Abstract
Introduction and hypothesis
To assess cognitive changes in women 12 months after starting anticholinergic medications for overactive bladder syndrome (OAB).
Methods
We present a prospective cohort study assessing changes in cognition in women seen in a referral urogynecology practice. We compared women who started anticholinergic OAB medications with women not on anticholinergic OAB medications. The primary outcome was change over time on the Montreal Cognitive Assessment (MOCA) screening score. At enrollment, women completed a baseline MOCA screening, a Geriatric Depression Screen (GDS), and an assessment of medications to create an anticholinergic burden score (ACB). At 3, 6, 9, and 12 months after enrollment women were administered the MOCA, GDS, and a review of their medications and medical problems. Statistical analysis was performed using a linear mixed effects model taking into account correlated error terms given multiple MOCA assessments at various time points per patient.
Results
A total of 106 women were enrolled, 60 in the OAB medication group and 46 in the control (non-OAB medication) group. The mean age was 77 years, 93% of women were Caucasian, and 98% completed high school, with no difference between groups. Over time there was no difference in change of MOCA score between the OAB and control groups when controlling for age, GDS score, and ACB score (p = 0.78). This association did not change when women with a neurological diagnosis were excluded (n = 6). On average MOCA scores for the OAB group increased by 0.76 over 12 months and the control group increased 0.39, with no difference between the groups (p = 0.53).
Conclusions
We found no changes in MOCA scores between OAB medication and control groups after controlling for age, depression, and polypharmacy after 12 months of follow-up.
Similar content being viewed by others
References
Campbell N, Boustani M, Limbil T, Hott C, Fox C, Maidment I, et al. The cognitive impact of anticholinergics: a clinical review. Clin Interv Aging. 2009;4:225–33.
US Census Bureau. An aging nation: The older population in the United States. Population estimates and projections. May 2014. www.census.gov.
Trowbridge E, Kim D, Barletta K, Fitz V, Larkin S, Hullfish K. Prevalence of positive screening test for cognitive impairment among elderly urogynecological patients. Am J Obstet Gynecol. 2016;215:663.e1-6.
Scheife R, Takeda M. Central nervous system safety of anticholinergic drugs for the treatment of overactive bladder in the elderly. Clin Ther. 2005;27(2):144–53.
Staskin D. Overactive bladder in the elderly: a guide to pharmacological management. Drugs Aging. 2005;22(12):1013–28.
Ruxton K, Woodman R, Mangoni A. Drugs with anticholinergic effects and cognitive impairment, falls and all-cause mortality in older adults: a systematic review and meta-analysis. Br J Clin Pharmacol. 2015;80(2):209–20.
Gray S, Anderson M, Dublin S, Hanlon J, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401–7.
Mate K, Kerr K, Pond D, Williams E, Marley J, Disler P, et al. Impact of multiple low-level anticholinergic medications on anticholinergic load of community-dwelling elderly with and without dementia. Drugs Aging. 2015;32:159–67.
Fox C, Richardson K, Maidment ID, Savva GM, Matthews FE, Smithard D, et al. Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council Cognitive Function and Ageing Study. J Am Geriatr Soc. 2011;59(8):1477–83.
Kay G, Crook T, Rereda L, Lima R, Ebinger U, Arguinzoniz M, et al. Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects. Eur Urol. 2006;50:317–26.
Kay G, Granville L. Antimuscarinic agents: implication and concerns in the management of overactive bladder in the elderly. Clin Ther. 2005;27(1):127–38.
Kay G, Staskin D, MacDiarmid S, McIlwain M, Dahl N. Cognitive effects of oxybutynin chloride topical gel in older healthy subjects: a 1-week, randomized, double-blind, placebo- and active-controlled study. Clin Drug Investig. 2012;32(10):707–14.
Kay G, Maruff P, Scholfield D, Malhorta B, Whelan L, Darekar A, et al. Evaluation of cognitive function in healthy older subjects treated with fesoterodine. Postgrad Med. 2012;124(3):7–15.
