ANTICHOLINERGIC bladder drugs are associated with an increased risk of dementia compared to non-use, but not when compared to the β3 agonist mirabegron, according to a Danish nationwide study. The research, conducted between 2000–2022, analysed data from 1.29 million individuals with dementia and 646,270 matched controls without dementia, aged 60-75 years. The study aimed to assess the association between cumulative use of anticholinergic bladder drugs and the risk of all-cause dementia.
The researchers used conditional logistic regression to calculate incidence rate ratios (IRR) for the association between anticholinergic bladder drugs and dementia, adjusting for various factors including educational level and comorbidities. Compared to non-use, ever use of anticholinergic bladder drugs was associated with an increased risk of dementia (IRR: 1.44; 95% CI: 1.40–1.48). The risk increased with cumulative drug use, from an IRR of 1.31 (95% CI: 1.27–1.36) for 1-90 defined daily doses to 1.68 (95% CI: 1.59-1.76) for >365 defined daily doses. All types of anticholinergic bladder drugs showed increased IRRs for dementia: tolterodine (1.43), solifenacin (1.37), trospium (1.52), and fesoterodine (1.48). However, when compared directly with the use of mirabegron, the increased risk of dementia with anticholinergic bladder drugs was not observed (IRR: 0.82; 95% CI: 0.74–0.92).
These findings highlight the importance of using an active comparator in pharmacoepidemiological studies. While the results suggest an association between anticholinergic bladder drugs and dementia risk compared to non-use, the lack of increased risk when compared to mirabegron raises questions about the true nature of this association. Clinicians should consider these findings when prescribing bladder medications, particularly for long-term use in older adults.
Jenna Lorge, EMJ
Reference
Pourhadi N et al. Bladder drugs and risk of dementia: Danish nationwide active comparator study. BMJ Med. 2025;4:e001125.
