Monday, 13 May 2013

Oxybutynin worsens cognitive impairment

Oxybutynin, an anticholinergic, is associated with worsening of cognitive function. #MSBlog #MSResearch

"I have been banging on about bladder symptoms and how they can impact on MSers quality of life in particular sleep and fatigue. Antichoinergics are a class of drugs that are often prescribed to try and relax the bladder and make it less irritable. The improve bladder function by reducing urinary frequency, urgency and episodes of incontinence. Oxybutynin is an older anticholinergic that crosses into the brain and acts on cognition centres reducing cognition. Newer anticholinergics are designed not to cross into the brain and therefore do not affect cognition. This study done in elderly subjects with minimal cognitive impairment or MCI demonstrates this difference between oxybutynin and solifenacin and supports other studies done in MSers. Elderly people with MCU or not to dissimilar to MSers in that the majority of MSers have cognitive impairment. The moral of this story is that if you are on oxybutynin you should ask your general practitioner, continence advisor or neurologist to switch you to a newer generation anticholinergic."

EpubWagg et al. Randomised, Multicentre, Placebo-controlled, Double-blind Crossover Study Investigating the Effect of Solifenacin and Oxybutynin in Elderly People with Mild Cognitive Impairment: The SENIOR Study. Eur Urol. 2013 Jan 11. pii: S0302-2838(13)00005-5.

BACKGROUND: Compared with younger people, the elderly are more likely to suffer from overactive bladder (OAB) and to have other chronic conditions that affect physical or cognitive function. Despite this, there are few data on the cognitive safety of antimuscarinic agents in older patients and none that examine the effect of these agents on those with mild cognitive impairment (MCI).

OBJECTIVE: To evaluate cognitive effects during chronic stable dosing with solifenacin and oxybutynin versus placebo in older (≥75 yr) subjects with MCI.

DESIGN, SETTING, AND PARTICIPANTS: A randomised, double-blind, triple-crossover trial in 26 elderly volunteers with MCI. Cognitive function was assessed using Cognitive Drug Research (CDR) computerised testing.

INTERVENTION: Three treatment periods of 21 d each with solifenacin 5mg once daily, oxybutynin 5mg twice daily, or placebo, separated by 21-d washout periods.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was change from baseline in cognitive function with solifenacin at 6h post dose and oxybutynin at 2h post dose (time points close to their predicted time to peak concentration). Secondary endpoints included change in cognitive function at additional time points, and safety and tolerability assessments.

RESULTS AND LIMITATIONS: Neither agent was associated with significant changes from baseline in any of the five standard, composite outcomes of cognitive function (power of attention, continuity of attention, quality of working memory, quality of episodic memory, and speed of memory). In a secondary analysis, oxybutynin was associated with significant decreases in power and continuity of attention versus placebo at 1-2h post dose  Both agents were well tolerated, with the most frequently reported adverse event being mild or moderate dry mouth.

CONCLUSIONS: Solifenacin had no detectable effect on cognition in this group of elderly people with MCI.



"If you have not so already can you please complete the following questionnaire on night-time bladder function. I am trying to explore the issue whether or not this needs to be looked at in more detail in clinic. Thank you."

1 comment:

  1. I went to see my GP today about switching from oxybutynin to a newer anticholinergic. He told me that the dose I take (2.5mg 3 times a day) is low and that it won't affect my cognition.

    He gave me the option to try something newer, but warned me they might not be as effective, so I've stuck with oxybutynin for now.

    This does leave me with one question: Is 7.5mg too low a dose to affect cognition in your opinion?

    Thanks,

    DD

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