Pharmacotherapy for Overactive Bladder Syndrome and the Risk of Incident Dementia - Beyond the Abstract
In our large retrospective cohort study of over 940,000 patients with OAB, we examined the association between specific pharmacologic treatments and incident dementia, adjusting for anticholinergic burden, comorbidity, age, and sex using propensity score–weighted models.
Our findings challenge the prevailing assumption that mirabegron carries little to no cognitive risk. We found a statistically significant association between mirabegron use and dementia across multiple age groups and in both sexes.
While most anticholinergic medications were also associated with increased dementia risk, fesoterodine stood out as the only agent not associated with an elevated risk in any subgroup.
Interestingly, the strongest associations were not observed in the oldest patients (>80 years), suggesting that patient-specific risk factors may modulate vulnerability to cognitive side effects. These results underscore the need for nuanced decision-making when treating OAB, particularly in younger patients or those at risk for neurodegenerative disease.
Our study adds to a growing body of literature questioning the cognitive safety of mirabegron and highlights the importance of individualized pharmacotherapy. Future prospective studies and mechanistic investigations are needed to clarify the causal pathways linking OAB treatments and dementia.
Written by: David Sheyn, MD, Associate Professor, Director, Division of Urogynecology and Reconstructive Pelvic Surgery, Urology Institute, University Hospitals, Cleveland, OH
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