Pharmacotherapy for overactive bladder syndrome and the risk of incident dementia.

Purpose: To compare the risk of incident dementia in patients prescribed either an anticholinergic medication or mirabegron.

Materials and methods: This was a retrospective cohort study of patients treated for OAB with pharmacotherapy between the years 2012 and 2023, using data from the TrinetX Research Collaborative Network. Patients who were diagnosed with OAB who were prescribed Mirabegron, Oxybutynin, Tolterodine, Darifenacin, Trospium, Fesoterodine, or Solifenacin after 1/1/2012 were identified. Anticholinergic medications were stratified into high-risk (Oxybutynin, Tolterodine, and Solifenacin) and low-risk (Darifenacin, Trospium and Fesoterodine) Patients with OAB who were not prescribed medications were included as a control group. The primary outcome was incidence of dementia occurring after initiation of pharmacotherapy or entry into the study (for the control group). Using Cox proportional hazard analyses, and adjusting for age and sex and adjusting for Elixhauser comorbidity index, anticholinergic burden score, and the average treatment effect, the risk of each medication on incident dementia was determined.

Results: A total of 941,402 met inclusion for the final analysis, with 83,550 prescribed any medication. With an average follow-up time of 4.3 years, the only medication not found to be associated with an increased risk of dementia in any group was fesoterodine, while mirabegron was found to have a significant association with dementia across all age groups for both sexes.

Conclusions: Most anticholinergic medications and mirabegron are associated with an increased risk of dementia compared to untreated controls with OAB, while fesoterodine was not found to be associated with an increased risk in any group.