Common overactive bladder drugs may not increase dementia risk

New research, published November 6^th in JAMA Network Open, finds anticholinergic medications, commonly prescribe for overactive bladder (OAB), may not increase dementia risk after all compared to beta-3 agonists, the newer drug class that has been presumed to be safer for the brain.

Researchers at University Hospitals Cleveland Medical Center Urology Institute used Epic Cosmos, a national electronic health record database, to follow 830,393 adults aged 40 to 90 who were newly treated for OAB between 2012 and 2025. Dementia rates were similar across drug classes and individual medications, the study demonstrates that in patients with OAB, anticholinergic medication, a foundational, second-line pharmacological treatment for the condition, does not carry a greater long- term risk of dementia than beta-3-agonists. The latter class of drugs were previously believed to be lower risk medication. This reverses a long- held belief that one group of drugs is any more risky than the other; instead, the findings align with the idea that OAB itself and the neurologic mechanisms that lead to urinary incontinence may be an early warning sign of neurodegenerative processes associated with dementia.

According to lead author David Sheyn, MD, a urogynecologist at University Hospitals Cleveland Medical Center Urology Institute, this is potentially good news. "If some cases of OAB are truly an early symptom of dementia, we might be able to use it as an early marker of frontal cortical dysfunction to identify dementia earlier and perhaps look for and stop that common mechanism or at least intervene early enough to make a significant impact in the disease process. While anticholinergic medications are still associated with short term side-effects related to cognition and memory, though not in the majority of people, these symptoms will resolve once the medication is stopped and patients can be reassured that a short trial of medication won't cause harm and if they gain substantial symptomatic relief, they can safely continue the medicine." Though he cautions, that these results are still new and will require reproduction prior to a change in clinical guidelines, and beta-3-agonists are still considered the better choice whenever possible.

Several well-done observational studies have linked anticholinergic medications to dementia, and that concern is often shared with patients, which may make them afraid to take medication that could help them. Dr. Sheyn said he wanted to study this because the process that causes dementia often starts decades before dementia symptoms show up, and most studies suggesting these bladder medications cause dementia followed patients for five years or less.

The study compared drug classes and did not include patients who took no medication, so it cannot show that these drugs carry no risk. It also cannot prove that OAB is an early sign of dementia on its own, only that the pattern fits that explanation.