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Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

International Neurourology Journal 2020년 24권 3호 p.231 ~ 240
김연주, 태범식, 배재현,
소속 상세정보
김연주 ( Kim Yeon-Joo ) - Daegu Fatima Hospital Department of Urology
태범식 ( Tae Bum-Sik ) - Korea University College of Medicine Korea University Ansan Hospital Department of Urology
배재현 ( Bae Jae-Hyun ) - Korea University College of Medicine Korea University Ansan Hospital Department of Urology

Abstract


Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

키워드

Adrenergic alpha-antagonists; 5-Alpha reductase inhibitors; Cholinergic antagonists; Adrenergic beta-3 agonists; Cognitive dysfunction; Dementia

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