More than 830,000 adults treated for overactive bladder were followed, and those taking anticholinergic medications did not develop dementia at higher rates than those on newer beta-3 agonists — the drug class long presumed safer for the brain. The study, published November 6 in JAMA Network Open, reverses a belief that has shaped prescribing conversations for years.
That belief matters because it has changed real decisions. Observational studies have linked anticholinergics to dementia, and the concern is often shared with patients, which can make them afraid of medication that might otherwise relieve urgent, frequent, or involuntary urination. Lead author David Sheyn, MD, a urogynecologist at University Hospitals Cleveland Medical Center Urology Institute, said he pursued the question because the disease process behind dementia often begins decades before symptoms appear — while most earlier studies of these bladder drugs followed patients for five years or less.
Anticholinergics Match Beta-3 Agonists on Dementia Rates
- Anticholinergic bladder medications — a foundational, second-line treatment for overactive bladder — showed dementia rates similar to beta-3 agonists in this large electronic-records study.
- Short-term memory or cognition side effects can occur, though not in most people; Dr. Sheyn said these resolve once the medication is stopped.
- He cautioned the findings are new, still need reproduction, and beta-3 agonists remain the preferred choice when possible.
How 830,393 Records Reversed a Presumption
Using Epic Cosmos, a national electronic health record database, a team from University Hospitals Cleveland Medical Center Urology Institute tracked 830,393 adults aged 40 to 90 who had recently begun treatment for overactive bladder during the period from 2012 to 2025. Dementia rates came out similar across drug classes and across individual medications.
The study’s design explains the difference from earlier work. Prior observational studies linking anticholinergics to dementia were shorter; this one followed patients treated between 2012 and 2025, covering the long latency period Dr. Sheyn identified. By comparing one treated class against another rather than against untreated patients, the analysis asked a narrower question: is one bladder drug class riskier than the other? The answer was no.
The Alternative Explanation: Bladder Symptoms as an Early Warning
The findings point somewhere unexpected — toward the bladder itself. The pattern fits the idea that overactive bladder, and the neurologic mechanisms that produce urinary incontinence, may be an early sign of the neurodegenerative processes associated with dementia, rather than the medications driving risk.
“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.”
Dr. Sheyn also offered a reassurance to patients: a brief trial of the medication is unlikely to cause harm, so those who experience meaningful relief of their symptoms can continue taking it without worry.
What the Study Cannot Prove
The limits are stated plainly in the source material. Because the analysis pitted drug classes against each other and left out patients who received no medication at all, it cannot establish that these drugs are risk-free. It also cannot prove that overactive bladder is an early sign of dementia on its own — only that the observed pattern fits that explanation.
Until then, beta-3 agonists are still considered the better choice whenever possible.
Talk to Your Prescriber Before Stopping Bladder Medication
Anticholinergic medications remain associated with short-term side effects related to cognition and memory, though these occur in a minority of people and resolve once the medication is stopped. Anyone experiencing new confusion, memory problems, or cognitive changes while on bladder medication should raise it with their prescriber before stopping treatment on their own. Because guidelines have not changed, treatment decisions belong with a clinician who can weigh individual history — and because the study did not include untreated patients, no one should interpret these results as a statement about starting or continuing any drug without medical advice.
The open question is whether future studies can confirm overactive bladder as an early marker of frontal cortical dysfunction — and whether that, as Dr. Sheyn suggested, could allow clinicians to identify dementia earlier and intervene before the disease process takes hold.
References
- Sheyn, D., et al. (2026). Drug therapies and incidence of dementia among adults with overactive bladder. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.42026 — JAMA Network Open
- University Hospitals Cleveland Medical Center (2026). Source announcement accompanying the study.
