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A study published Nov. 6 in JAMA Network Open found similar dementia rates among adults with overactive bladder who started anticholinergic drugs and those who started beta-3 agonists. The observational study does not show that either class carries no dementia risk, and its authors say the results need replication before clinical guidance changes.
A study of 830,393 adults with overactive bladder found similar dementia rates among people newly treated with anticholinergic drugs and those given beta-3 agonists, challenging the assumption that the newer drug class is safer for the brain. The research, published Nov. 6 in JAMA Network Open, compares the two medication groups but does not establish that either treatment carries no dementia risk.
Researchers at the University Hospitals Cleveland Medical Center Urology Institute used the Epic Cosmos electronic health-record database to follow adults aged 40 to 90 who began overactive bladder treatment from 2012 through 2025. The study compared dementia incidence across the two medication classes and among individual drugs. The reported rates were similar between groups.
Anticholinergic medicines are an established, second-line drug treatment for overactive bladder. Beta-3 agonists are a newer class that has often been viewed as a lower-risk option for cognition. The authors’ findings do not show that anticholinergics are safer, or that beta-3 agonists raise dementia risk; they show that this study did not find a higher dementia rate in the anticholinergic group relative to the comparison group.
The study was observational and included people who received one of the medications, not a group of patients who took no OAB drug. It therefore cannot determine whether either class changes risk compared with no medication. The report also does not establish that overactive bladder itself causes or predicts dementia. The research was published as “Drug therapies and incidence of dementia among adults with overactive bladder” in JAMA Network Open (DOI: 10.1001/jamanetworkopen.2026.42026).
How the Findings May Affect OAB Treatment
The findings speak to a concern that can affect whether patients accept treatment for a condition that disrupts daily life. The report notes that earlier observational studies linked anticholinergic medicines with dementia, a concern that may make patients wary of using drugs that could ease bladder symptoms. This new comparison offers evidence that, among the patients studied, dementia rates were not higher for anticholinergic users than for beta-3 agonist users.
That is not the same as proving long-term safety. Lead author David Sheyn said the results are new and need to be reproduced before clinical guidelines change. He also cautioned that beta-3 agonists remain the preferred choice when possible. Separately, anticholinergic drugs can have short-term effects on cognition and memory, according to Sheyn; the study’s dementia comparison does not rule out those effects or mean an individual patient should change medication without clinical advice.
The research also points to a different possibility: urinary symptoms might sometimes be associated with neurologic changes that precede dementia, rather than being caused by a particular drug. That interpretation is a hypothesis consistent with the pattern, not a conclusion proven by the study. For clinicians and patients, the practical message is narrower: the results may ease one specific concern, but they do not settle the risks and benefits for every person.
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Why Researchers Compared These Drug Classes
Overactive bladder causes urinary urgency and related symptoms for which medication may be considered. Anticholinergics have long been used as a pharmacological option, while beta-3 agonists have been regarded as a potentially safer alternative for the brain. The question is consequential because dementia develops over a long period, making it difficult to distinguish a drug effect from other factors in shorter follow-up studies.
Sheyn said he pursued the question because the processes associated with dementia may begin decades before dementia symptoms appear, while many prior studies linking bladder medicines to dementia followed patients for five years or less. The new analysis drew on records spanning 2012 to 2025 and included a much larger group of patients. Its scale and duration add evidence to the comparison, but the observational design still limits what researchers can infer about cause and effect.
The authors’ proposed alternative explanation is that overactive bladder, or neurologic mechanisms linked to urinary incontinence, could in some cases be an early signal of neurodegenerative processes. The study did not test whether OAB independently predicts dementia or identify a mechanism connecting the conditions. That possibility requires separate research.
“This is potentially good news.”
— David Sheyn, lead author and urogynecologist at the University Hospitals Cleveland Medical Center Urology Institute
Limits of the Dementia Comparison
The study compared people taking anticholinergics with people taking beta-3 agonists; it did not include an untreated comparison group. It therefore cannot establish whether either class raises or lowers dementia risk relative to taking no OAB medication. Because the research is observational, it also cannot prove that a drug caused or prevented dementia.
The report does not provide evidence that OAB itself is an early dementia marker; it says the findings are consistent with that possibility. The specific reasons for the similar rates, and whether the pattern holds in other populations or with longer follow-up, remain open questions. The study’s findings also do not settle the risks of short-term cognitive side effects, which Sheyn says can occur with anticholinergics.
Replication Before Guidance Changes
Researchers will need to reproduce the findings in other patient groups and study designs before they can support a change in clinical guidelines. Further work could also examine whether OAB symptoms precede dementia in some patients and whether that relationship can be separated from medication effects and other factors.
For now, the study does not establish a new prescribing rule. People considering or taking OAB medication should discuss its possible benefits and risks with a qualified health professional, particularly if they notice cognitive symptoms or have concerns about long-term use. Any choice between drug classes remains a clinical decision rather than a conclusion dictated by this single study.
Key Questions
What did the study find about OAB drugs and dementia?
Among 830,393 adults newly treated for overactive bladder, reported dementia rates were similar for those taking anticholinergics and those taking beta-3 agonists. The study did not show that either class has no dementia risk.
Does this prove anticholinergic drugs cannot cause dementia?
No. The research was observational and compared two groups of medication users. It did not include people taking no OAB medication, and it cannot prove that a drug caused or prevented dementia.
Does the study mean beta-3 agonists are no longer preferred?
No change in guidance was established. Lead author David Sheyn said the findings need replication before guidelines change and said beta-3 agonists remain the better choice whenever possible.
Could overactive bladder be an early sign of dementia?
The authors say the pattern is consistent with that possibility, but the study did not prove that OAB predicts dementia or identify a cause. Further research is needed.
Source: news-medical.net
