Brief Reports
Cognitive, Behavioral, and Physiological Changes in Alzheimer Disease Patients as a Function of Incontinence Medications

https://doi.org/10.1097/00019442-200504000-00009Get rights and content

Objective

Authors evaluated the cognitive, neurophysiologic, and behavioral effects of incontinence medications in patients with Alzheimer disease (AD).

Methods

Nine patients were evaluated, both on and off incontinence medication, for cognitive status, neuropsychiatric status, activities of daily living, and serum anticholinergic level. Caregivers were interviewed to evaluate behavioral status and caregiver burden.

Results

Patients showed better performance on specific measures of cognition and behavior when not taking medication for incontinence. A significant, inverse correlation was found between mental status and anticholinergic level.

Conclusion

Although the sample size was small, the findings suggest that, in patients with AD, incontinence medications with anticholinergic properties may have detrimental effects on mental status and behavior.

Section snippets

Subjects

Inclusion criteria were the following: 1) diagnosis of AD; 2) Mini-Mental State Exam (MMSE) score of 10–26, inclusive; 3) required treatment for incontinence with either oxybutynin chloride or tolterodine for a minimum of 4 weeks; 4) hearing, vision, and English comprehension adequate for testing; and 5) a responsible caregiver who could accompany the subject to the evaluations. Exclusion criteria included the following: 1) regular use of antipsychotics, narcotic analgesics, or sedatives; 2)

Baseline Characteristics

A total of 12 subjects fulfilled eligibility criteria and completed the study. However, the data of three subjects were excluded because of technical difficulties in processing the serum assay. The analysis of the Activities of Daily Living Scale, Caregiver Burden Scale, and Memory and Behavior Checklist includes only eight subjects because one caregiver did not complete all caregiver assessments. The study sample consisted of two men and seven women, with a mean age of 78.22 years (standard

DISCUSSION

The purpose of this study was to examine whether patients with AD showed worsening of disease-related deficits as a function of being on incontinence medications with anticholinergic properties. Although the sample size was small, the findings provide preliminary evidence that, when taken off incontinence medications, patients showed better performance on tests of mental status (as assessed by the MMSE) and behavior. Six of nine patients had higher scores on the MMSE and seven of eight patients

References (10)

  • M-A Bedard et al.

    Acute and long-term administration of anticholinergics in Parkinson's disease: specific effects on the subcortico-frontal syndrome

    Brain Cogn

    (1999)
  • J Ouslander

    Incontinence

  • BF O'Donnell et al.

    Incontinence and troublesome behaviors predict institutionalization in dementia

    J Geriatr Psychiatry Neurol

    (1992)
  • I Katz et al.

    Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride

    J Am Geriatr Soc

    (1998)
  • A Agnoli et al.

    Effect of cholinergic and anticholinergic drugs on short-term memory in Alzheimer's dementia: a neuropsychological and computerized electroencephalographic study

    Clin Neuropharmacol

    (1983)
There are more references available in the full text version of this article.

Cited by (78)

  • An (Old) New Strategy to Manage BPSD

    2018, American Journal of Geriatric Psychiatry
  • Bladder antimuscarinics and cognitive decline in elderly patients

    2017, Alzheimer's and Dementia: Translational Research and Clinical Interventions
    Citation Excerpt :

    Our results are in line with other studies that previously investigated the relationship between antimuscarinic initiation and cognitive decline. A single-blind crossover design study on nine patients with AD measured MMSE, the Neuropsychiatric Inventory, and the Memory and Behavior Problems Checklist on and off antimuscarinics and showed that antimuscarinics produce cognitive, behavioral, and physiological changes; moreover, the study showed that antimuscarinics with stronger anticholinergic activity were associated with greater decline in MMSE [10]. Similarly, a randomized clinical trial on 150 healthy volunteers found that antimuscarinics decreased delayed recall and suggested differences in effects for different antimuscarinics depending on their selectivity for different muscarinic receptors; specifically, the study identified significantly more important impairment associated with the nonselective antimuscarinics (oxybutynin) as compared to the bladder-selective one (darifenacin) [11].

View all citing articles on Scopus

This study was funded by a grant from Emory University, Nell Hodgson Woodruff School of Nursing. The authors thank the Emory University Alzheimer's Disease Center (AG10130) and the Geriatric Medicine Incontinence Clinic at the Wesley Woods Center at Emory University.

View full text