Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder

George Araklitis, Dudley Robinson, Linda Cardozo Urogynaecology Department, King’s College Hospital, London, UKCorrespondence: George Araklitis Urogynaecology DepartmentKing’s College Hospital, London SE5 9RS, United KingdomTel +44 2032993568Email george.araklitis@nhs.netAbstract...

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Autores principales:	Araklitis G, Robinson D, Cardozo L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	anticholinergic burden anticholinergic load dementia elderly overactive bladder Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/0e4a1c7ac38a4a4e974299bc19ae1aa9
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spelling	oai:doaj.org-article:0e4a1c7ac38a4a4e974299bc19ae1aa92021-12-02T09:37:53ZCognitive Effects of Anticholinergic Load in Women with Overactive Bladder1178-1998https://doaj.org/article/0e4a1c7ac38a4a4e974299bc19ae1aa92020-08-01T00:00:00Zhttps://www.dovepress.com/cognitive-effects-of-anticholinergic-load-in-women-with-overactive-bla-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998George Araklitis, Dudley Robinson, Linda Cardozo Urogynaecology Department, King’s College Hospital, London, UKCorrespondence: George Araklitis Urogynaecology DepartmentKing’s College Hospital, London SE5 9RS, United KingdomTel +44 2032993568Email george.araklitis@nhs.netAbstract: Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. The mainstay of treatment of OAB is anticholinergic/antimuscarinic medication. These drugs block muscarinic receptors throughout the body, not only the bladder, including in the brain, which may lead to cognitive side effects. Anticholinergic load or burden is the cumulative effect of taking drugs that are capable of producing anticholinergic adverse effects. The elderly are more susceptible to these effects, especially as there is increased permeability of the blood brain barrier. The anticholinergic drugs for OAB are able to enter the central nervous system and lead to central side effects. There is increasing evidence that a high anticholinergic load is linked to the development of cognitive impairment and even dementia. Some studies have found an increased risk of mortality. In view of this, care is needed when treating OAB in the elderly. Trospium chloride is a quaternary amine anticholinergic, which has a molecular structure, which theoretically means it is less likely to cross the blood brain barrier and exert central side effects. Alternatively, mirabegron can be used, which is a beta-3 adrenoceptor agonist, which does not add to the anticholinergic load or exert central nervous system side effects. Conservative therapy can be used as an alternative to pharmacological treatment in the form of behavioral modification, fluid management and bladder retraining. Neuromodulation or the use of botox can also be alternatives, but success may be less in the older adult and will require increased hospital attendances.Keywords: anticholinergic burden, anticholinergic load, dementia, elderly, overactive bladderAraklitis GRobinson DCardozo LDove Medical Pressarticleanticholinergic burdenanticholinergic loaddementiaelderlyoveractive bladderGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 15, Pp 1493-1503 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticholinergic burden anticholinergic load dementia elderly overactive bladder Geriatrics RC952-954.6
spellingShingle	anticholinergic burden anticholinergic load dementia elderly overactive bladder Geriatrics RC952-954.6 Araklitis G Robinson D Cardozo L Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder
description	George Araklitis, Dudley Robinson, Linda Cardozo Urogynaecology Department, King’s College Hospital, London, UKCorrespondence: George Araklitis Urogynaecology DepartmentKing’s College Hospital, London SE5 9RS, United KingdomTel +44 2032993568Email george.araklitis@nhs.netAbstract: Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. The mainstay of treatment of OAB is anticholinergic/antimuscarinic medication. These drugs block muscarinic receptors throughout the body, not only the bladder, including in the brain, which may lead to cognitive side effects. Anticholinergic load or burden is the cumulative effect of taking drugs that are capable of producing anticholinergic adverse effects. The elderly are more susceptible to these effects, especially as there is increased permeability of the blood brain barrier. The anticholinergic drugs for OAB are able to enter the central nervous system and lead to central side effects. There is increasing evidence that a high anticholinergic load is linked to the development of cognitive impairment and even dementia. Some studies have found an increased risk of mortality. In view of this, care is needed when treating OAB in the elderly. Trospium chloride is a quaternary amine anticholinergic, which has a molecular structure, which theoretically means it is less likely to cross the blood brain barrier and exert central side effects. Alternatively, mirabegron can be used, which is a beta-3 adrenoceptor agonist, which does not add to the anticholinergic load or exert central nervous system side effects. Conservative therapy can be used as an alternative to pharmacological treatment in the form of behavioral modification, fluid management and bladder retraining. Neuromodulation or the use of botox can also be alternatives, but success may be less in the older adult and will require increased hospital attendances.Keywords: anticholinergic burden, anticholinergic load, dementia, elderly, overactive bladder
format	article
author	Araklitis G Robinson D Cardozo L
author_facet	Araklitis G Robinson D Cardozo L
author_sort	Araklitis G
title	Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder
title_short	Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder
title_full	Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder
title_fullStr	Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder
title_full_unstemmed	Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder
title_sort	cognitive effects of anticholinergic load in women with overactive bladder
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/0e4a1c7ac38a4a4e974299bc19ae1aa9
work_keys_str_mv	AT araklitisg cognitiveeffectsofanticholinergicloadinwomenwithoveractivebladder AT robinsond cognitiveeffectsofanticholinergicloadinwomenwithoveractivebladder AT cardozol cognitiveeffectsofanticholinergicloadinwomenwithoveractivebladder
_version_	1718398046858903552

Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder

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