Aims: Anticholinergic medications are commonly prescribed for urinary urgency in older adults and have been linked to cognitive impairment in cross-sectional studies. This study examined whether anticholinergics used for urinary urgency were associated with changes in overall and domain specific cognitive performance over a three year period in relatively healthy community-dwelling older Australians.
Methods: A longitudinal cohort analysis was conducted including participants who had urinary urgency, were aged at least 70 years, and were participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study. The anticholinergics included were oxybutynin, darifenacin and solifenacin. Anticholinergic exposure trajectory was classified as never, persistent, stopped, or started, at baseline and at year three of follow-up. Cognitive outcomes included total global performance (Modified Mini-Metal State Exam, 3MS) and domain-specific scores for orientation, attention, memory, language, visuospatial, and executive functioning. Mixed-effects models with random intercepts were used to estimate differences in cognitive performance by exposure trajectory, adjusting for age, sex, frailty, and polypharmacy. Effect modification by frailty was explored.
Results: Among 4,078 participants reporting urinary urgency, 658 had anticholinergic exposure during the three-year period. Exposure trajectories were not associated with statistically significant differences in total 3MS over three years compared with no exposure. No consistent pattern of decline was observed across cognitive domains by anticholinergic exposure. Exploratory analyses suggested possible effect modification by frailty.
Conclusions: In relatively healthy, community-dwelling older adults with urinary urgency, anticholinergic exposure trajectories were not associated with statistically significant changes in cognition over a three year time period.