Incontinence Drugs Linked to Memory Loss in Seniors
| April 17, 2008 Associated Press |
CHICAGO — Commonly used incontinence drugs may cause memory
problems in some older people, a study has found.
"Our message is to be careful when using these medicines," said U.S. Navy
neurologist Dr. Jack Tsao, who led the study. "It may be better to use
diapers and be able to think clearly than the other way around."
Urinary incontinence sometimes can be resolved with non-drug
treatments, he added, so patients should ask about alternatives. Exercises,
biofeedback and keeping to a schedule of bathroom breaks work for many.
U.S. sales of prescription drugs to treat urinary problems topped $3 billion
in 2007, according to IMS Health, which tracks drug sales. Bladder control
trouble affects about one in 10 people age 65 and older, according to the
National Institute on Aging, which helped fund the study. Women are more
likely to be affected than men. Causes include nerve damage, loss of
muscle tone or, in men, enlarged prostate.
The research began after Tsao met a 73-year-old patient. Shortly after
starting an incontinence drug, she began hallucinating conversations with
dead relatives and having memory problems. Her thinking improved when
she stopped the drug for several months.
Tsao and his colleagues knew of similar reports. They decided to look at a
large group of people to see if they could measure an effect of these and
other medications that affect acetylcholine, a chemical messenger that
shuttles signals through the brain and the rest of the nervous system. The
drugs block some nerve impulses, such as spasms of the bladder.
The findings, released Thursday at a meeting of the American Academy of
Neurology, come from an analysis of the medication use and cognitive test
scores of 870 older Catholic priests, nuns and brothers who participated in
the Religious Orders Study at Chicago's Rush University Medical Center.
The average age was 75.
Researchers tracked them for nearly eight years, testing yearly for
cognitive decline. They asked them to recite strings of numbers backward
and forward, to name as many different kinds of fruit as they could in one
minute and to complete other challenges during the annual testing.
Nearly 80 percent of the study participants took one or more of a class of
drugs called anticholinergics, including drugs for high blood pressure,
asthma, Parkinson's disease and incontinence drugs such as Detrol and
Ditropan.
The people who took the drugs had a 50 percent faster rate of cognitive
decline compared to those who didn't take any. The researchers
considered other risk factors for memory loss, such as age, and still found
the link. The researchers found no increased risk for the memory-robbing
disorder Alzheimer's in people taking the drugs.
The incontinence drugs were among the most potent and were the most
frequently taken of all the anticholinergics in the study. That's why the
researchers believe they are driving the memory problems, Tsao said.
Some experts said the research supports previous observations and is
helpful because it measures the size of the effect.
"This paper adds important new data to the picture," said Dr. Elaine Perry
of Newcastle University in England, who has done similar research but was
not involved in the new study.
More research is needed on the effects of anticholinergic drugs on
memory, Tsao said. Doctors should do baseline cognitive testing on
patients before prescribing the drugs, he recommended.
A representative of Pfizer Inc., maker of the top-selling Detrol, said patients
should always talk to their doctors about problems while taking medication.
"Detrol has been on the market since 1998. It has been prescribed more
than 100 million times worldwide," said Ponni Subbiah, Pfizer's vice
president of medical affairs, in an e-mail response to questions.
Confusion and memory impairment were added to prescribing information
for Detrol in 2006, Subbiah said, after some patients reported the problems.
Since the reports weren't part of a medical study, "the frequency of events
and the role of Detrol in their causation cannot be reliably determined," he
said.
problems in some older people, a study has found.
"Our message is to be careful when using these medicines," said U.S. Navy
neurologist Dr. Jack Tsao, who led the study. "It may be better to use
diapers and be able to think clearly than the other way around."
Urinary incontinence sometimes can be resolved with non-drug
treatments, he added, so patients should ask about alternatives. Exercises,
biofeedback and keeping to a schedule of bathroom breaks work for many.
U.S. sales of prescription drugs to treat urinary problems topped $3 billion
in 2007, according to IMS Health, which tracks drug sales. Bladder control
trouble affects about one in 10 people age 65 and older, according to the
National Institute on Aging, which helped fund the study. Women are more
likely to be affected than men. Causes include nerve damage, loss of
muscle tone or, in men, enlarged prostate.
The research began after Tsao met a 73-year-old patient. Shortly after
starting an incontinence drug, she began hallucinating conversations with
dead relatives and having memory problems. Her thinking improved when
she stopped the drug for several months.
Tsao and his colleagues knew of similar reports. They decided to look at a
large group of people to see if they could measure an effect of these and
other medications that affect acetylcholine, a chemical messenger that
shuttles signals through the brain and the rest of the nervous system. The
drugs block some nerve impulses, such as spasms of the bladder.
The findings, released Thursday at a meeting of the American Academy of
Neurology, come from an analysis of the medication use and cognitive test
scores of 870 older Catholic priests, nuns and brothers who participated in
the Religious Orders Study at Chicago's Rush University Medical Center.
The average age was 75.
Researchers tracked them for nearly eight years, testing yearly for
cognitive decline. They asked them to recite strings of numbers backward
and forward, to name as many different kinds of fruit as they could in one
minute and to complete other challenges during the annual testing.
Nearly 80 percent of the study participants took one or more of a class of
drugs called anticholinergics, including drugs for high blood pressure,
asthma, Parkinson's disease and incontinence drugs such as Detrol and
Ditropan.
The people who took the drugs had a 50 percent faster rate of cognitive
decline compared to those who didn't take any. The researchers
considered other risk factors for memory loss, such as age, and still found
the link. The researchers found no increased risk for the memory-robbing
disorder Alzheimer's in people taking the drugs.
The incontinence drugs were among the most potent and were the most
frequently taken of all the anticholinergics in the study. That's why the
researchers believe they are driving the memory problems, Tsao said.
Some experts said the research supports previous observations and is
helpful because it measures the size of the effect.
"This paper adds important new data to the picture," said Dr. Elaine Perry
of Newcastle University in England, who has done similar research but was
not involved in the new study.
More research is needed on the effects of anticholinergic drugs on
memory, Tsao said. Doctors should do baseline cognitive testing on
patients before prescribing the drugs, he recommended.
A representative of Pfizer Inc., maker of the top-selling Detrol, said patients
should always talk to their doctors about problems while taking medication.
"Detrol has been on the market since 1998. It has been prescribed more
than 100 million times worldwide," said Ponni Subbiah, Pfizer's vice
president of medical affairs, in an e-mail response to questions.
Confusion and memory impairment were added to prescribing information
for Detrol in 2006, Subbiah said, after some patients reported the problems.
Since the reports weren't part of a medical study, "the frequency of events
and the role of Detrol in their causation cannot be reliably determined," he
said.
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