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Cognitive Effects of Anticholinergics in the Geriatric Patient Population: Safety and Treatment Considerations

  • Overactive Bladder (U Lee, Section Editor)
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Abstract

Purpose of Review

Anticholinergics are one of the mainstay medications for treatment of overactive bladder syndrome. This review is an assessment of the most current literature describing the cognitive adverse effects related to anticholinergic medication use in the elderly population.

Recent Findings

Anticholinergic medications are not without adverse drug effects because of their activity on receptors on multiple sites in the body. Many of these side effects, including constipation, dry mouth, and confusion, have been thought to be self-limited to the duration of medication exposure, but recent studies have shown an association between long-term anticholinergic medication use and an increased risk for irreversible cognitive changes such as dementia.

Summary

Urologists should be aware of these recent studies in order to provide counseling about anticholinergic dose minimization, discontinuation of anticholinergics with any signs of cognitive decline, the potential risk of long-term cognitive effects, and balance these with the immediate benefits of decreasing incontinence and improvements in quality of life.

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Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA

    Sara M. Lenherr

  2. Department of Urology, Medical College of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA

    Lindsey Cox

Authors
  1. Sara M. Lenherr
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  2. Lindsey Cox
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Correspondence to Sara M. Lenherr.

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Conflict of Interest

Dr. Lenherr is a grant recipient from the Patient Centered Outcomes Research Institute (PCORI CER14092138) and the Department of Defense (DoD W81XWH-16-1-0688).

Dr. Cox declares no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Key Points

1. Overactive bladder syndrome and urinary urgency are common with increasing age; therefore, anticholinergics are frequently prescribed to older adults.

2. Older patients are specifically at higher risk for anticholinergic side effects because of the pharmacokinetics of these medications in the elderly, and therefore, anticholinergics are included in many lists of medications to avoid by geriatric societies.

3. Small observational studies have shown variable declines in cognition when on anticholinergic medications for short periods of time.

4. Larger population-based studies have shown a significant association with long-term anticholinergic exposure and dementia.

5. Patients should be counseled on dose minimization, discontinuation of anticholinergics with any signs of cognitive decline, the potential risk of long-term cognitive effects, and balancing these with the immediate benefits of decreasing incontinence and improvements in quality of life.

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Lenherr, S.M., Cox, L. Cognitive Effects of Anticholinergics in the Geriatric Patient Population: Safety and Treatment Considerations. Curr Bladder Dysfunct Rep 12, 104–111 (2017). https://doi.org/10.1007/s11884-017-0413-8

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