The Impact of Real-world Use of Overactive Bladder Medications on Dementia Risk in Younger Adults

Abstract

Background and objective

Overactive bladder (OAB) is often treated with anticholinergic medications, but concerns have emerged regarding their potential long-term risk of dementia. Our objective was to investigate whether the use of OAB anticholinergics, as compared with beta-3 agonists, is associated with new-onset dementia individuals under 65 yr of age.

Methods

A retrospective, propensity-weighted cohort study was conducted using population-based data from Canada. The study population included people aged 18–64 yr who started a prescription of an OAB anticholinergic medication or the beta-3 agonist mirabegron. Inverse propensity of treatment weighting was used to balance baseline characteristics. The primary outcome was the incidence of dementia. The Fine-Gray subdistribution hazard model, adjusted for age and sex, was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Key findings and limitations

A total of 57 975 patients were included in the study, with 48 454 in the OAB anticholinergic group (305 724 person-years of follow-up) and 9521 in the beta-3 agonist group (34 605 person-years of follow-up). After propensity score weighting, there was no significant difference in the risk of dementia between OAB anticholinergic users and beta-3 agonist users (HR 0.99, 95% CI 0.86–1.15, p = 0.9). The study limitations are the risk of misclassification and residual confounding.

Conclusions and clinical implications

Among people <65 yr of age, the use of OAB anticholinergics versus beta-3 agonists was not significantly associated with dementia. This serves to reassure physicians and patients who use these medications in younger adults.

Patient summary

In adults aged 18–64 yr who have overactive bladder, the use of different types of oral medications are not associated with dementia.