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A study published November 6 in JAMA Network Open found similar dementia rates among adults newly treated for overactive bladder with anticholinergic drugs or beta-3 agonists. It compared the two drug classes, not medication with no treatment, and does not prove either class carries no risk or that bladder symptoms signal dementia.
A study of 830,393 adults newly treated for overactive bladder found similar dementia rates among people prescribed anticholinergic drugs and those prescribed beta-3 agonists, challenging the assumption that the newer drug class carries a lower long-term dementia risk. The research, published November 6 in JAMA Network Open, does not establish that either class is risk-free or that the bladder drugs cause no harm.
Researchers at the University Hospitals Cleveland Medical Center Urology Institute used Epic Cosmos, a national electronic health record database, to study adults aged 40 to 90 who began treatment for overactive bladder between 2012 and 2025. The analysis compared dementia incidence among users of the two drug classes and across individual medications, according to the report.
The authors found dementia rates were similar between the groups. Anticholinergics are an established second-line medication option for overactive bladder; beta-3 agonists are a newer class that had been presumed to be safer for the brain. The study’s result concerns the comparison between these treatments, rather than a comparison with people who received no medication.
Lead author David Sheyn, a urogynecologist at the Cleveland center, said the results are new and need to be reproduced before they prompt a change in clinical guidelines. He also cautioned that beta-3 agonists remain the preferred option when possible. The study does not prove that anticholinergics cannot contribute to dementia risk, nor does it establish that overactive bladder is itself an early dementia symptom.
How the Findings Affect Drug Choices
The findings speak to a concern that can affect treatment decisions: some observational studies have linked anticholinergic medicines with dementia, and the concern may make people reluctant to use a treatment for bladder symptoms. The new study offers a different comparison, finding no higher dementia rate for anticholinergic users than for beta-3 agonist users in the population examined.
That result may inform conversations between patients and clinicians, but it is not a reason to change medication or treatment guidelines on its own. The research did not compare treated patients with untreated patients, and observational records cannot establish that a drug caused or prevented dementia. Choice of treatment still calls for individual medical advice, including discussion of benefits, side effects and alternatives with a qualified professional.
The researchers also raise a possible alternative explanation: overactive bladder or the neurological processes associated with it may be related to changes that precede dementia. If that pattern is borne out in further research, bladder symptoms could potentially help identify some people for earlier evaluation. This study, however, does not show that overactive bladder predicts dementia in an individual or that early intervention would alter disease progression.
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Why Researchers Revisited Bladder Drugs
Anticholinergic drugs are commonly used for overactive bladder and have been linked to dementia in several observational studies. The concern is part of why beta-3 agonists have often been viewed as a potentially safer alternative for the brain. But those earlier studies, Sheyn said, often followed patients for five years or less, while processes associated with dementia may begin decades before symptoms are recognized.
The new analysis extends the period covered by the medical records to patients starting treatment from 2012 through 2025. It compares outcomes among people receiving the two drug classes, rather than testing whether either treatment is safer than no medication. The distinction matters: similar rates between two groups do not establish that the rate in either group is the same as it would have been without treatment.
Sheyn said the possibility that overactive bladder could be an early marker of neurological change is a hypothesis that fits the observed pattern, not a conclusion proved by the study. The work is published as “Drug therapies and incidence of dementia among adults with overactive bladder” in JAMA Network Open, with DOI 10.1001/jamanetworkopen.2026.42026.
“This is potentially good news.”
— David Sheyn, lead author and urogynecologist at University Hospitals Cleveland Medical Center Urology Institute
Limits of the Dementia Comparison
The study compared people prescribed anticholinergics with people prescribed beta-3 agonists; it did not include a no-medication group. It therefore cannot determine whether either class increases dementia risk relative to receiving no drug, or rule out a risk shared by both groups. The source report also does not provide specific dementia rates, effect estimates or details about how long individuals were followed.
Because the research used electronic health records and was observational, it cannot by itself establish cause and effect. The reported similarity between drug classes does not prove that the medicines have identical effects for every patient. It also cannot establish that overactive bladder is an early warning sign of dementia; that remains a proposed explanation for the pattern.
Short-term cognitive or memory side effects associated with anticholinergics remain a separate concern. Sheyn said such effects do not occur in most people and, when they do, are expected to resolve after stopping the medicine. The study’s long-term comparison does not settle how frequently these short-term effects occur or which treatment is most suitable for a particular patient.
Replication Before Guideline Changes
The next step is for other researchers to test whether the similar dementia rates are seen in independent patient populations and with other study designs. The report says the findings need reproduction before clinical guidelines change; it does not identify a date for that work or for any guideline review.
Researchers may also need to investigate whether overactive bladder symptoms are associated with neurological changes that precede dementia, and whether such symptoms can provide useful information beyond established assessments. Until more evidence is available, patients should not treat the study as proof that either drug class is risk-free or as a reason to stop or switch medication. People with questions about overactive bladder treatment should discuss their options with a qualified clinician.
Key Questions
What did the study find?
It found similar dementia rates among adults newly treated for overactive bladder with anticholinergic drugs and those treated with beta-3 agonists.
Does this prove anticholinergic drugs do not increase dementia risk?
No. The study compared two treatment groups and included no group taking no medication. It cannot rule out risk from either class or prove that the drugs have no effect.
Does overactive bladder mean someone may have dementia?
No such conclusion can be drawn from this study. The authors raise a possible connection between bladder symptoms and neurological processes, but the research does not show that overactive bladder predicts dementia in an individual.
Should patients change their medication?
The study does not provide a basis for changing treatment without medical advice. Its lead author said the results need replication before guidelines change; patients should discuss treatment choices and side effects with a qualified clinician.
Source: news-medical.net
