Baseline Anticholinergic Medication Burden in Patients with Overactive Bladder

Area of Science:

• Urogynecology
• Geriatric Medicine
• Pharmacology

Background:

• Overactive bladder (OAB) affects many women, often managed with medications.
• Anticholinergic medications carry a risk of cognitive burden (ACB), particularly concerning in older adults.
• Quantifying ACB scores in OAB patients is essential for safe and effective treatment.

Purpose of the Study:

• To determine baseline Anticholinergic Cognitive Burden (ACB) scores in women with overactive bladder (OAB) symptoms.
• To identify patient characteristics linked to elevated ACB scores.
• To evaluate the association between ACB scores and OAB treatment choices.

Main Methods:

• Retrospective analysis of 242 new female patients with OAB symptoms at an academic urogynecology practice.
• Abstraction of baseline characteristics and medications from electronic health records.
• Assessment of ACB scores using a validated scale and review of subsequent OAB treatments.

Main Results:

• Median ACB score was 1; 37% of patients had high-risk scores (≥3).
• Anticholinergics were prescribed to 3% of patients, 71% with high-risk ACB.
• High-risk ACB scores correlated with comorbidities and increased likelihood of sacral neuromodulation.
• Beta-3 agonists were prescribed to 15%, but 43% cited cost as a barrier.

Conclusions:

• A significant proportion of women with OAB present with high-risk ACB scores.
• Careful assessment is needed due to cognitive risks of anticholinergics.
• Promoting safer alternatives like beta-3 agonists and addressing cost barriers can optimize OAB care.