1. To test whether replacement of oral anticholinergic (AC) agents with mirabegron for neurogenic lower urinary tract dysfunction (NLUTD) yields improved cognitive function in older persons with spinal cord injury (SCI). 2. To test whether mirabegron is safe and as efficacious as AC.
Pilot study: Twenty older (>60 y/o) persons with SCI taking chronic (>6 months) AC medication for NLUTD were enrolled. All participants were first studied on AC at baseline then switched to mirabegron for 6 months. Primary outcomes were cognitive tests of (1) executive function (TEXAS, SDMT); (2) attention (SCWT); and (3) memory (SLUMS and WMS-IV Story A/B). Secondary outcomes assessed efficacy and safety including Neurogenic Bladder Symptom Score (NBSS), bladder diary, neurogenic bowel dysfunction (NBD) survey, heart rate (HR), electrocardiogram (EKG), and mean arterial pressure (MAP).
When switching from AC to mirabegron for NLUTD, older persons with SCI exhibited statistically significant improvements in immediate Story A recall (p = 0.01), delayed story A and B recall (p = 0.01, 0.004), and in TEXAS (p = 0.04). Three subscores within NBSS significantly improved (p = 0.001) and the frequency of incontinence decreased (p = 0.03) on mirabegron. NBD, HR, MAP, and EKGs were unchanged.
Older persons with SCI on AC for NLUTD demonstrated improved short-term and delayed memory (WMS-IV Story A/B) as well as executive function (TEXAS) when switched to mirabegron. Efficacy of mirabegron for NLUTD symptoms was superior to AC with no adverse effects on bowel or cardiovascular function.
Claude D. Pepper Older Americans Independence Center.
Spinal cord series and cases. 2021 Jun 10*** epublish ***
Michelle Trbovich, Terry Romo, Marsha Polk, Wouter Koek, Che Kelly, Sharon Stowe, Stephen Kraus, Dean Kellogg
Department of Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX, USA. ., Geriatric Research Education and Clinical Center, University of Texas Health San Antonio, San Antonio, TX, USA., Department of Psychiatry/Division of Aging and Geriatrics, University of Texas Health San Antonio, San Antonio, TX, USA., Department of Psychiatry, University of Texas Health San Antonio, San Antonio, TX, USA., South Texas Veteran's Health Care System, San Antonio, TX, USA., Spinal Cord Injury Service, South Texas Veteran's Health Care System, San Antonio, TX, USA.