Could Overactive Bladder Treatment Increase Dementia Risk in Diabetes Patients?

Patients with diabetes mellitus taking certain drugs for treatment of overactive bladder may be at higher risk of developing dementia, researchers reported.

Diabetes mellitus is frequently accompanied by overactive bladder, and treatment is often a prescription for the anticholinergic drugs oxybutynin, solifenacin, or tolterodine. These drugs improve overactive bladder symptoms by using muscarinic acetylcholine receptors to lessen spasmolyitic effects on bladder smooth muscle. Muscarinic acetylcholine receptors are found in the brain though, so researchers hypothesize that blocking of the receptors could be implicated in the development of dementia.
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To investigate this possibility, researchers from the China Medical University in Taichung, Taiwan, analyzed the diabetes dataset of the Taiwan National Health Insurance Research Database. Of the total patients evaluated in the cohort study, there were 10,938 who had taken one type of oxybutynin, solifenacin, or tolterodine. There were 564,733 patients who had not received those medications.

Six-year follow-up showed that patients who took oxybutynin had a dementia event rate of 3.9%. Those taking solifenacin had a 4.3% dementia event rate, while patients taking tolterodine had a 2.2% rate. Patients in the control group had a 1.2% dementia event rate.

Adjustment for factors such as comorbidities, patient age, patient gender, socioeconomic status, geographical region, and urbanization revealed that oxybutynin was associated with the greatest dementia risk (hazard ratio [HR] 2.35; 95% CI, 1.96-2.81). Risks for solifenacin (HR 2.16; 95% CI, 1.81-2.58) and for tolterodine (HR 2.24; 95% CI, 1.85-2.73) were also high, when compared with results from the control group.

The researchers stated that “clinicians should be mindful of the results of the present study, which indicates that long-term anticholinergic drug treatment of overactive bladder patients is associated with increased risk for dementia.” They added that “Occasionally alternating treatment protocols (eg, urination behavior therapy, intravesical drug injection, etc.) for patients who would otherwise undergo long-term oral anticholinergic drug treatment for overactive bladder may provide safer long-term outcomes.”

—Lauren LeBano

References

Yang YW, Liu HH, Lin TH Chuang HY, Hsieh T. Association between different anticholinergic drugs and subsequent dementia risk in patients with diabetes mellitus. 2017; https://doi.org/10.1371/journal.pone.0175335.