title: Effect of anticholinergic use for the treatment of overactive bladder on cognitive function in postmenopausal women.
abstract: BACKGROUND
  Overactive bladder (OAB) is a common condition affecting the elderly. The mainstay of treatment for OAB is medical therapy with anticholinergics. However, adverse events have been reported with this class of drugs, including cognitive changes.
  
  
  OBJECTIVE
  The objective of this study was to investigate the effect of an anticholinergic medication, trospium chloride, on cognitive function in postmenopausal women being treated for OAB.
  
  
  METHODS
  This was a prospective cohort study conducted at a urogynaecology clinic at one academic medical centre from January to December 2010, with 12-week follow-up after medication initiation. Women aged 55 years or older seeking treatment for OAB and opting for anticholinergic therapy were recruited. Baseline cognitive function was assessed via the Hopkins Verbal Learning Test-Revised Form (HVLT-R) [and its five subscales], the Orientation, Memory & Concentration (OMC) short form, and the Mini-Cog evaluation. After initiation of trospium chloride extended release, cognitive function was reassessed at Day 1, Week 1, Week 4 and Week 12. Bladder function was assessed via three condition-specific quality-of-life questionnaires. Secondary outcomes included change in bladder symptoms, correlation between cognitive and bladder symptoms, and overall medication compliance. The main outcome measure was change in HVLT-R score at Week 4 after medication initiation, compared with baseline (pre-medication) score.
  
  
  RESULTS
  Of 50 women enrolled, 35 completed the assessment. The average age was 70.4 years and 77.1% had previously taken anticholinergic medication for OAB. At enrollment 65.7% had severe overactive bladder and 71.4% had severe urge incontinence. Cognitive function showed an initial decline on Day 1 in HVLT-R total score (p = 0.037), HVLT-R Delayed Recognition subscale (p = 0.011) and HVLT-R Recognition Bias subscale (p = 0.01). At Week 1 the HVLT-R Learning subscale declined from baseline (p = 0.029). All HVLT-R scores normalized by Week 4. OMC remained stable throughout. The Mini-Cog nadired at a 90.9% pass rate at Week 4. OAB symptoms did not improve until Week 4, based on questionnaire scores (p < 0.05).
  
  
  CONCLUSIONS
  Cognitive function exhibited early changes after initiation of trospium chloride but normalized within 4 weeks. Cognitive changes occurred weeks prior to OAB symptom improvement. Surveillance for cognitive changes with anticholinergic use should be part of OAB management.
authors.affiliation: University of North Carolina at Chapel Hill, Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Chapel Hill, North Carolina 27599-7570, USA. egeller@med.unc.edu
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Geller
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Crane
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Wells
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Robinson
authors.forename: Mary L
authors.initials: ML
authors.lastname: Jannelli
authors.forename: Christine M
authors.initials: CM
authors.lastname: Khandelwal
authors.forename: Annamarie
authors.initials: A
authors.lastname: Connolly
authors.forename: Brent A
authors.initials: BA
authors.lastname: Parnell
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Matthews
authors.forename: Julie B
authors.initials: JB
authors.lastname: Dumond
authors.forename: Jan
authors.initials: J
authors.lastname: Busby-Whitehead
mesh_terms: D000368:Aged; D001288:Attention / Q000187:drug effects; D001561:Benzilates; D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D055118:Medication Adherence; D008568:Memory / Q000187:drug effects; D008875:Middle Aged; D009483:Neuropsychological Tests; D009662:Nortropanes / Q000009:adverse effects* / Q000627:therapeutic use*; D017698:Postmenopause / Q000523:psychology*; D011446:Prospective Studies; D001743:Urinary Bladder / Q000187:drug effects; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D053202:Urinary Incontinence, Urge / Q000188:drug therapy; D014706:Verbal Learning / Q000187:drug effects
chemical_list: D001561:Benzilates; D018680:Cholinergic Antagonists; D009662:Nortropanes; C003330:trospium chloride