Blayne Welk, urology surgeon at St. Joseph’s Health Care London.
A commonly prescribed family of drugs used to treat overactive bladders is linked to new cases of dementia, a study by London researchers has found.
The takeaway for patients, the study’s lead author says, is to have a conversation with your doctor if you’re taking an anticholinergic drug for bladder issues.
“It doesn’t mean you have to panic and stop, but it might be worth discussing it with your doctor,” said Blayne Welk, a urology surgeon at St. Joseph’s Health Care London.
Using nearly a decade of Ontario health system data, the study authors found the rate of dementia in patients taking one category of drugs, anticholinergics, to treat an overactive bladder was 20 per cent higher than the rate among patients using a different family of drugs to treat the same condition.
Overactive bladder is a condition that makes patients feel the frequent urge to urinate, whether or not their bladder is full. It affects one in 10 Canadians and can be treated with two different classes of medication – anticholinergics or beta-3 agonists.
“This research is consistent that anticholinergic medications, as a class, can affect cognitive function and that’s something that should be taken seriously,” said Blayne Welk, the lead study author and a urology surgeon at St. Joseph’s Health Care London.
Anticholinergics bind to a specific receptor in the brain and block a specific chemical messenger, or neurotransmitter, from sending messages to other cells. The class of drug stops the bladder from spasms, reducing the urge to urinate.
Beta-3 agonists bind to different receptors in the brain and promote bladder muscle relaxation, lessening the urge to pee.
“It’s two different ways of getting the same effect,” Welk said. “You can even use both medications in some cases to treat bladder symptoms because they work differently but the end effect is the same.”
The team studied health data from more than 60,000 Ontario patients from 2010 to 2018, focusing on people with an overactive bladder diagnosis. Study authors compared the outcomes of patients taking anticholinergic drugs to ones on beta-3 agonists.
While the overall risk for dementia was low among the patients, 2.3 per cent of people developed dementia if they used an anticholinergic compared to 1.6 per cent of patients on beta-3 agonist medication.
The study looked at overactive bladder patients on a variety of different medications that fall within the anticholinergic or beta-3 agonist drug families. The next research step will be to study how specific anticholinergic drugs compare to others when it comes to dementia rates, Welk said.
Anticholinergic drugs for overactive bladders include medications sold under the brand names Ditropan XL, Oxytrol, Detrol, Enablex, Vesicare and Toviaz.
The study, published in the British Journal of Urology, was completed by researchers from Western University, Lawson Health Research Institute – the medical research arm of London’s hospitals – and the Institute for Clinical Evaluative Sciences (ICES), a non-profit organization that compiles and processes provincial health data.
Welk said the findings shouldn’t deter doctors from prescribing anticholinergic drugs for overactive bladder, but should prompt extra vigilance by physicians.
“This adds some evidence why prescribers may want to consider alternate medications like beta-3 agonists to treat patients, especially elderly patients or patients with some underlying cognitive dysfunction,” Welk said.
“It’s not that everyone needs to stop anticholinergic medication,” he said, suggesting patients discuss it with their doctor.
