Patients should not have to choose between bladder control and brain function, but some medications prescribed for overactive bladder can have a negative impact on memory and concentration.
In a recent study, researchers followed more than 800 older Catholic nuns, priests and brothers for eight years, testing mental function annually. Those who were taking medications called anticholinergics (drugs for overactive bladder, Parkinson’s disease, stomach cramps, motion sickness and ulcers) had greater declines in test scores.
This finding should not come as a great surprise to doctors. The neurochemical acetylcholine is essential for nervous system function. Anticholinergic drugs interfere with its ability to bind to nerve cells.
Loss of bladder control is extremely distressing to older people and their families. That’s why doctors prescribe drugs like Detrol (tolterodine) or Ditropan (oxybutynin). They don’t always warn people, however, about side effects such as disorientation, drowsiness, insomnia, agitation or hallucinations.
One reader described her mother’s situation: “My mother was recently prescribed Detrol. She has become increasingly disoriented and has a lot of trouble sleeping. It’s really heartbreaking to see her go this way in bits and pieces.
“She has no appetite or energy but they keep piling on more and more medication. Her kidney doctor said that the Detrol had no side effects, but a regular doctor said it could cause disorientation. Her quality of life (and ours) is suffering. She is becoming less and less able to take care of herself.”
A study at Wake Forest University School of Medicine found that older people taking such anticholinergic medicines slow down physically as well as mentally. They walk slower and are less able to care for themselves.
Drugs for overactive bladder are not the only problem. A surprising number of medications can interfere with the action of acetylcholine, leading to negative effects for both physical and mental wellbeing.
In addition to medications for bladder control, many old-fashioned antidepressants such as amitriptyline (Elavil) also have anticholinergic activity. These drugs are not prescribed as much for depression these days, but they are increasingly used to treat debilitating nerve pain.
More surprisingly, the antihistamine diphenhydramine (Benadryl) also has significant anticholinergic action. Because this drug causes drowsiness, it is frequently found in over-the-counter sleep medications such as Nytol, Simply Sleep, Sominex and Unisom SleepGels. It is also a key ingredient in popular nighttime pain relievers such as Advil PM, Alka-Seltzer PM, Excedrin PM or Tylenol PM.
Many other medications also have some anticholinergic activity. The list is too long to reproduce here, but some of the medicines include scopolamine (Transderm Scop) for motion sickness, prednisone for inflammation, nifedipine (Adalat, Procardia) for blood pressure control and phenobarbital for sedation.
No one should stop such medications without consulting a physician, but older people experiencing symptoms of disorientation or memory loss should have their medications evaluated. A family member may need to request this if the patient is unable to do so.