tolterodine-tartrate and Cognition-Disorders

overactive bladder (OAB) affects 17-41% older adults in community dwelled setting. For several years, antimuscarinics have been validated as the first-line medical treatment for OAB. Despite abundant data obtained from clinical trials provisions the use of antimuscarinics, investigation about the effect of this drug on cognitive function in elderly remains scarce. The objective of this study is to investigate the effect of antimuscarinics therapy on cognitive functions in OAB geriatric patients.. this study design is a systematic review and meta-analysis. Studies were collected using several search engines; those were PubMed, Science Direct, Cochrane, and EBSCOhost using predetermined MeSH keywords with Boolean operators. Selection of studies was done by three reviewers. Studies which fulfilled the inclusion and exclusion criteria underwent full-text review. For every selected full text, we extracted the following data if available: patients demographics, types of antimuscarinics used, placebo, dose, follow-up period, and Mini-Mental State Examination (MMSE) total score.. a total of 8 studies from an initial 146 publications were selected. There were 8 antimuscarinic agents evaluated in the studies, including Oxybutynin, Darifenacin, Tolterodine, Trospium, Imidafenacin, Propiverine hydrochloride, Fesoterodine, and Solifenacin. Oxybutynin was shown to have largest effect towards the decline of MMSE score [Mean difference: -2.90; 95% CI: -4.07, -1.73]. Darifenacin and Tolterodine were also shown to be significant in the decline of total MMSE score, although still inferior to Oxybutynin.. the use of most antimuscarinics medication has little to no effect towards the cognitive function in the management of overactive bladder in elderly patients. However, Oxybutynin, Darifenacin, and Tolterodine was shown to have significant decrease in cognitive functions, as shown in the decline of total MMSE score.

Topics: Aged; Benzofurans; Cognition Disorders; Humans; Mandelic Acids; Mental Status and Dementia Tests; Muscarinic Antagonists; Pyrrolidines; Tolterodine Tartrate; Urinary Bladder, Overactive

Incidences of overactive bladder (OAB) and cognitive dysfunction increase with aging. Treatment of OAB with antimuscarinic agents may result in cognitive decline, especially in patients with Alzheimer's disease (AD). The aim of this study is to evaluate the effect of antimuscarinic treatment on cognitive functions, depression, and quality of life (QOL) of patients with OAB.. This non-interventional prospective observational study was conducted in a geriatric medicine outpatient clinic. Overall, 168 OAB patients were enrolled. Patients were followed up in five groups: oxybutynin, darifenacin, tolterodine, trospium, and control groups. Follow-up visits were done at second, third, and sixth months. Comprehensive geriatric assessment, cognitive and mood assessment, QOL scales (IIQ-7, UDI-6) were performed.. Mean age of the patients was 73.5 ± 6.1. Of the 168 patients, 92.3% were female, 83.3% benefited from the treatment, and 37.1% discontinued the medication. Discontinuation rate and frequency of side effects were more frequent in the oxybutynin group. Mini Mental State Examination scores did not decline after treatment, even in AD patients. Geriatric Depression Scale scores, Activities of Daily Living scores, and QOL scores significantly improved after treatment.. Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Benzhydryl Compounds; Benzilates; Benzofurans; Cognition Disorders; Cresols; Depression; Female; Follow-Up Studies; Geriatric Assessment; Humans; Male; Mandelic Acids; Muscarinic Antagonists; Nortropanes; Phenylpropanolamine; Pyrrolidines; Quality of Life; Tolterodine Tartrate; Treatment Outcome; Urinary Bladder, Overactive

To compare the brain anticholinergic activities of five urinary spasmolytic drugs (USDs).. In vitro study.. Laboratory.. None.. A validated 96-well anticholinergic radio receptor bioassay using small incubation volumes (240 μL per well) was applied in the current study. The different USDs (tolterodine, oxybutynin, solifenacin, darifenacin, and 5-hydroxy-methyl-tolterodine (5-HMT; the active metabolite of fesoterodine) were dissolved in plasma in their respective therapeutic concentration ranges. The plasma samples were added directly to the wells of 96 filter plates, wherein the incubation, filtration, and counting of undisplaced radioactivity was performed. Standard curves with atropine were used as reference for estimations of anticholinergic activity (AA).. 5-HMT and tolterodine displayed the highest AA of the tested USDs. In the middle of the therapeutic concentration range, the central anticholinergic potency of 5-HMT and tolterodine was more than 10 times as high as that of oxybutynin, solifenacin, and darifenacin. Darifenacin exhibited the lowest AA at therapeutic serum concentrations (< one-third the AA of oxybutynin and solifenacin).. Tolterodine and fesoterodine appear to have the highest pharmacodynamic potential to induce central anticholinergic side effects of the tested USDs. Darifenacin displayed the lowest AA, and combined with a low degree of brain distribution, it has probably the most favorable pharmacological profile of the USDs with respect to risk of cognitive impairment in older adults.

