Welk Blayne
Department of Surgery, Western University, London, Ontario, Canada.
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Indian J Urol. 2024 Apr-Jun;40(2):82-87. doi: 10.4103/iju.iju_352_23. Epub 2024 Apr 1.
This narrative review discusses the relationship between anticholinergic medications and cognitive change specifically in patients with neurogenic lower urinary tract dysfunction (NLUTD). NLUTD is prevalent in various conditions, including spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS), Parkinson's, stroke, and dementia and often requires anticholinergic overactive bladder (OAB) medications. In the general population, and among those with OAB, several studies have found a significant association between this class of medications and cognitive side effects, mostly when used for > 90 days. These cognitive side effects may be particularly relevant to people with NLUTD due to their higher baseline risk of cognitive impairment. Two studies (one in people with SCI and another in MS) found evidence of cognitive impairment with the use of OAB anticholinergics (specifically oxybutynin and tolterodine). People with dementia commonly use OAB anticholinergics, and there is evidence that oxybutynin and tolterodine may impair cognition in this population. Two recent studies in children with SB studied 12 months of solifenacin and 6 months of fesoterodine/oxybutynin and found there was no significant change in neuropsychological testing. Clinical studies in people with Parkinson's disease and prior stroke have not shown that trospium, darifenacin, or fesoterodine have a significant impact on cognitive measures. In summary, oxybutynin and tolterodine may pose a higher risk of cognitive impairment than newer OAB anticholinergics in people with NLUTD; there is no evidence that children with SB experience cognitive impairment with OAB anticholinergics. Further study is necessary to confirm cognitive safety, particularly as the NLUTD population may have a high exposure to OAB anticholinergics. Advocating for potentially safer OAB medications is necessary if there is concern about cognitive risks.
本叙述性综述探讨了抗胆碱能药物与认知变化之间的关系，特别是在神经源性下尿路功能障碍（NLUTD）患者中。NLUTD在多种疾病中普遍存在，包括脊髓损伤（SCI）、脊柱裂（SB）、多发性硬化症（MS）、帕金森病、中风和痴呆症，并且通常需要使用抗胆碱能的膀胱过度活动症（OAB）药物。在普通人群以及OAB患者中，多项研究发现这类药物与认知副作用之间存在显著关联，主要是在使用超过90天时。由于NLUTD患者认知障碍的基线风险较高，这些认知副作用可能与他们尤为相关。两项研究（一项针对SCI患者，另一项针对MS患者）发现使用OAB抗胆碱能药物（特别是奥昔布宁和托特罗定）存在认知障碍的证据。痴呆症患者通常使用OAB抗胆碱能药物，并且有证据表明奥昔布宁和托特罗定可能会损害该人群的认知功能。最近两项针对SB儿童的研究分别对索利那新进行了12个月的研究以及对非索罗定/奥昔布宁进行了6个月的研究，发现神经心理学测试没有显著变化。针对帕金森病患者和既往中风患者的临床研究并未表明曲司氯铵、达非那新或非索罗定对认知指标有显著影响。总之，在NLUTD患者中，奥昔布宁和托特罗定可能比新型OAB抗胆碱能药物带来更高的认知障碍风险；没有证据表明SB儿童使用OAB抗胆碱能药物会出现认知障碍。有必要进行进一步研究以确认认知安全性，特别是鉴于NLUTD人群可能大量接触OAB抗胆碱能药物。如果担心存在认知风险，提倡使用潜在更安全 的OAB药物是必要的。
