia in patients prescribed anticholinergic medications versus mirabegron.
  • To evaluate dementia risk associated with specific anticholinergic drugs stratified by risk level.

Main Methods:

  • Retrospective cohort study (2012-2023) using the TrinetX Research Collaborative Network.
  • Included patients treated for OAB with mirabegron, specific anticholinergics (high-risk: oxybutynin, tolterodine, solifenacin; low-risk: darifenacin, trospium, fesoterodine), or no medication (control).
  • Cox proportional hazard analyses adjusted for age, sex, Elixhauser comorbidity index, and anticholinergic burden score.

Main Results:

  • Analysis included 941,402 patients, with 83,550 on medication, followed for an average of 4.3 years.
  • Mirabegron was significantly associated with increased dementia risk across all demographics.
  • Fesoterodine was the only medication not associated with an increased dementia risk; most other anticholinergics also showed increased risk.

Conclusions:

  • Both mirabegron and most anticholinergic medications are linked to a higher incidence of dementia compared to untreated OAB patients.
  • Fesoterodine appears to be a safer alternative regarding dementia risk among OAB pharmacotherapies.
  • Further research into the long-term neurocognitive effects of OAB medications is warranted.
Keywords:
Anti-cholinergic medicationsDementiaMirabegronOAB

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