Do incontinence drugs accelerate mental decline?


New York: Elderly people treated with drugs for dementia and bladder incontinence at the same time declined faster than those treated only for demenia, according to new research from the Wake Forest University School of Medicine in North Carolina.

Lead researcher Kaycee M Sink MD, MAS, Assistant Professor of Internal Medicine at the school commented: “It is likely that the oppositional effects of the drugs contributed to the accelerated decline.

“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 combination of drugs affected older adults who started out with higher levels of function in activities of daily living such as dressing, personal hygiene, toileting, transferring, bed mobility, eating, and being able to get around the unit. The results which reveal a 50% greater decline are pubished in the Journal of the American Geriatrics Society.

The study looked at 395 nursing home residents in Indiana who were taking medications for both conditions and 3,141 who were taking only a dementia medication.

Residents included in the analysis were aged 65 years and older and had had at least two consecutive prescriptions for cholinesterase inhibitors, for example, donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon), and tacrine (Cognex). These drugs are designed to increase levels of acetylcholine, a chemical that enhances communication between nerve cells in the brain.

About 10% of the residents were also taking either oxybutynin or tolterodine, the two most commonly prescribed drugs for urinary incontinence. These drugs are known as anticholinergic agents and are designed to block acetylcholine, a substance required by the brain for optimum function.

“The two drugs are pharmacological opposites, which led us to hypothesise that the simultaneous treatment of dementia and incontinence could lead to reduced effectiveness of one or both drugs,” said Dr. Sink.

She said 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.

“Until now, the clinical dilemma for managing incontinence and dementia has been largely theoretical. This research suggests it may lead to worse outcomes, which is the opposite intention of therapy for dementia.”

The researchers also measured whether the residents taking both drugs experienced a decline in mental function as well, but there was no difference between the two groups, possibly because the test was not sensitive enough. Dr. Sink said that similar research should be extended to community-dwelling older adults with dementia and that more sensitive measures for cognition should be used. Previous studies have shown that the bladder medications are associated with cognitive decline and that people with dementia are especially sensitive to this side effect.

“The results suggest that clinicians should continue to try nondrug management strategies for incontinence before beginning therapy with one of these common drugs,” said Dr. Sink.

She noted that the study was conducted in 2003 and 2004, before newer incontinence medications were introduced that may have less effect on acetylcholine in the brain.

Get a free pelvic health guide


London: Receive a free pelvic health guide…

A lack of strong pelvic floor muscles means that half of all women of all ages suffer stress incontinence when laughing, coughing and exercising.

Effective exercise develops tighter muscles which also brings the benefits of greater intimate contact!

This new website offers help and information about Kegel exercises, dedicated sexercises and products designed to help you regain control of your bladder and your sex life!

For those without internet access, a hardcopy version can be obtained by writing to:

Health Guide, SPM Ltd, PO Box 330, BRISTOL, BS9 2WJ, UK

Or calling 0870 701 9601- free within UK only

About female incontinence:

Between 1 in five and 1 in seven women are suffering the embarrassment and social stigma of uncontrolled leaks as you read this. That is around 3,000,000 women. And it is not a disease of the elderly – it affects a third of new mums and women of any age. Half of all women WILL suffer SUI.

The sad thing is that 80% of cases could be quickly and easily cured with a simple exercise programme.

The criminal fact is that women are not told how to exercise effectively and that it is ESSENTIAL to exercise by squeezing against a resistance as recommended by Arnold Kegel, the ‘founder’ of pelvic floor exercises over 50 years ago.

This informative new website designed to emphasise the importance of pelvic floor health and to recommend simple methods to help overcome the distressing and socially isolating problems of stress incontinence.

Visit or email admin@spml.bizfor more information.

Get a strong pelvic floor – your questions answered


London: Learn how to strengthen your pelvic muscles in seven simple steps – live web chat with expert Kari Bo: date: Tuesday 11th September 2007 Chat time: 16:30 (GMT-1)

Whether you have just had a baby or are just looking to increase sexual comfort and pleasure, help is at hand. Kari Bo, a world expert in exercise science and physiotherapy has spent 20 years researching and treating women with pelvic floor problems. She has found that the failure to exercise these muscles is due to a lack of knowledge and guidance of how. In a rare opportunity, she joins us today to demonstrate some simple steps to strengthen your inner core, from her brand new DVD- PELVICORE Technique. So clear a space in your living room, grab a yoga mat and learn from the expert.

There are seven main exercises that Kari has pioneered and developed that will help women of all ages restore balance and regain control of their body. By following her brilliantly simple exercise programme you can improve your tummy tone, posture and even your sex life.

The pelvic floor specifically helps control posture, movement, control and tummy tone. Childbirth, age and loss of tone can all contribute to a loss of control, which can be unexpected and unnerving for any woman. The great thing is that by regularly doing these very simple exercises, you can strengthen the muscles to their former glory. Whether you have back pain, bladder weaknesses, stress incontinence, or are merely looking to enhance your sex life, Kari Bo is here to help you regain control and demonstrate her simple exercises.

Kari Bo joins us live online at Kari Bo web chat on 11th September at 16:30 to demonstrate how by following some simple exercises we can improve the tone and control of our pelvic floor muscles.

Her DVD is available FREE to anyone who joins the Core Wellness programme- a unique Europe-wide project to help women regain balance and improve their health and wellbeing in an increasingly hectic life.

If you enjoy the routine, please visit to receive your FREE copy

Click here to submit questions before the chat