Study Finds OAB Drugs May Not Increase Dementia Risk

New research finds that anticholinergic medications commonly prescribed for overactive bladder may not increase dementia risk compared to beta-3 agonists, according to a study.

A Decade-Long Look at 830,000 Patients

Published on November 6 in JAMA Network Open, the study challenges the long-held belief that foundational anticholinergic medications carry a significantly higher risk of dementia than newer beta-3 agonists. For years, beta-3 agonists have been prescribed under the assumption that they offer a safer profile for aging brains, steering clinical preference away older, highly effective second-line therapies.

Researchers at University Hospitals Cleveland Medical Center Urology Institute utilized Epic Cosmos, a vast national electronic health record database, to track 830,393 adults between the ages of 40 and 90. Every patient in the cohort was newly treated for overactive bladder between 2012 and 2025, allowing for a comprehensive longitudinal view that bypassed the limitations of earlier, shorter investigations.

Similar Dementia Rates Across Drug Classes

When the data settled, dementia rates proved remarkably similar across drug classes and individual medications. Rather than proving that older bladder drugs actively trigger cognitive decline, the findings suggest a different clinical reality entirely.

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 in the disease process

David Sheyn, MD, urogynecologist at University Hospitals Cleveland Medical Center Urology Institute

Dr. Sheyn noted that while anticholinergic medications remain associated with short-term side effects related to cognition and memory in a minority of patients, those symptoms will resolve once the drug is stopped. Patients can be reassured that a short trial of medication won’t cause harm, and if they gain substantial symptomatic relief, they can safely continue the treatment.

Re-evaluating Years of Observational Caution

Several well-done observational studies previously linked anticholinergic medications to dementia, creating an atmosphere of caution that often left patients afraid to take effective prescriptions. Dr. Sheyn wanted to reexamine the connection because the underlying neurodegenerative process often starts decades before overt symptoms appear, yet most earlier research followed patients for five years or less.

Study Limits Require Further Clinical Confirmation

Despite the reassuring scope of the new registry data, important caveats remain. The study compared drug classes directly against one another and did not include an unmedicated control group, meaning it cannot prove the drugs carry no risk. Nor can it definitively prove that overactive bladder is an early sign of dementia on its own, only that the pattern fits that explanation.

Dr. Sheyn cautioned that these results are still new and will require reproduction prior to any formal update in clinical guidelines, meaning beta-3 agonists are still considered the better choice whenever possible.