Risk of dementia in patients treated with anticholinergics for overactive bladder syndrome: a systematic review and meta-analysis

Kotochinsky, Martin, Mora, Laura, Carrazzoni Godoi, Diogo, da Silva, Fátima Maria Thaiz da Fonte Gomes, Guedes Amorim, Karolina, Fernandes Oliveira Amador, Wellgner, Barroso, Douglas and Pardini Fagundes, Thales 2025. Risk of dementia in patients treated with anticholinergics for overactive bladder syndrome: a systematic review and meta-analysis. Neurological Sciences 10.1007/s10072-025-08546-4 Item availability restricted.

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Abstract

Background Urinary anticholinergic (AC) medications are commonly prescribed for Overactive Bladder (OAB) syndrome. Although recent studies suggest a potential link between their use and an increased risk of dementia, this association remains debated. Methods We conducted a systematic review and meta-analysis to evaluate the risk of dementia in patients receiving AC treatment for OAB syndrome. A comprehensive search of PubMed, Embase, and Cochrane databases was performed. Outcomes of interest included dementia risk and its association with age, sex distribution, treatment duration, and follow-up length. Two subgroup analyses were assessed: (1) AC vs. no drug therapy and (2) AC vs. mirabegron, a beta-3 agonist and current standard of care for OAB syndrome. Relative risk (RR) with p-value < 0.05 was considered statistically significant. Results Eight studies were included, comprising a total of 3,656,686 patients diagnosed with OAB syndrome, of whom 44.7% were exposed to urinary AC. The comparison between AC and no drug therapy showed a statistically significant higher risk of dementia in the exposed group (RR 1.2, 95% CI [1.09–1.32], I²=96%, p < 0.01). When the AC group was compared to patients who received Mirabegron, the AC use also presented a statistically significant increase in dementia risk (RR 1.28; 95% CI [1.03–1.58], I²=98%, p = 0.02). Conclusions Patients who received urinary AC therapy for OAB syndrome were associated with an increased risk of dementia compared to both no drug therapy and medical therapy with mirabegron. These findings suggest that, for the long-term treatment of adult patients with OAB syndrome, alternative therapeutic options to AC should be considered, with Mirabegron emerging as a valid choice in clinical decision-making.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Psychology
Publisher:	Springer
ISSN:	1590-1874
Date of First Compliant Deposit:	20 October 2025
Date of Acceptance:	16 September 2025
Last Modified:	21 Nov 2025 14:15
URI:	https://orca.cardiff.ac.uk/id/eprint/181756

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