1. The impact of anticholinergics on cognitive function in patients with neurogenic lower urinary tract dysfunction: A narrative review
- Author
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Welk, Blayne
- Subjects
Spina bifida -- Research -- Care and treatment -- Complications and side effects ,Stroke (Disease) -- Complications and side effects -- Research -- Care and treatment ,Medical research ,Medicine, Experimental ,Trospium -- Research -- Complications and side effects ,Multiple sclerosis -- Complications and side effects -- Research -- Care and treatment ,Cognition -- Research ,Spinal cord injuries -- Research -- Complications and side effects -- Care and treatment ,Parasympatholytic agents -- Research -- Complications and side effects ,Urinary incontinence -- Research -- Complications and side effects -- Care and treatment ,Neurophysiology -- Research ,Health - Abstract
This narrative review discusses the relationship between anticholinergic medications and cognitive change specifically in patients with neurogenic lower urinary tract dysfunction (NLUTD). NLUTD is prevalent in various conditions, including spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS), Parkinson's, stroke, and dementia and often requires anticholinergic overactive bladder (OAB) medications. In the general population, and among those with OAB, several studies have found a significant association between this class of medications and cognitive side effects, mostly when used for > 90 days. These cognitive side effects may be particularly relevant to people with NLUTD due to their higher baseline risk of cognitive impairment. Two studies (one in people with SCI and another in MS) found evidence of cognitive impairment with the use of OAB anticholinergics (specifically oxybutynin and tolterodine). People with dementia commonly use OAB anticholinergics, and there is evidence that oxybutynin and tolterodine may impair cognition in this population. Two recent studies in children with SB studied 12 months of solifenacin and 6 months of fesoterodine/oxybutynin and found there was no significant change in neuropsychological testing. Clinical studies in people with Parkinson's disease and prior stroke have not shown that trospium, darifenacin, or fesoterodine have a significant impact on cognitive measures. In summary, oxybutynin and tolterodine may pose a higher risk of cognitive impairment than newer OAB anticholinergics in people with NLUTD; there is no evidence that children with SB experience cognitive impairment with OAB anticholinergics. Further study is necessary to confirm cognitive safety, particularly as the NLUTD population may have a high exposure to OAB anticholinergics. Advocating for potentially safer OAB medications is necessary if there is concern about cognitive risks., Author(s): Blayne Welk (corresponding author) [1,2] INTRODUCTION TO NEUROGENIC LOWER URINARY TRACT DYSFUNCTION Neurogenic lower urinary tract dysfunction (NLUTD) is defined by the International Continence Society as 'abnormal or difficult [...]
- Published
- 2024
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