Deprescribing Anticholinergic Medications in Older Adults with Overactive Bladder: A Literature Review on Cognitive Outcomes

Abstract

Introduction: Anticholinergic drugs for overactive bladder (OAB) are commonly prescribed to older adults but are linked to cognitive decline. Deprescribing may reverse effects, yet clinicians fear symptom recurrence. This review examines cognitive and urinary outcomes after anticholinergic withdrawal.
Methods: Literature review of RCTs, pre-post studies, and cohort studies (≥50 participants, age ≥65, on anticholinergic for OAB ≥6 months) reporting change in Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) after deprescribing, with or without switch to beta-3 agonist.
Results: Eight studies (n=2,301) identified. Deprescribing alone (no substitute) improved MMSE by 1.8 points (95% CI 0.9–2.7) at 6 months. Switching to mirabegron gave additional 0.9-point gain (p=0.045). Urinary urgency episodes increased transiently (by 1.2/day) at week 2 but returned to baseline by week 8. Number needed to harm for symptom relapse was 12.
Discussion: Cognitive benefits emerge by 3 months, likely due to reduced muscarinic receptor blockade in hippocampus. The transient worsening of OAB symptoms is acceptable to most patients when counselled. Limitations: short follow-up (max 12 months), lack of long-term cognitive trajectory data.
Conclusions: Deprescribing anticholinergics for OAB improves cognition without persistent urinary deterioration. Beta-3 agonist switch further enhances benefit.