Tough choice, isn't it? But some commonly used incontinence drugs may cause memory problems in some older people, according to a new study. "Our message is to be careful when using these medicines," US Navy neurologist Jack Tsao, the lead author, tells the
Associated Press. "It may be better to use diapers and be able to think clearly than the other way around."The research began after Tsao met a 73-year-old patient who, shortly after starting an incontinence drug, began hallucinating conversations with dead relatives and having memory problems. Her thinking improved when she stopped the drug for several months. Aware of similar reports, Tsao and his colleagues looked at a large group of people to measure the effect of these and other med have on acetylcholine, a chemical messenger that shuttles signals through the brain and the rest of the nervous system, the AP writes. The drugs block some nerve impulses, such as spasms of the bladder.
The findings, which were released 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, the AP writes.
Nearly 80 percent of the 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 drug. The researchers considered other risk factors for memory loss, such as age, and still found the link, but found no increased risk for 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 tells the AP.
US sales of prescription drugs to treat urinary problems topped $3 billion in 2007, according to IMS Health. 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 AP notes.
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," Elaine Perry of Newcastle University in England, who has done similar research but was not involved in the new study, tells the AP.
More research is needed on the effects of anticholinergic drugs on memory, Tsao tells the AP, but adds that docs should do baseline cognitive testing on patients before prescribing the drugs.
An exec at Pfizer, which makes Detrol, says patients should always talk to their docs about problems while taking medication. "Detrol has been on the market since 1998. It has been prescribed more than 100 million times worldwide," Ponni Subbiah, Pfizer's vp of medical affairs, in an e-mail to the AP. Confusion and memory impairment were added to Detrol prescribing info in 2006, Subbiah adds, 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 writes.
Source: The Associated Press
14 Comments
Related to this Post, the disease of OAB and its prevelance, according to researchers, et. al., is possibly not a disease by definition, yet manufacturers of such drugs as mentioned were determined that OAB is a very concerning and important flaw that requires correction. It is now a new disease state created by greed instead of a health focus. Some blame Fred Hassan for the massive growth of OAB drugs in a short period of time.
Have to go now to take my reality reducer to improve my fictional reality amount in my cognition so I will be viewed as one within normal limits and without flaws.
Not to plug a book, but Melody P's latest is particularly interesting on the OAB story.
No doubt there are people who really do need some help with "control." But the "gotta go" imagery, and the anxiety states depicted, arencertainly compelling. Sometime along the way, we've all been in a "gotta go" situation. It would, indeed, be a pisser if that were constant.
Ed,
Maybe I missed it, but I didn't see you highlite any other stories from AAN. Why did you pick this one?
Jack
Hi Jack,
I have written about studies from AAN previously, you're right. I seized on this after seeing the Associated Press story simply because I found it interesting. No other reason, though. Anything else that I should have noted?
Regards ed
Given the facts that (a) the current mainstays of treatment for Alzheimer's are drugs that increase the levels and activity of acetylcholine in the brain; and (b) anticholinergics reduce the activity of acetylcholine, there is certainly a biological plausibility to this.
Issues of whether OAB is an actual disorder or pharmaceutical "disease mongering" are, IMHO, beside the point. The news here is that a new and concerning side effect of a widely used class of drugs has been discovered (perhaps a little later than it might have been, given the mechanistic simplicity of the hypothesis) and the implications for pharmacotherapy in those suffering from dementia need careful consideration.
BTW, cholinesterase inhibitors like Aricept are not thought to address the underlying mechanisms of Alzheimer's, merely to partially address one of the neurotransmitter deficits that the disease creates. So Detrol et al., shouldn't be thought of as causing dementia, merely with the potential to worsen the course of pre-existing dementia.
Because when I go to AAN's website and look up press releases this week I get this list (below). Many of these are applicable to the pharmaceutical industry.
I'd say the one you chose to highlite is about tied for being the most drug-negative. I think it's part of the media's general bias (and pharmalot in particular) of picking up on the negative or pseudo-negative.
If the scandal was like the Vytorin scandal I can understand that. That's the real possibility of companies behaving badly, and with drugs that command mucho-big $$. People should know about. Without researching it furhter, this seems like small potatoes to me - to highlite this seems like a deliberate search for "bad" news.
