Use of β3 adrenergic agonists and anticholinergics for overactive bladder are associated with similar dementia risk

1. Use of β3 adrenergic agonists was not associated with a lower risk of dementia compared to anticholinergics in the management of overactive bladder (OAB).

Evidence Rating Level: 2 (Good)

OAB is a common disorder affecting up to one third of adults. Management options most commonly centres around pharmacotherapy with either anticholinergic agents or β3 adrenergic receptor agonists. While emerging literature has shown associations between exposure to anticholinergic medications and long-term dementia risk, it is unclear whether β3 adrenergic receptor agonists provide a more favourable neuroprotective profile compared with anticholinergics. This retrospective cohort study therefore sought to investigate the long-term risk of dementia among patients receiving β3 agonists compared with anticholinergics for OAB. Using the Epic Cosmos electronic health record data from 2012 to 2025, 830,393 adults (median [IQR] age, 67 [57-76] years; 70.5% female) between 40 to 90 years of age diagnosed with OAB and receiving OAB therapy with either β3 agonism or an anticholinergic agent were included in the study. High-risk anticholinergic therapy was associated with a significantly lower risk of dementia than β3 agonists (hazard ratio [HR], 0.93; 95% CI, 0.90-0.96; p < 0.001). β3 agonists were associated with a similar risk of dementia compared with low-risk anticholinergic therapy (HR, 0.97; 95% CI, 0.93-1.01; p = 0.16). Overall, this study found that among patients with OAB, use of β3 adrenergic agonists was not associated with a reduced dementia risk when compared with anticholinergic therapy. 

Click here to read this study in JAMA Network Open

Citation: Sheyn D, Rhodes S, Mohamed Z, Hijaz A. Drug Therapies and Incidence of Dementia Among Adults With Overactive Bladder. JAMA Netw Open. 2026 Nov 2;9(11):e2642026. doi: 10.1001/jamanetworkopen.2026.42026. PMID: 42993548; PMCID: PMC13744023.

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