Overactive bladder drugs: anticholinergics showed no higher dementia rate than beta-3 agonists in 830,000 patients

A study published in JAMA Network Open and publicized on 9 November 2026 challenges a widespread worry: that anticholinergic drugs for overactive bladder (OAB) raise the risk of dementia more than the newer beta-3 agonists.

What the researchers did

A team from University Hospitals Cleveland Medical Center used Epic Cosmos, a large US electronic health record database, to follow 830,393 adults aged 40 to 90 who started OAB treatment between 2012 and 2025.

What they found

Dementia rates were similar across drug classes and across individual medicines. The authors suggest that OAB itself — and the neurological changes behind urinary urgency — may in some people be an early sign of the processes that lead to dementia, rather than the drugs causing it. Lead author David Sheyn, a urogynecologist, said that if so, OAB could serve as an early marker for identifying dementia sooner.

Limitations

• This is an observational study of health records, not a randomized trial; it cannot prove cause and effect.
• It compared drug classes only and did not include untreated patients, so it cannot show that these drugs carry no dementia risk at all.
• It cannot prove that OAB is an early sign of dementia; the pattern only fits that explanation.
• Earlier observational studies did link anticholinergics to dementia. Sheyn says the findings must be replicated before guidelines change and that beta-3 agonists remain the preferred choice where possible.

Anyone taking these medicines should not stop or switch them without talking to their doctor.