Pagoria D, O'Connor C, Guralnick M. Antimuscarinic drugs: review of the cognitive impact when used to treat overactive bladder in elderly patients. Curr Urol Rep. 2011;12:351–7.
Yarker YE, Goa KL, Fitton A. Oxybutynin: a review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in detrusor instability. Drugs Aging. 1995;6(3):243–62.
Hobson J. The Montreal Cognitive Assessment (MOCA). Occup Med. 2015;65:764–5.
Roalf D, Moberg P, Xie S, Wolk D, Moelter S, Arnold S. Comparative accuracies of two common screening instruments for classification of Alzheimer's disease, mild cognitive impairment, and healthy aging. Alzheimers Dement. 2013;9:529–37.
Nasreddine Z, Phillips N, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53:695–9.
Trzepacz P, Hochstetler H, Wang S, Walker B, Saykin A. Relationship between the Montreal Cognitive Assessment and Mini-mental State Examination for assessment of mild cognitive impairment in older adults. BMC Geriatr. 2015;15:107.
Lonie J, Tierney K, Ebmeier K. Screening for mild cognitive impairment: a systematic review. Int J Geriatr Psychiatry. 2009;24:902–15.
Rossetti H, Lacritz L, Cullum M, Weiner M. Normative data for the Montreal Cognitive Assessment (MOCA) in a population based sample. Neurology. 2011;77:1272–5.
Malek-Ahmadi M, Powell JJ, Belden CM, O'Connor K, Evans L, Coon DW, et al. Age and education adjusted normative data for the Montreal Cognitive Assessment (MoCA) in older adults age 70-99. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2015;22(6):755–61.
Thyrian JR, Eichler T, Reimann M, Wucherer D, Dreier A, Michalowsky B, et al. Depressive symptoms and depression in people screened positive for dementia in primary care—results of the DelpHi-study. Int Psychogeriatr. 2016;28(6):929–37.
Salahudeen M, Duffall S, Nishtala P. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015;15(31):1–14.
West T, Pruchnicki M, Porter K, Emptage R. Evaluation of anticholinergic burden of medications in older adults. J Am Pharm Assoc. 2013;53:496–504.
Villalba-Moreno A, Alfaro-Lara E, Perez-Guerrero M, Nieto-Martin D, Santos-Ramos B. Systematic review on the use of anticholinergic scales in poly pathological patients. Arch Gerontol Geriatr. 2016;62:1–8.
Cao YJ, Mager DE, Simonsick EM et al. Physical and cognitive burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther. 2008;83(3):422-9.
Nasreddine Z, Phillips N, Chertkow H. Normative data for the Montreal Cognitive Assessment (MOCA) in a population-based sample, response. Neurology. 2012;78:765–6.
Kujawski S, Kujawska A, Gajos M, Topka W, Perkowski R, Androsiuk-Perkowska J, et al. Cognitive functioning in older people, results of the first wave of cognition of older people, education, recreational activities, nutrition, comorbidities, functional capacity studies (COPERNICUS). Front Aging Neurosci. 2018;10:421.
Chancellor MB, Staskin DR, Kay GG, Sandage BW, Oefelein MG, Tsao JW. Blood-brain barrier permeation and efflux exclusion of anticholinergics used in the treatment of overactive bladder. Drugs Aging. 2012;29(4):259–73.
Lebedeva E, Huang M, Koski L. Comparison of alternate and original items on the Montreal Cognitive Assessment. Can Geriatr J. 2016;19(1):15–8.
Acknowledgements
This study was approved by the NorthShore University Health Systems IRB (EH16-057).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No external funding was received for this study.
Conflicts of interest
None of the authors has any conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Iyer, S., Lozo, S., Botros, C. et al. Cognitive changes in women starting anticholinergic medications for overactive bladder: a prospective study. Int Urogynecol J 31, 2653–2660 (2020). https://doi.org/10.1007/s00192-019-04140-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-019-04140-3