Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report

Katherine L. Dengler, Rachel A. High, Daniela C. Moga, Jacqueline Zillioux, Adrian Wagg, Catherine E. Dubeau, Mary F. Ackenbom, Marianna Alperin, Chantale Dumoulin, Lori A. Birder, Donna Mazloomdoost, H. Henry Lai, Vivian W. Sung, Shelly L. Gray, Tatiana V.D. Sanses

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Importance: Overactive bladder (OAB) is prevalent in older adults in whom management is complicated by comorbidities and greater vulnerability to the cognitive effects of antimuscarinic medications. Objectives: The aim of this study is to provide a comprehensive evidence-based summary of the 2021 State-of-the-Science (SOS) conference and a multidisciplinary expert literature review on OAB and cognitive impairment. Study Design: The American Urogynecologic Society and the Pelvic Floor Disorders Research Foundation convened a 3-day collaborative conference. Experts from multidisciplinary fields examined cognitive function, higher neural control of the OAB patient, risk factors for cognitive impairment in older patients, cognitive effects of antimuscarinic medications for OAB treatment, OAB phenotyping, conservative and advanced OAB therapies, and the need for a multidisciplinary approach to person-centered treatment. Translational topics included the blood-brain barrier, purine metabolome, mechanotransduction, and gene therapy for OAB targets. Results: Research surrounding OAB treatment efficacy in cognitively impaired individuals is limited. Short- and long-term outcomes regarding antimuscarinic effects on cognition are mixed; however, greater anticholinergic burden and duration of use influence risk. Oxybutynin is most consistently associated with negative cognitive effects in short-term, prospective studies. Although data are limited, beta-adrenergic agonists do not appear to confer the same cognitive risk. Conclusions: The 2021 SOS summary report provides a comprehensive review of the fundamental, translational, and clinical research on OAB with emphasis on cognitive impairment risks to antimuscarinic medications. Duration of use and antimuscarinic type, specifically oxybutynin when examining OAB treatments, appears to have the most cognitive impact; however, conclusions are limited by the primarily cognitively intact population studied. Given current evidence, it appears prudent to minimize anticholinergic burden by emphasizing nonantimuscarinic therapeutic regimens in the older population and/or those with cognitive impairment.

Original languageEnglish
Pages (from-to)S1-S19
JournalUrogynecology
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2023

Bibliographical note

Funding Information:
The State of the Science Conference was supported by Axonics, Abbvie, Coloplast, and Urovant Sciences.

Publisher Copyright:
© 2023 American Urogynecologic Society.

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Surgery
  • Urology

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