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A study published November 6 in JAMA Network Open found similar dementia rates among adults newly treated for overactive bladder with anticholinergic drugs and beta-3 agonists. The observational study did not compare users with people taking no medication, and researchers say the findings need replication before clinical guidance changes.
Adults treated for overactive bladder with anticholinergic drugs had dementia rates similar to those treated with beta-3 agonists, according to a study published November 6 in JAMA Network Open. The finding challenges the assumption that the newer drug class carries a lower long-term dementia risk, but it does not establish that either class is risk-free or that the drugs have no effect compared with taking no medication.
Researchers at the University Hospitals Cleveland Medical Center Urology Institute analyzed electronic health records for 830,393 adults aged 40 to 90 who began treatment for overactive bladder between 2012 and 2025. Using the Epic Cosmos database, they compared dementia incidence among people receiving different drug classes and individual medications. The report says rates were similar across the groups.
The study, titled “Drug therapies and incidence of dementia among adults with overactive bladder,” was published in JAMA Network Open. Its results concern patients treated for overactive bladder and compare medication choices; they do not compare medication users with a group that received no drug treatment. The authors therefore cannot use this analysis to rule out a dementia risk from either class.
Lead author David Sheyn, a urogynecologist at the University Hospitals Cleveland Medical Center Urology Institute, said the results may reassure some patients who are concerned about a potential long-term association. He also cautioned that the findings are new and need replication before they support a change in clinical guidance. The report notes that beta-3 agonists remain the preferred choice whenever possible, despite the similar dementia rates in this analysis.
How the Findings Could Affect OAB Treatment
Overactive bladder can disrupt daily activities, and medication decisions may involve weighing symptom relief against possible side effects. Concern about dementia has been a reason some patients may hesitate to use anticholinergic drugs, which are a foundational second-line treatment for the condition. The study’s comparison may help clinicians and patients discuss that concern with more evidence, but it does not settle the question of long-term risk.
The results also point to a different possible explanation for the observed association between bladder symptoms and dementia. Sheyn said overactive bladder or the neurological processes linked to urinary incontinence could, in some cases, precede dementia rather than medication being the cause. That is a hypothesis consistent with the findings, not something this study proves. If supported by further research, it could affect how clinicians interpret bladder symptoms, but the present analysis does not establish overactive bladder as an early dementia marker.
Short-term cognitive or memory side effects remain a separate issue from a long-term dementia diagnosis. The source report says anticholinergic drugs can be associated with short-term effects, though not in most people, and that these symptoms resolve after stopping the medication. Patients should discuss individual risks, benefits and symptoms with a qualified health professional rather than changing treatment based on one study.
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Why Researchers Revisited Bladder Drugs
Anticholinergic medicines have long been used to treat overactive bladder, while beta-3 agonists are a newer class often regarded as a potentially safer option for the brain. The concern about anticholinergics arose partly from observational studies linking their use to dementia. Such studies can identify associations, but by themselves they cannot show that a medication caused the outcome.
Sheyn said earlier studies often followed patients for five years or less, while processes that contribute to dementia may begin decades before symptoms emerge. The new study used records spanning 2012 to 2025 and compared outcomes among people treated with different drug classes. That longer period and large sample provide additional evidence, but the study remains observational and its comparison groups leave important questions unanswered.
“This is potentially good news.”
— David Sheyn, lead author and urogynecologist at University Hospitals Cleveland Medical Center Urology Institute
What the Study Cannot Establish
The study did not include an untreated comparison group, so it cannot determine whether either medication class changes dementia risk compared with taking no overactive bladder drug. Its observational design also cannot prove that anticholinergic drugs do not cause harm, or that bladder symptoms themselves are an early sign of dementia.
The report provides no specific dementia-rate figures or effect estimates in its summary, so the size and precision of the differences cannot be assessed here. It also remains unclear whether the findings apply equally to every patient, duration of use or medication. Researchers say the results require replication before clinical guidelines change; the study does not remove concerns about short-term cognitive side effects.
Replication Before Guidance Changes
The next step is for other researchers to test whether similar results appear in independent patient groups and with other study designs. Further work would need to examine longer-term outcomes and help separate medication effects from the possibility that overactive bladder symptoms are associated with neurological changes that precede dementia.
For now, the study does not call for a change in prescribing guidance. Sheyn said beta-3 agonists remain the better choice whenever possible, while the new findings may inform discussions about anticholinergic treatment. Patients considering starting, stopping or changing an overactive bladder medicine should consult a qualified health professional.
Key Questions
What did the study find?
Among 830,393 adults newly treated for overactive bladder, dementia rates were similar for those prescribed anticholinergic drugs and those prescribed beta-3 agonists.
Does this prove anticholinergic drugs do not raise dementia risk?
No. The study compared drug classes and did not include people taking no medication. Its observational design cannot establish that either class is risk-free or prove cause and effect.
Does the study show that overactive bladder is an early sign of dementia?
No. The authors say that possibility could fit the pattern, but the study cannot prove that overactive bladder is an early dementia symptom.
Should patients change their medication?
The study does not establish a reason to change treatment or clinical guidance. Patients should discuss medication choices and side effects with a qualified health professional.
Source: news-medical.net
