Long-term clinical efficacy and cognitive impact of medications for overactive bladder related to the central nervous
Yu Khun Lee1, Hann-Chorng Kuo2
1Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Section 3, Chung Yang Road, 707, Hualien, Taiwan.
Purpose:
This study evaluated the long-term clinical efficacy and cognitive impact of medications for central nervous system (CNS)-related overactive bladder (OAB).
Methods:
A retrospective cohort of 170 patients with cerebrovascular accident (CVA), dementia, or Parkinson's disease (PD) was analyzed between February 2019 and July 2024. Urinary symptoms were assessed with the Overactive Bladder Symptom Score (OABSS) and Urgency Severity Score (USS), and cognitive function with the Mini-Mental State Examination (MMSE). Outcomes were measured at baseline, 12, 24, and 36 months. OAB improvement was defined as a ≥ 3-point reduction in OABSS. A decline of more than 3 points in the MMSE score indicated cognitive deterioration.
Results:
Baseline characteristics differed significantly among subgroups; dementia patients were older, more often female, and had lower MMSE scores. Medication discontinuation was higher in dementia (69.8%) and PD (62.5%) compared with CVA (40%, p = 0.002). Symptom improvement (12.4%) and global response assessment (GRA) scores at one year were modest and similar among groups. Severe cognitive impairment was associated with higher discontinuation, poorer symptom improvement (5.9%), lower GRA scores, and greater cognitive decline (25%, p = 0.049). Among medications, solifenacin showed the highest discontinuation (77.8%, p = 0.002), whereas tolterodine SR had the lowest (36.4%). Cognitive function remained generally stable across medications, but patients with cognitive deterioration had worse urinary outcomes and GRA scores.
Conclusions:
OAB medication efficacy was comparable across medication types, but tolerability varied significantly, with the dementia, PD and solifenacin groups showing higher discontinuation rates. Cognitive impairment significantly influenced treatment outcomes, underscoring the need for tailored therapeutic strategies and regular cognitive assessments to optimise treatment effectiveness and maintain quality of life in patients with CNS-related OAB.
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