LAUSR

available at http://www.ncbi.nlm.nih.gov/pubmed/31233095 Editorial Comment: The potential risk of short-term cognitive side effects of anticholinergics is well known and can be particularly problematic in geriatric patients. However, the long-term effects of these medications on cognition are less clear. Recently concern has been voiced over the potential association between long-term use of these medications and the risk of Alzheimer disease and other forms of dementia. This large database analysis from general clinical practices in England used a nested case-control design to examine potential risk of dementia in relation to prior anticholinergic exposure. A total of 284,343 subjects were analyzed, including cases and matched controls. Overall, the authors found that exposure to strong anticholinergics was associated with an increased risk of dementia. The overall adjusted odds ratio for dementia ranged from 1.06 (95% CI 1.03 to 1.09) for the group with lowest drug exposure to 1.49 (95% CI 1.44 to 1.54) in those with highest drug exposure. Of specific interest to urologists was that 11.7% of subjects who manifested dementia compared to 8.3% of controls who did not were exposed to antimuscarinic medications used to treat overactive bladder. Unadjusted OR for these medications and dementia ranged from 1.21 to 1.73 depending on overall degree of drug exposure. Methods to reduce overall anticholinergic burden, particularly in elderly patients, have been included in some clinical practice recommendations. Although this research raises intriguing questions, it is important to recognize that correlation does not equal causation, and additional research will be needed to examine this relationship in more detail. Tomas L. Griebling, MD, MPH Re: Impact of Coexisting Overactive Bladder in Medicare Patients with Dementia on Clinical and Economic Outcomes E. O. Caplan, I. M. Abbass, B. T. Suehs, D. B. Ng, K. Gooch and D. van Amerongen Humana Healthcare Research, Inc., Louisville, Kentucky, Astellas Pharma Global Development, Inc., Northbrook, Illinois, and Humana, Inc., Cincinnati, Ohio Am J Alzheimers Dis Other Demen 2019; 34: 492e499. doi: 10.1177/1533317519841164 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/30966757available at http://www.ncbi.nlm.nih.gov/pubmed/30966757 Editorial Comment: Dementia is common in geriatric patients and many also suffer from overactive bladder (OAB). This case-control study was designed to examine the effects of concomitant OAB in 3,861 matched pairs of patients with dementia with vs without OAB. Compared to controls, those with OAB were significantly more likely to suffer falls and/or fractures and urinary tract infections. In addition, they had more clinical encounters for health care and higher costs (23% increased overall costs, 13% higher dementia related costs) vs controls without OAB. Other studies in general populations have shown similar incremental increases in health care utilization and costs in those with OAB. This series is unique in that it is the first to examine OAB specifically in a population with underlying dementia. The study was done using administrative claims data, which may limit interpretation of some results. High drug attrition and switching rates also limit some of the generalizability of 858 GERIATRICS Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.