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Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk


Introduction and hypothesis

Recent publications show an association between exposure to anticholinergic medications and the risk of developing dementia. We hypothesized that urogynecology providers have changed their overactive bladder syndrome treatment as a result of this literature.


This was an anonymous, cross-sectional, web-based survey of American Urogynecologic Society members. Survey questions queried awareness of the referenced literature, prescribing practices, the impact of insurance on treatment plans, and demographics. Our primary outcome measured the change in prescribing practice in response to literature linking anticholinergic medications with the risk of dementia. Descriptive statistics were used.


A total of 222 urogynecology providers completed the survey. Nearly all respondents (99.1%) were aware of the recent literature, and, as a result, 90.5% reported changing their practice. Prior to the publication of recent literature, a “non-CNS-sparing” anticholinergic (e.g., oxybutynin) was most commonly prescribed (64.4%), whereas after the literature was published, this shifted to ß3-adrenoceptor agonists (58.5%, p < 0.001). A majority of respondents (96.6%) reported that insurance restrictions led to a change in treatment for some patients, with 73.5% describing the prior-authorization process as difficult. Many providers (61.8%) reported that a trial of anticholinergics was required by insurance companies prior to authorizing mirabegron.


The recent literature associating anticholinergic medications with the development of dementia has changed practice patterns among survey respondents, with a shift away from anticholinergic medications and toward ß3-adrenoceptor agonists. The majority of respondents report insurance barriers to non-anticholinergic therapies, resulting in alteration of their preferred practices.

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American Urogynecologic Society


Confidence interval


Central nervous system


Overactive bladder syndrome


Odds ratio


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Authors and Affiliations



K Menhaji: Study coordination and planning, Protocol/project development, Data collection and management; Manuscript writing/editing.

OO Cardenas-Trowers: Protocol/project development, IRB coordination, Data collection and management; Manuscript writing/editing.

OH Chang: Protocol/project development, Data analysis; Manuscript writing/editing.

EF Hall: Protocol/project development, Data analysis; Manuscript writing/editing.

NE Ringel: Protocol/project development, Data collection and management; Manuscript writing/editing.

K Falk: Study coordination and planning, Protocol/project development, Data collection and management; Manuscript writing/editing.

Corresponding author

Correspondence to Kerac N. Falk.

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Conflicts of interest

Dr. Cardenas-Trowers received research funding from AMAG Pharmaceuticals, Inc., unrelated to this work. The remaining authors report no conflicts of interest.

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Menhaji, K., Cardenas-Trowers, O.O., Chang, O.H. et al. Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk. Int Urogynecol J 32, 2819–2826 (2021).

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  • Anticholinergic medications
  • Dementia
  • Urogynecology
  • Mirabegron
  • Overactive bladder
  • Oxybutynin