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

To analyze the relationship between use of anticholinergic drugs to treat overactive bladder (OAB) and risk of incident dementia in older patients; overall and for each drug separately.

We conducted a nested case-control study using the French national medical-administrative database. We identified incident dementia cases and controls from January 1, 2013 to December 31, 2018 in individuals aged ≥60 years. Controls were matched 5:1 to cases by date of case diagnosis (index date), age, sex, and income. We set a 5-year exposure period ending 2 years before the index date (lag-time period to avoid protopathic bias). We quantified cumulative exposure to flavoxate, oxybutynin, solifenacin, trospium and fesoterodine, using the Defined Daily Doses (DDD). We performed conditional logistic regression analyses adjusted for factors known to be associated with overactive bladder and/or dementia including obesity, diabetes, stroke, coronary heart disease, and psychotic disorders.

We analyzed 4,810 cases and 24,050 matched controls, with a median age of 82. OAB anticholinergic use was associated with an increased risk of dementia (adjusted OR=1.23, 95%CI 1.10-1.37) with a cumulative dose-response: aOR=1.07 (95%CI 0.91-1.25) for 1-90 DDD, aOR=1.29 (1.05-1.58) for 91-365 DDD and aOR=1.48 (1.22-1.80) for > 365 DDD. Considering each OAB anticholinergic separately showed a particularly marked increased risk of deentia for oxybutynin and solifenacin, but no increased risk for trospium.

When treating overactive bladder in older patients, OAB anticholinergics should be used with caution taking into account the patient's cognitive status, the anticholinergic load, and the different therapeutic options.

The Journal of urology. 2022 Jun 10 [Epub ahead of print]

Marie France Malcher, Stephane Droupy, Claudine Berr, Abdelkrim Ziad, Helena Huguet, Jean-Luc Faillie, Chris Serrand, Thibault Mura

Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University Montpellier, Nîmes, France., Department of Urology and Andrology, CHU Nîmes, University of Montpellier, Nîmes, France., Univ Montpellier, INSERM, INM (Institute for Neurosciences of Montpellier) Montpellier, France., ClinSearch-110, Avenue Pierre Brossolette, Malakoff, France., Clinical Research and Epidemiology Unit, CHU de Montpellier, University of Montpellier, Montpellier, France., Department of Medical Pharmacology and Toxicology, CHU Montpellier University Hospital, Montpellier, France.