A new study published on November 6th in JAMA Network Open challenges the belief that anticholinergic medications for overactive bladder (OAB) increase dementia risk. Researchers at University Hospitals Cleveland Medical Center Urology Institute utilized Epic Cosmos, a national electronic health record database, to analyze data from 830,393 adults aged 40 to 90 who were newly treated for OAB between 2012 and 2025. The study, available at DOI: 10.1001/jamanetworkopen.2026.42026, demonstrates that anticholinergic medications, a foundational treatment for OAB, do not carry a greater long-term dementia risk compared to beta-3 agonists.
Study Finds Similar Dementia Rates Across Drug Classes
The study found similar dementia rates among patients taking anticholinergic medications and those on beta-3 agonists, a newer drug class previously considered safer for the brain. Lead author David Sheyn, MD, a urogynecologist at the institute, noted that this challenges the long-held belief that one group of drugs is riskier than the other. The findings also showed consistent dementia rates across individual medications within each class, further supporting the conclusion that neither drug type is inherently more harmful in terms of dementia risk.
Instead, the findings suggest that OAB itself and the neurological mechanisms leading to urinary incontinence may be early warning signs of neurodegenerative processes associated with dementia. This shift in understanding could lead to earlier identification and intervention in dementia cases, potentially altering the trajectory of the disease. Dr. Sheyn emphasized the importance of recognizing OAB as a possible marker of frontal cortical dysfunction, which could pave the way for targeted therapies.
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Short-Term Side Effects Remain a Concern
While anticholinergic medications are associated with short-term cognitive and memory side effects, these symptoms typically resolve once the medication is discontinued. Dr. Sheyn reassured patients that a short trial of these medications won’t cause long-term harm, particularly if they provide significant symptomatic relief. However, he cautioned that these results are preliminary and require further replication before clinical guidelines can be updated. Beta-3 agonists remain the preferred choice when possible due to their more favorable side effect profile.
Addressing Patient Concerns and Future Research
Previous observational studies have linked anticholinergic medications to dementia, often leading to patient concerns and reluctance to take these drugs. Dr. Sheyn highlighted the need for longer-term studies, as dementia often develops decades before symptoms appear. Most prior studies suggesting a link between bladder medications and dementia followed patients for five years or less, which may not capture the full timeline of neurodegenerative processes.
The current study compared drug classes but did not include a no-medication group, so it cannot definitively rule out all risks. It also cannot prove that OAB is an independent early sign of dementia, only that the pattern aligns with this explanation. However, the study’s large sample size and long follow-up period provide robust evidence for reevaluating the perceived risks of anticholinergic medications.
