Anticholinergic prescribing declined among urogynecologists after the overactive bladder (OAB) drugs were linked with increased dementia risk.

In an online survey from the American Urogynecologic Society of 222 mostly US-based providers, virtually all respondents (99.1%) were aware of the recent findings linking anticholinergics to increased dementia risk, and 90.5% reported changing their prescribing habits.

“More prescribers are providing non-anticholinergic treatment options for OAB, particularly mirabegron, after the publication of this literature,” Kerac N. Falk, MD, of Emory University School of Medicine, in Atlanta, Georgia, and colleagues reported in the International Urogynecology Journal.

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Respondents practicing for less than 5 years had 3.4-fold increased odds of changing OAB management compared with those practicing longer. All but 2% of respondents counseled patients differently in light of the dementia research. However, less than half of patients declined anticholinergic medications for OAB after counseling, according to half of surveyed providers.

A non-central nervous system-sparing anticholinergic, such as oxybutynin, tolterodine, and solifenacin, was most commonly prescribed (64.4%) prior to the dementia research. Afterward, providers increasingly prescribed the beta-3-adrenoceptor agonist mirabegron (58.5%). Most respondents prescribed mirabegron more often, and 50.2% increasingly offered third-line therapies.

The more comorbidities and anticholinergic burden a hypothetical patient had, the higher the likelihood that respondents would start with mirabegron or proceed directly to third-line therapies. For patients with hypertension, however, 51.5% of respondents would start with CNS-sparing anticholinergics.

Most respondents (96.6%) also reported that insurance restrictions led to a change in their OAB treatment plans. Nearly two-thirds of providers (61.8%) noted that insurance companies require a trial of anticholinergics before authorizing a beta-3-adrenoceptor agonist, and 70% reported that 2 oral medications must be trialed prior to insurance approval of third-line therapy. Nearly three-quarters of respondents (73.5%) reported difficulty with the prior-authorization process.  

 “While there has been a recent proliferation of literature linking anticholinergic exposure with dementia, there is still a need for continued research into these risks,” according to Dr Falk’s team.


Menhaji K, Cardenas-Trowers OO, Chang OH, Hall EF, Ringel NE, Falk KN. Anticholinergic prescribing pattern changes of urogynecology providers in response to evidence of potential dementia risk. Published online March 8, 2021. Int Urogynecol J. doi:10.1007/s00192-021-04736-8