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JU INSIGHT Dementia Associated with Anticholinergic Drugs Used for Overactive Bladder: A Nested Case-Control Study Using the French National Medical-Administrative Database

By: Marie France Malcher, MD, MSc; Stephane Droupy, MD, PhD; Claudine Berr, MD, PhD; Abdelkrim Ziad, MD, PhD; Helena Huguet, MSc; Jean-Luc Faillie, MD, PhD; Chris Serrand, MD, MSc; Thibault Mura, MD, PhD | Posted on: 01 Oct 2022

Malcher MF, Droupy S, Berr C, et al. Dementia associated with anticholinergic drugs used for overactive bladder: a nested case-control study using the french national medical-administrative database. J Urol. 2022;208(4)863-871.

Study Need and Importance

Overactive bladder (OAB) is a common condition in older patients, for which first-line treatment includes anticholinergic drugs. However, these drugs are suspected of increasing the risk of dementia. The American Urological Association has highlighted the lack of studies on the long-term cognitive effects of OAB anticholinergic drugs overall and for each drug separately.  

Figure. Association between OAB anticholinergic drugs and dementia (adjusted OR with 95%CI).

What We Found

In our nested case-control study using the French National Medical-Administrative Database, cumulative use of OAB anticholinergic drugs over a 5-year period was associated with an increased risk of dementia (adjusted OR=1.23). Furthermore, we found a cumulative dose-response relationship: aOR=1.07 for 1–90 cumulative defined daily doses (cDDDs) over the exposure period, aOR=1.29 for 91–365 cDDDs, and aOR=1.48 for >365 cDDDs. Oxybutynin showed a particularly marked increased risk of dementia (aOR=1.28), followed by solifenacin (aOR=1.29), but trospium showed no statistically significant increased risk (aOR=1.17; see Figure).

Limitations

The limitations of our study are due to the medical-administrative nature of the data. Although we had complete information of drug dispensing, we lacked information on treatment adherence, and so cannot exclude misclassification bias. In addition, our analyses were adjusted for available potential confounders; however, we may have missed important confounders and others may have been imperfectly reported.

Interpretation for Patient Care

When treating OAB in older patients, OAB anticholinergic drugs should be used with caution, taking into account the patient’s cognitive status, the anticholinergic load, and the different therapeutic options, especially for oxybutynin and solifenacin.

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