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A study published November 6 in JAMA Network Open found similar dementia rates among adults newly treated for overactive bladder with anticholinergics and beta-3 agonists. The comparison does not show that either class is risk-free, and researchers say the findings need replication before clinical guidance changes.
A study of 830,393 adults newly treated for overactive bladder found similar dementia rates among those prescribed anticholinergic drugs and those prescribed beta-3 agonists, challenging the assumption that the newer drug class carries a lower long-term dementia risk. Routine blood tests may offer clues to future dementia risk. The research, published November 6 in JAMA Network Open, compares the two treatments but does not establish that either is free of 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 treatment for overactive bladder between 2012 and 2025. The study examined dementia incidence across the two medication classes and individual drugs. According to the report, rates were similar between the groups.
Anticholinergic medicines are a long-used, second-line treatment for overactive bladder. Beta-3 agonists are a newer class that has been considered a safer option for the brain. The study’s result challenges the idea that anticholinergics carry a greater long-term dementia risk than beta-3 agonists among people treated for the bladder condition; it does not show that medication has no effect compared with taking no treatment.
Lead author David Sheyn, a urogynecologist at the institute, said the results are preliminary and must be reproduced before clinical guidelines change. He also noted that short-term cognitive and memory side effects can occur with anticholinergics, although the source report says they do not affect most people and can resolve after stopping the medicine. Patients should discuss treatment choices and side effects with a qualified health professional.
What the Findings Mean for Treatment
Concerns about dementia have made some patients wary of taking bladder medicines that could ease overactive bladder symptoms. Similar dementia rates in this study may help inform those conversations, but they do not settle the safety question: the researchers compared people taking two active drug classes, not medication users with people who took no medication.
The result also matters because it points to a different possible explanation for the association seen in earlier research. If dementia rates are similar across drug classes, the bladder condition or neurological changes related to it could contribute to the pattern. That possibility could make overactive bladder relevant to future research into early signs of dementia, but this study does not prove that the condition signals neurodegeneration or that it can identify dementia in an individual.
For now, the report does not support changing treatment guidance on its own. Sheyn said beta-3 agonists remain the preferred choice when possible, while stressing that the new findings need confirmation.
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Why Researchers Compared These Drugs
Several observational studies have linked anticholinergic medicines with dementia, a concern that clinicians may raise with patients considering treatment for overactive bladder. Sheyn said he pursued the question partly because the processes associated with dementia may begin decades before symptoms appear, while many earlier studies of these bladder drugs followed patients for five years or less.
The new analysis used records spanning 2012 to 2025 and compared patients who started anticholinergics with those who started beta-3 agonists. Its findings do not erase earlier observational evidence. Rather, they add a large comparison between treatment groups and raise the possibility that overactive bladder itself, or neurological processes associated with it, may help explain why dementia appears in these populations.
The study is reported as Sheyn and colleagues’ 2026 paper, “Drug therapies and incidence of dementia among adults with overactive bladder,” published in JAMA Network Open (DOI: 10.1001/jamanetworkopen.2026.42026).
““This is potentially good news.””
— David Sheyn, lead author and urogynecologist at University Hospitals Cleveland Medical Center Urology Institute
What the Study Cannot Establish
The study compared two groups of people receiving treatment and did not include an untreated comparison group. It therefore cannot establish whether either drug class increases dementia risk compared with taking no medication, or prove that the medicines carry no risk. The source material also does not provide the absolute dementia rates or detailed effect estimates, so the size of any difference cannot be assessed here.
The findings are observational and do not show that overactive bladder causes dementia or is an early symptom in every affected person. The idea that the condition could reflect early neurological changes is an interpretation consistent with the pattern, not a demonstrated mechanism. The study’s results are new and require reproduction before they can support changes to clinical guidelines.
Short-term cognitive or memory side effects remain a separate concern from the study’s long-term dementia comparison. People considering or using these medicines should seek advice from a qualified clinician about their individual circumstances.
Replication Before Guidance Changes
The next step identified by Sheyn is reproducing the results in further research. The available report does not set out a timeline for replication or name a specific next study. Until findings are confirmed and considered alongside other evidence, current treatment guidance should not be treated as changed by this analysis alone.
Further research would need to clarify how dementia rates compare with those of people who do not take either drug class, and whether overactive bladder can reliably indicate early neurological changes. In the meantime, patients can discuss the benefits, alternatives and possible short-term side effects of treatment with their clinician.
Key Questions
What did the study find about overactive bladder drugs and dementia?
In a study of 830,393 adults newly treated for overactive bladder, dementia rates were similar among people prescribed anticholinergics and those prescribed beta-3 agonists. The comparison does not establish that either class is risk-free.
Does this prove anticholinergic drugs do not increase dementia risk?
No. The study compared two medication classes and had no group taking neither. It cannot show whether either class changes risk compared with no medication, and the results need replication.
Does overactive bladder mean someone may have dementia?
No such conclusion can be drawn from this study. Researchers said the pattern could fit the possibility that overactive bladder is related to early neurological changes, but the study does not prove that connection or make overactive bladder a dementia test.
Should patients change their medication based on these findings?
The report says the findings are too new to justify a change in clinical guidelines. Patients should discuss treatment decisions and possible side effects with a qualified health professional.
Source: news-medical.net
