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Overactive Bladder

I've heard bladder medication can cause dementia. Is that true?

The concern attaches to one class of bladder drug, not all of them. In older Koreans, that class accounted for two-thirds of their entire anticholinergic exposure — and the alternative contributes none.

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Answer

The concern is real for one class of bladder drug and does not apply to the other: in Korean National Health Insurance data covering 2,360 patients aged 65 or over with overactive bladder and 11,676 matched patients without it, the cumulative 100-day anticholinergic cognitive burden score was 15.2 times higher in the overactive bladder group (320.1 against 21.0), 66.9 percent of that burden was attributable to the bladder medication itself in patients taking antimuscarinics alone, and mirabegron — a beta-3 agonist rather than an antimuscarinic — contributed zero anticholinergic burden.

Key takeaways

  • 2,360 Korean patients aged 65 or over with overactive bladder were compared with 11,676 matched patients without it.
  • The cumulative 100-day anticholinergic cognitive burden score was 320.1 against 21.0 — 15.2 times higher.
  • Anticholinergic medication was dispensed to 96.9 percent of the overactive bladder group against 33.6 percent of the comparison group.
  • Strong anticholinergic use was almost four times more prevalent, at 94.7 against 24.1 percent.
  • 66.9 percent of the burden was attributable to the bladder drug in patients on antimuscarinics alone, and 64.3 percent in those on an antimuscarinic plus mirabegron.
  • Mirabegron taken alone contributed zero anticholinergic burden, by mechanism.
  • The study measured drug exposure rather than cognitive outcomes, so harm is inferred from a validated burden score and was not observed directly.

The claim circulating is too broad and the underlying concern is too specific to dismiss. Anticholinergic burden — the running total of anticholinergic activity across everything a person takes — is associated with cognitive impairment in older people, and one class of bladder drug contributes heavily to it.

Which drug you are on is the whole question

Antimuscarinics — solifenacin, tolterodine, fesoterodine, oxybutynin and similar — work by blocking muscarinic receptors, and that is exactly the activity the burden score counts. Mirabegron works through a different receptor entirely, as a beta-3 adrenergic agonist, and contributed nothing to the score. Not a low figure. Zero, because of how it works.

320.1 vs 21.0

cumulative 100-day anticholinergic cognitive burden score, Korean over-65s with overactive bladder against matched patients without itLee KS et al., International Neurourology Journal, 2025

The fifteenfold gap is not explained by the overactive bladder group being older or sicker — the two groups were matched. It comes from what the condition is treated with: 96.9 percent of them received an anticholinergic and 94.7 percent received one classed as strong.

What this does not show

Nobody in this study was followed to see whether their cognition declined. The harm is inferred from a validated exposure score, not observed. Antimuscarinics also remain effective drugs, and mirabegron has questions of its own — a separate Korean study of 2,091 patients found systolic blood pressure rose by 10 mmHg or more in 8.8 percent of users.

So the choice is not between a dangerous drug and a safe one. It is between a cognitive exposure in an older patient and a cardiovascular one, and which matters more depends on the person. The reasonable question at the next appointment is simply which class you are on, and what your total anticholinergic burden looks like once everything else you take is counted.

Sources

  1. 1

    Lee KS, Cho J, Kang D, Ko KJ, Foo CY, Stoelzel M, Hadi FA, Kim S

    A Retrospective Database Analysis of Anticholinergic Burden Among Older Patients With and Without Overactive Bladder in South Korea

    International Neurourology Journal 2025;29(3):188-196

    doi:10.5213/inj.2550112.056 · PMID:41077792

    https://doi.org/10.5213/inj.2550112.056
  2. 2

    Lee JH, Kim A, Shim JS, Ko KJ

    Blood pressure increases and other safety and medication compliance in overactive bladder patients treated with Selebeta PR tablets: A noninterventional, multicenter, retrospective observational study

    Investigative and Clinical Urology 2026;67(3):273-280

    doi:10.4111/icu.20250489 · PMID:42065663

    https://doi.org/10.4111/icu.20250489