Dual Tx of incontinence, dementia linked to functional decline

Older nursing home residents who take cholinesterase inhibitors for dementia and older anticholinergic agents for incontinence concurrently have a 50% faster decline in function than those who are being treated only for dementia, according to a study led by researchers at Wake Forest University School of Medicine, Winston-Salem, NC.

“It is likely that the oppositional effects of the drugs contributed to the accelerated decline,” said first author Kaycee M. Sink, MD. “Over a year’s time, the decline we observed would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity.”

The study involved 395 nursing home residents in Indiana who were taking medications for both conditions and 3,141 who were taking only a dementia medication. Patients were 65 years and older and had had at least two consecutive prescriptions for cholinesterase inhibitors. About 10% of the residents were also taking either oxybutynin (Ditropan) or tolterodine (Detrol). Dr. Sink noted that the research was conducted in 2003 and 2004 before newer incontinence medications were introduced that may have less effect on acetylcholine in the brain.

The finding of the more rapid decline among residents taking both types of drugs represents a significant public health problem because an estimated 33% of people with dementia also take a drug for incontinence, she pointed out.

“Until now, the clinical dilemma for managing incontinence and dementia has been largely theoretical. The results suggest that clinicians should continue to try non-drug management strategies for incontinence before beginning therapy with one of these common drugs,” Dr. Sink said.

The study, which included co-authors from Purdue University, Lafayette, IN, was published in the Journal of the American Geriatrics Society (2008; 56:847-53).