Topics: Benzhydryl Compounds; Benzofurans; Biological Assay; Brain; Cognition Disorders; Cresols; Humans; In Vitro Techniques; Mandelic Acids; Muscarinic Antagonists; Phenylpropanolamine; Pyrrolidines; Quinuclidines; Solifenacin Succinate; Tetrahydroisoquinolines; Tolterodine Tartrate

To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine.. Prospective cohort study.. Nursing homes (NHs) in the state of Indiana.. Three thousand five hundred thirty-six Medicaid-eligible NH residents aged 65 and older taking a ChI between January 1, 2003, and December 31, 2004. Residents were excluded if they were taking an anticholinergic other than oxybutynin or tolterodine.. Indiana Medicaid claims data were merged with data from the Minimum Data Set (MDS). Repeated-measures analyses were performed to assess the effects of dual therapy on change in cognitive function measured using the MDS Cognition Scale (MDS-COGS; scored 0-10) and change in activity of daily living (ADL) function using the seven ADL items in the MDS (scored 0-28). Potential covariates included age, sex, race, number of medications, and Charlson Comorbidity Index score.. Three hundred seventy-six (10.6%) residents were prescribed oxybutynin or tolterodine concomitantly with a ChI. In residents in the top quartile of ADL function, ADL function declined an average of 1.08 points per quarter when not taking bladder anticholinergics (ChI alone), compared with 1.62 points per quarter when taking dual therapy, a 50% greater rate in quarterly decline in ADL function (P=.01). There was no excess decline attributable to dual therapy in MDS-COGS scores or in ADL function for residents who started out with lower functioning.. In higher-functioning NH residents, dual use of ChIs and bladder anticholinergics may result in greater rates of functional decline than use of ChIs alone. The MDS-COGS may not be sensitive enough to detect differences in cognition due to dual use.

Topics: Activities of Daily Living; Aged; Alzheimer Disease; Benzhydryl Compounds; Cholinergic Antagonists; Cholinesterase Inhibitors; Cognition Disorders; Cohort Studies; Cresols; Drug Interactions; Drug Therapy, Combination; Female; Follow-Up Studies; Homes for the Aged; Humans; Male; Mandelic Acids; Neuropsychological Tests; Nursing Homes; Phenylpropanolamine; Prospective Studies; Tolterodine Tartrate; Treatment Outcome; Urinary Incontinence

This is the first case of a 65 year old healthy woman developing de novo mental confusion during treatment with 2 mg tolterodine twice daily. It is a rare complication of therapy for overactive bladder and resolved when dosage was reduced to 1 mg, although overactive bladder symptoms were still controlled.

Topics: Aged; Benzhydryl Compounds; Cognition Disorders; Cresols; Female; Humans; Phenylpropanolamine; Tolterodine Tartrate; Urinary Bladder, Overactive

Authors evaluated the cognitive, neurophysiologic, and behavioral effects of incontinence medications in patients with Alzheimer disease (AD).. Nine patients were evaluated, both on and off incontinence medication, for cognitive status, neuropsychiatric status, activities of daily living, and serum anticholinergic level. Caregivers were interviewed to evaluate behavioral status and caregiver burden.. Patients showed better performance on specific measures of cognition and behavior when not taking medication for incontinence. A significant, inverse correlation was found between mental status and anticholinergic level.. Although the sample size was small, the findings suggest that, in patients with AD, incontinence medications with anticholinergic properties may have detrimental effects on mental status and behavior.

Topics: Activities of Daily Living; Alzheimer Disease; Benzhydryl Compounds; Caregivers; Cholinergic Antagonists; Cognition Disorders; Cresols; Cross-Over Studies; Humans; Memory Disorders; Mental Disorders; Muscarinic Antagonists; Neuropsychological Tests; Phenylpropanolamine; Psychometrics; Single-Blind Method; Surveys and Questionnaires; Tolterodine Tartrate; Urinary Incontinence; Wakefulness

Anticholinergic drugs are known to produce or enhance cognitive deficits. Tolterodine tartrate is marketed as a bladder-selective anticholinergic drug that is reported to be free of significant cognitive adverse effects.. To describe a 46-year-old woman who had memory loss and abnormal memory test results that improved when she discontinued tolterodine therapy.. While taking tolterodine, the patient's score on the delayed free recall portion of the Hopkins Verbal Learning Test-Revised was at the first percentile. One month after discontinuing tolterodine therapy, this test was administered a second time using an alternative form and she showed marked improvement scoring above the 75th percentile.. Tolterodine therapy caused cognitive dysfunction in our patient. It is possible that cognitive dysfunction is a common result of tolterodine treatment, but in the absence of testing, remains undiagnosed. Alternatively, our patient may have had aberrant metabolism of this drug or an increased sensitivity as a result of incipient Alzheimer disease.

Topics: Benzhydryl Compounds; Cognition Disorders; Cresols; Female; Humans; Memory Disorders; Mental Recall; Middle Aged; Muscarinic Antagonists; Phenylpropanolamine; Tolterodine Tartrate; Urination Disorders