Study challenges long-held fears about overactive bladder drugs and dementia

by University Hospitals Cleveland Medical Center

edited by Sadie Harley, reviewed by Robert Egan

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New research published in JAMA Network Open finds anticholinergic medications, commonly prescribed for overactive bladder (OAB), may not increase dementia risk after all compared to beta-3 agonists, the newer drug class that has been presumed to be safer for the brain.

Researchers at University Hospitals Cleveland Medical Center Urology Institute used Epic Cosmos, a national electronic health record database, to follow 830,393 adults ages 40 to 90 who were newly treated for OAB between 2012 and 2025. Dementia rates were similar across drug classes and individual medications.

The study demonstrates that in patients with OAB, anticholinergic medication, a foundational, second-line pharmacological treatment for the condition, does not carry a greater long-term risk of dementia than beta-3 agonists. Drugs in the latter class were previously believed to pose a lower risk.

Bladder symptoms as an early warning

This reverses a long-held belief that one group of drugs is riskier than the other; instead, the findings align with the idea that OAB itself and the neurologic mechanisms that lead to urinary incontinence may be early warning signs of neurodegenerative processes associated with dementia.

According to lead author David Sheyn, M.D., a urogynecologist at University Hospitals Cleveland Medical Center Urology Institute, this is potentially good news: "If some cases of OAB are truly an early symptom of dementia, we might be able to use it as an early marker of frontal cortical dysfunction to identify dementia earlier and perhaps look for and stop that common mechanism or at least intervene early enough to make a significant impact on the disease process."

Clinical caution and study limits

He cautions, though, that these results are still new and will require reproduction prior to a change in clinical guidelines, and beta-3 agonists are still considered the better choice whenever possible.

Several well-done observational studies have linked anticholinergic medications to dementia, and that concern is often shared with patients, which may make them afraid to take medication that could help them.

Sheyn said he wanted to study this because the process that causes dementia often starts decades before dementia symptoms show up, and most studies suggesting these bladder medications cause dementia followed patients for five years or less.

The study compared drug classes and did not include patients who took no medication, so it cannot show that these drugs carry no risk. It also cannot prove that OAB is an early sign of dementia on its own, only that the pattern fits that explanation.

Publication details

David Sheyn et al., Drug Therapies and Incidence of Dementia Among Adults With Overactive Bladder, JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.42026

Journal information: JAMA Network Open

Key medical concepts

Agent, AnticholinergicDementiaOveractive Bladder

Clinical categories

UrologyNeurologyClinical pharmacology Provided by University Hospitals Cleveland Medical Center Who's behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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