A new study has linked some commonly used incontinence drugs to memory problems in some older patients. “Our message is to be careful when using these medicines,” said study leader and US Navy neurologist Dr. Jack Tsao. “It may be better to use diapers and be able to think clearly than the other way around,” Tsao added. Tsao also advised that urinary incontinence can sometimes be resolved with non-drug treatments such as exercise, biofeedback, and maintaining a bathroom break schedule. Because of this, he added, patients should speak to their physicians and healthcare providers about alternatives to incontinence drugs.
In 2007, US sales of prescription drugs to treat urinary problems exceeded $3 billion, according to IMS Health, a drug sales tracker. Also, according to the National Institute on Aging, bladder control trouble affects about one in 10 people age 65 and older; women are more likely to be affected than men; and causes include nerve damage, loss of muscle tone or, in men, enlarged prostate. The National Institute on Aging helped fund the study whose research was prompted when Tsao met a 73-year-old patient who began hallucinating conversations with dead relatives and having memory problems shortly after starting an incontinence drug. The patient’s mental condition improved when she stopped the drug for several months.
Tsao and his colleagues knew of similar reports and proceeded to review a large group of people—870 older Catholic priests, nuns and brothers participating in the Religious Orders Study at Chicago’s Rush University Medical Center—to determine if they could measure an effect of these and other medications that affect acetylcholine. Acetylcholine is a chemical messenger; drugs block some nerve impulses, such as bladder spasms. The findings, just released at a meeting of the American Academy of Neurology, come from an analysis of the medication use and cognitive test scores. The average patient age was 75.
Researchers tracked the group for nearly eight years, testing yearly for cognitive decline. Nearly 80 percent of the study participants took one or more of a class of drugs called anticholinergics, including drugs for high blood pressure, asthma, Parkinson’s disease, and incontinence drugs such as Detrol and Ditropan. Those medicated experienced a 50 percent faster rate of cognitive decline over those not on medication. Even considering other risk factors for memory loss, such as age, a link was still established.
The incontinence drugs were among the most potent and were the most frequently taken of all the anticholinergics in the study, which is why the researchers feel they are the link to the memory problems, Tsao said Some experts said the research supports previous observations and is helpful because it measures the size of the effect. “This paper adds important new data to the picture,” said Dr. Elaine Perry of Newcastle University in England, who has conducted similar, but separate, research. Tsao said that more research is needed on the effects of anticholinergic drugs on memory and suggests physicians do baseline cognitive testing on patients before prescribing the drugs.
Confusion and memory impairment were added to prescribing information for Detrol in 2006.