Short-term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A...

Neurogenic lower urinary tract dysfunction (NLUTD) is common in individuals with neurological disorders, leading to bladder overactivity and incontinence. Anticholinergic medications are frequently prescribed for symptom control, but concerns exist regarding potential cognitive impairments. The present systematic review and meta-analysis aimed to evaluate the short-term cognitive effects of anticholinergics in patients with NLUTD. PubMed, Embase, Cochrane Library and Scopus (inception to February 2025) were searched for randomized controlled trials and observational studies assessing short-term cognitive outcomes in patients with NLUTD treated with anticholinergics. Study characteristics, anticholinergic type/dosage, and standardized cognitive measures were extracted. A random-effects model was used to calculate pooled effect sizes (standardized mean differences, SMDs), and heterogeneity was assessed via the Q-statistic, τ², and precision interval analysis. A total of three studies involving 139 participants (22 comparisons) met inclusion criteria. The overall pooled SMD for cognitive performance was -0.33 (95% CI: -0.72 to 0.06; P=0.10), indicating a non-significant trend toward negative cognitive effects. Subgroup analyses showed notable impairments in memory, executive function and attention, while global measures exhibited minimal change. Heterogeneity was high (Q=162.25; P<0.001), likely due to differences in patient populations, anticholinergic agents and cognitive assessments. Although short-term use of anticholinergic medications may negatively impact certain cognitive domains in patients with NLUTD, the pooled effect was not statistically significant under a random-effects model. These findings emphasize the importance of cautious agent selection and the need for further, larger-scale studies to clarify long-term cognitive safety. Future research should also assess alternative therapies, such as β3-adrenergic agonists, which have notably fewer adverse central effects.