I don't work in OAB, so I can't say with the same certainty as Dan, but it definetly seems like it could be a real thing.
Breastfeeding While Taking Seizure Medicine Does Not Appear to Harm Children (Apr 18) Children with Migraine at Increased Risk of Sleep Disturbances (Apr 18) Overuse of Codeine, Oxycodone and Barbiturates Increases Risk of Chronic Migraine (Apr 18) Using Anticholinergic Drugs May Increase Cognitive Decline in Older People (Apr 18) Migraine Frequency Linked with Women’s Risk of Cardiovascular Disease (Apr 18) New Details Presented in Outbreak in Pork Processing Plant Workers (Apr 17) People with Cardiac Arrest Less Likely To Survive If Admitted on Weekend (Apr 17) Chemical Exposure May Increase Risk of ALS (Apr 17) High Cholesterol in Your 40s Increases Risk of Alzheimer's Disease (Apr 17) Alzheimer’s Starts Earlier for Heavy Drinkers, Smokers (Apr 17) Women More Likely to Comply with Stroke Prevention Despite Being More Depressed (Apr 17) Men More Likely to Have Problems with Memory and Thinking Skills (Apr 17) Chemotherapy May Not Affect Memory in Breast Cancer Patients (Apr 16) How Big Is Your Brain? Its Size May Protect You from Memory Loss (Apr 16) Vitamin E May Help Alzheimer’s Patients Live Longer (Apr 16) AAN Foundation and The ALS Association Honor Philadelphia Researcher for ALS Research (Apr 16) AAN Foundation and National Multiple Sclerosis Society Honor Boston Researcher (Apr 16) Prolonged Fasting Increases Risk of Rare Type of Stroke (Apr 16) Oral Drug, FTY720, Reduces Disease Activity in Multiple Sclerosis (Apr 16) High Blood Pressure May Protect Against Migraine (Apr 16) Kids with Autism May Have Gene That Causes Muscle Weakness (Apr 14)
Ditropan has been llong known to have significant CNS effects in the elderly. In fact, it is included on the Beer's list, which identifies drugs that should be used with caution in the elderly. I'm not sure why this researcher seemed surprised by this finding.
One other note...it looks as though this study is not powered enough to make strong conclusions about any individual drug. In this instance, the entire set of drugs is indicted. It would be valuable to know which of these drugs had the greatest impact and which had the least. It could be that some of the drugs uses for OAB, for instance, have more or less effect than others. That information would be most useful to prescribers and patients alike.
Medicatins have helped many, but at the same time, pharmceutical companies do not tell the truth and the doctors are protecing the patients that are being seruiously harmed leading to fatality. Though Pharmalot is informative---does this site change the issues that are effecting the adverse side effects that are causing health problems for all Americnas? New Jersey Patiebnt Safety Act is in name only and is not protecting the people. Does any anyone have the answer? Discussing the issues here is not changing our health care system. We need action and thruth and honesty.
Medicatins have helped many, but at the same time, pharmceutical companies do not tell the truth and the doctors are protecing the patients that are being seruiously harmed leading to fatality. Though Pharmalot is informative---does this site change the issues that are effecting the adverse side effects that are causing health problems for all Americnas? New Jersey Patiebnt Safety Act is in name only and is not protecting the people. Does any anyone have the answer? Discussing the issues here is not changing our health care system. We need action and truth and honesty.
Dan, you have never had urine running down your legs as you sprint for the bathroom. I have, so don't tell me about disease-mongering. I personally couldn't care less about men and their erections.
Dan, you have never had urine running down your legs as you sprint for the bathroom. I have, so don't tell me about disease-mongering. I personally couldn't care less about men and their erections. Lilli, this isn't about fatalities or pharma fraud. Your constant mantra is tiresome. This is about being stuck between a rock and a hard place. Maybe a 75 yo in a nursing home doesn't mind diapers, but it would make my life complicated.
Is Vesicare the same definition as Detrol?
I, for one, will try going with out Detrol, as have a mild cognitive Impairment dx'd recently. Now I sure do wonder as was on 11 medications. I am down two of those now. One is Detrol.I am trying going off it to see if improvement and then ultimately may go off another to help Memory. I am age 83 with this newest DX. so will see how all comes out.