Department of Clinical Neurological Sciences, Western University, London Health Sciences Center, LHSC-UH, 339 Windermere Rd, London N6A 5A5, ON, Canada.
Department of Clinical Neurological Sciences, London Health Sciences Center, London, ON, Canada.
J Neurol Sci. 2018 Feb 15;385:39-44. doi: 10.1016/j.jns.2017.11.028. Epub 2017 Nov 22.
Bladder dysfunction is common in persons with MS (PwMS), often due to detrusor muscle overactivity. Anticholinergic medications are considered the first line treatment for bladder dysfunction and are known to worsen cognition in healthy older adults and in persons with dementia. Yet, it is not known if these medications have the same effect on PwMS. Thus, the Objective of this prospective matched-cohort study was to determine if anticholinergic medications affect objective measures of cognition in PwMS. We recruited PwMS starting either oxybutynin or tolterodine (cases). Cases and controls were tested with the Brief International Cognitive Assessment for MS (BiCAMS) battery prior to starting anticholinergic medications and 12weeks later. The primary outcome was change on the Symbol Digit Modalities Test (SDMT) between groups; secondary outcomes were changes on the other BiCAMS measures. Analysis of Covariance with baseline measures as covariates to assess the significance of between group differences was performed at 12weeks. Forty eight PwMS starting anticholinergic medications and 21 matched PwMS controls were recruited. There was a significant difference (p<0.001) in the change on the cognitive measures over 12weeks between groups. The controls demonstrated improvement, consistent with practice effect, while the cases remained unchanged. This study demonstrates that anticholinergic medications may have a negative effect on cognition in PwMS; further confirmatory studies are needed.
膀胱功能障碍在多发性硬化症患者（PwMS）中很常见，通常是由于逼尿肌过度活动引起的。抗胆碱能药物被认为是治疗膀胱功能障碍的首选药物，已知它们会使健康的老年成年人和痴呆症患者的认知能力恶化。然而，目前尚不清楚这些药物是否对 PwMS 有相同的影响。因此，本前瞻性匹配队列研究的目的是确定抗胆碱能药物是否会影响 PwMS 的认知客观指标。我们招募了开始使用奥昔布宁或托特罗定（病例）的 PwMS。在开始使用抗胆碱能药物之前和 12 周后，对病例和对照组进行了简短国际认知评估多发性硬化症（BiCAMS）电池测试。主要结局是两组间符号数字模态测试（SDMT）的变化；次要结局是其他 BiCAMS 测量的变化。使用协方差分析，将基线测量值作为协变量，以评估 12 周时组间差异的显著性。招募了 48 名开始使用抗胆碱能药物的 PwMS 和 21 名匹配的 PwMS 对照组。在 12 周内，两组间认知测量的变化存在显著差异（p<0.001）。对照组表现出改善，与练习效应一致，而病例组则保持不变。这项研究表明，抗胆碱能药物可能对 PwMS 的认知产生负面影响；需要进一步的确认性研究。
