Anticholinergic agents used in overactive bladder and their effect on cognitive function in elderly

Abstract

Overactive bladder is common condition in elderly. Anticholinergic agents are the mainstay of pharmacological treatment of overactive bladder. They are effective but can decline the cognitive function. This adverse event depends on their ability to cross the blood – brain barrier and binding on muscarinic M1 receptors in central nervous system. Crossing of anticholinegics across the hematoencephalic barrier is dependent upon the molecular size, ionic charge, lipophilicity and if the anticholinergic is a P-glyco-protein substrate. Results of studies have shown the inappropriate anticholinergic agent to treat overactive bladder in elderly is oxybutynin, which frequently causes the cognitive impairment. On the contrary, trospium, solifenacin, darifenacin a fesoterodine have insignificant effect on cognitive functions in the elderly. The article provides an overview of pharmacotherapeutic options for treatment of overactive bladder on an example of elderly female patient with age-associated cognitive decline.