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New research published in JAMA Network Open finds anticholinergic medications, commonly prescribed for overactive bladder (OAB), may not increase dementia risk after all compared to beta-3 agonists, the newer drug class that has been presumed to be safer for the brain.

Researchers at University Hospitals Cleveland Medical Center Urology Institute used Epic Cosmos, a national electronic health record database, to follow 830,393 adults ages 40 to 90 who were newly treated for OAB between 2012 and 2025. Dementia rates were similar across drug classes and individual medications.

The study demonstrates that in patients with OAB, anticholinergic medication, a foundational, second-line pharmacological treatment for the condition, does not carry a greater long-term risk of dementia than beta-3 agonists. Drugs in the latter class were previously believed to pose a lower risk.

This reverses a long-held belief that one group of drugs is riskier than the other; instead, the findings align with the idea that OAB itself and the neurologic mechanisms that lead to urinary incontinence may be early warning signs of neurodegenerative processes associated with dementia.

According to lead author David Sheyn, M.D., a urogynecologist at University Hospitals Cleveland Medical Center Urology Institute, this is potentially good news: "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 on the disease process."

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