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A study published in JAMA Network Open found similar dementia rates among adults newly treated for overactive bladder with anticholinergic drugs and beta-3 agonists. The observational study compared medication groups, not medication users with untreated patients, so it cannot establish that either class carries no dementia risk.
A study of 830,393 adults treated for overactive bladder found similar dementia rates among people prescribed anticholinergic medications and those prescribed beta-3 agonists, challenging the assumption that the newer drug class is safer for the brain. The research, published November 6 in JAMA Network Open, does not show that either treatment carries no risk, because it compared the two drug groups rather than medication users with people who received no treatment.
Researchers at the University Hospitals Cleveland Medical Center Urology Institute used Epic Cosmos electronic health records to study adults aged 40 to 90 who began overactive bladder treatment between 2012 and 2025. The analysis compared dementia incidence among users of anticholinergics, a long-established treatment class, and beta-3 agonists, which have been presumed to pose less risk to the brain.
The report says dementia rates were similar across the two drug classes and individual medications. The authors’ finding is specific to this comparison: it does not establish that the drugs are risk-free, nor does it determine whether taking either medicine changes a person’s dementia risk compared with taking no medication.
Lead author David Sheyn, a urogynecologist at the Cleveland center, said the results are preliminary and should be reproduced before they prompt changes to clinical guidelines. He also cautioned that anticholinergics can have short-term effects on cognition and memory. The study’s findings do not settle the question of how clinicians should choose medication for an individual patient.
What Similar Rates Mean for Treatment
The findings could affect discussions with patients who need relief from overactive bladder symptoms but are concerned about a possible long-term dementia risk from anticholinergics. Earlier observational studies have linked these medications to dementia, and the concern may discourage some people from using treatment, according to the report. The new comparison offers evidence that, in this large study, dementia rates were not higher for anticholinergic users than for beta-3 agonist users.
That is not the same as proving the medicines have no effect. The results may inform future research and patient conversations, but they do not provide a basis on their own to abandon existing prescribing guidance. Sheyn said beta-3 agonists remain the preferred option when possible, while emphasizing that the new findings need replication. Medication choices and concerns about side effects should be discussed with a qualified health professional.
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Why Researchers Compared These Drugs
Overactive bladder can be treated with different medication classes, including anticholinergics, which are commonly prescribed, and beta-3 agonists. Concern about anticholinergics has been shaped by observational research linking their use with dementia. The report says those earlier studies often followed patients for five years or less, while dementia-related processes may begin decades before symptoms become apparent.
Sheyn said he pursued the study partly because of that gap in follow-up and because patients may worry that bladder medication could harm their cognition. The researchers also raised a different possible explanation for the observed pattern: overactive bladder itself, or neurological processes related to urinary symptoms, could be associated with the development of dementia. This study does not establish that explanation; it says the pattern is consistent with it.
The paper is titled “Drug therapies and incidence of dementia among adults with overactive bladder” and appeared in JAMA Network Open. Its DOI is 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
Because the researchers compared people using two drug classes and included no untreated comparison group, the study cannot show whether either medication increases or decreases dementia risk relative to taking no medication. As an observational analysis of health records, it also cannot establish that a drug caused or prevented dementia.
The report does not provide enough detail to determine how differences in patients’ health, treatment choices, or other factors may have affected the results. It also does not prove that overactive bladder is an early sign of dementia. Whether the similar rates will be reproduced in other populations and over longer follow-up remains unknown.
Short-term cognitive or memory side effects are a separate concern from dementia incidence. Sheyn said such effects can occur with anticholinergics; patients should seek advice from a qualified professional about symptoms, treatment choices, and whether to continue a medication.
Replication Before Guidance Changes
The next step is for other researchers to replicate the findings, as Sheyn said is needed before clinical guidelines change. Further studies could help clarify how long-term outcomes compare across treatments and whether overactive bladder symptoms are associated with neurological changes independently of medication use.
For now, the study adds evidence to a debate about dementia risk but does not settle it. Patients should not stop or change prescribed medication based on the study alone; they can discuss the research and any cognitive or memory symptoms with their health professional.
Key Questions
Did the study find that overactive bladder drugs do not cause dementia?
No. It found similar dementia rates between anticholinergic and beta-3 agonist users. Because it did not compare users with people taking no medication and was observational, it cannot show that either class carries no risk or determine whether a drug caused dementia.
Which medications were compared?
The study compared anticholinergics, a commonly used overactive bladder treatment, with beta-3 agonists, a newer class often presumed to be safer for the brain.
Does the study change which drug class is preferred?
Not on its own. Lead author David Sheyn said the findings need to be reproduced before clinical guidelines change and that beta-3 agonists remain the preferred choice when possible.
Could overactive bladder be an early sign of dementia?
The researchers said that possibility fits the pattern they observed, but the study does not prove that overactive bladder is an early dementia symptom. More research is needed to test that explanation.
What should someone taking an overactive bladder medication do?
The report does not advise patients to stop or change treatment. Anyone concerned about dementia risk or experiencing cognitive or memory symptoms should discuss their medication with a qualified health professional.
Source: news-medical.net
