AUGS 2021 Clinical Consensus Statement
Concerns have emerged regarding prolonged use of ACH medication and the associated risk of cognitive impairment, dementia, and Alzheimer’s disease in the general population. In 2021, the American Urogynecologic Society (AUGS) issued a clinical consensus statement on emerging concerns about prolonged use of ACH medications and associated risk of cognitive impairment, dementia, and Alzheimer’s disease in the general population.
The AUGS 2021 clinical consensus statement included the following recommendations: When behavioral therapies fail and pharmacologic treatment of OAB/DO is considered, providers should counsel on the associated risk of cognitive impairment, dementia, and AD associated with ACH medications in comparison with potential benefits related to improvement in quality of life or overall health of the individual patient. To reduce overall ACH burden, the lowest effective dose should be prescribed, and consideration should be given to alternative medications such as β3 agonists. Consideration should be given to changing or decreasing the dosage of other ACH medications a patient may be taking.
The AUGS Choosing Wisely® initiative suggests that use of ACH medication in women older than 70 years should be avoided. When ACH medications have to be used in elderly patients, consideration should be given to use those that have low potential to cross the blood-brain barrier, recognizing that there are limited clinical data. Third-line therapies such as intradetrusor onabotulinumtoxinA or neuromodulation should also be considered in patients not desiring to use medications for OAB/DO because of their adverse effects.
Reference: American Urogynecologic Society Guidelines Committee. Clinical consensus statement: association of anticholinergic medication use and cognition in women with overactive bladder. Female Pelvic Med Reconstr Surg. 2021;27(2):69-71.
