title: [Impact on cognitive function of anticholinergic drugs used for the treatment of overactive bladder in the elderly].
abstract: OBJECTIVE
  Describe the central nervous system (CNS) adverse effects of anticholinergic drugs used for the treatment of overactive bladder (OAB) in the elderly.
  
  
  METHODS
  Relevant data from the literature were identified primarily through a Medline search of articles published through December 2013. The search terms included overactive bladder, central nervous system, elderly, anticholinergic, and antimuscarinic. Articles were chosen for inclusion based on their pertinence to the focus on treatment of OAB in the elderly.
  
  
  RESULTS
  Several anticholinergic drugs are available for the treatment of OAB, including oxybutinin, tolterodine, trospium chloride, solifenacine, fesoterodine. Among the agents reviewed, penetration of the blood-brain barrier (as predicted by lipophilicity, polarity, and molecular size and structure) is highest for oxybutinin, lower for tolterodine, solifenacine, and darifenacine, and lowest for fesoterodine and trospium chloride. Unwanted CNS adverse effects depend in part on patient specific variability in pharmacokinetic parameters, blood-brain barrier permeability, degree of cholinergic neuronal degeneration, total anticholinergic drug burden and patient's baseline cognitive status. The spectrum of anticholinergic CNS adverse effects ranges from drowsiness to hallucinations, severe cognitive impairment, and coma. Among the different anticholinergic agents, oxybutinin has been associated with cognitive impairment and trospium chloride and fesoterodine have shown favorable CNS tolerability.
  
  
  CONCLUSIONS
  Anticholinergic drugs improve significatively overactive bladder symptoms in older adults. However, potential CNS adverse effects of anticholinergic agents used in OAB must lead to a full evaluation before and during the treatment in order to evaluate benefice, risks and central side effects in this frail population.
authors.affiliation: Service de rééducation neurologique de Kerpape, Ploemeur, France.
authors.forename: J
authors.initials: J
authors.lastname: Kerdraon
authors.affiliation: GRC01 UPMC GREEN, service de médecine physique et de réadaptation, hôpital Rothschild, AP-HP, 75571 Paris cedex 12, France.
authors.forename: G
authors.initials: G
authors.lastname: Robain
authors.affiliation: Service de gériatrie, CHU de Montpellier, avenue Charles-Flahault, 34295 Montpellier cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Jeandel
authors.affiliation: Service d'urologie, hôpital Saint-Louis, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Mongiat Artus
authors.affiliation: Département d'urologie, transplantation rénale et andrologie, CHU de Rangueil, 31059 Toulouse, France.
authors.forename: X
authors.initials: X
authors.lastname: Gamé
authors.affiliation: Service de gynécologie, CHU de Nîmes, place R.-Debré, 30029 Nîmes cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Fatton
authors.affiliation: Cabinet médical de neurologie et neuro-urologie, 17, place de l'Europe, 69006 Lyon, France.
authors.forename: M C
authors.initials: MC
authors.lastname: Scheiber-Nogueira
authors.affiliation: Service de gériatrie, centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans cedex, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Vetel
authors.affiliation: Service de gynécologie, CHU de Nîmes, place R.-Debré, 30029 Nîmes cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Mares
authors.affiliation: Centre de santé, 8, rue Neibecker, 93440 Dugny, France.
authors.forename: A-C
authors.initials: AC
authors.lastname: Petit
authors.affiliation: GRC01 UPMC GREEN (groupe de recherche clinique en neuro-urologie), service de neuro-urologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France. Electronic address: gerard.amarenco@tnn.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Amarenco
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000139:chemically induced*; D006801:Humans; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*
chemical_list: D018680:Cholinergic Antagonists
keywords: Altération cognitive; Anticholinergic drugs; Anticholinergiques; Central nervous system; Cognitive impairment; Drug safety; Effets secondaires; Overactive bladder; Système nerveux central; Vessie hyperactive