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Incontinence and Dementia treatment linked
to functional decline
Newswise — Older nursing home residents who
took medications for dementia and
incontinence at the same time had a 50
percent faster decline in function than
those who were being treated only for
dementia, according to a study from
researchers at Wake Forest University School
of Medicine and colleagues.
“It is likely that the oppositional effects
of the drugs contributed to the accelerated
decline,” said Kaycee M. Sink, M.D., M.A.S.,
lead author.
“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 were published online by the
Journal of the American Geriatrics Society
and will appear in a future print issue.
The two most common medical conditions among
nursing home residents are dementia and
urinary incontinence and they often coexist.
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.
Residents included in the analysis were age
65 and older and had had at least two
consecutive prescriptions for cholinesterase
inhibitors, a family of drugs used to treat
dementia.
Examples include 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 percent 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.
“The two drugs are pharmacological
opposites, which led us to hypothesize that
the simultaneous treatment of dementia and
incontinence could lead to reduced
effectiveness of one or both drugs,” said
Sink, an assistant professor of internal
medicine-gerontology.
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 percent 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 also experienced
a decline in mental function, but there was
no difference between the two groups,
possibly because the test was not sensitive
enough.
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 non-drug management
strategies for incontinence before beginning
therapy with one of these common drugs,”
said 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.
The research was funded by the Hartford
Geriatrics Health Outcomes program, the
Kulynych Center for Cognition Research, and
the Regenstrief Foundation.
Co-researchers were Steven Kirtchevsky,
Ph.D., with Wake Forest, and Joseph Thomas,
Ph.D., Huiping Xu, Ph.D., Bruce Craig,
Ph.D., and Laura Sands, Ph.D., all with
Purdue University.
Wake Forest University Baptist Medical
Center (www.wfubmc.edu) is an academic
health system comprised of North Carolina
Baptist Hospital, Brenner Children’s
Hospital, Wake Forest University Physicians,
and Wake Forest University Health Sciences,
which operates the university’s School of
Medicine and Piedmont Triad Research Park.
The system comprises 1,154 acute care,
rehabilitation and long-term care beds and
has been ranked as one of “America’s Best
Hospitals” by U.S. News & World Report since
1993.
Wake Forest Baptist is ranked 32nd in the
nation by America’s Top Doctors for the
number of its doctors considered best by
their peers.
The institution ranks in the top third in
funding by the National Institutes of Health
and fourth in the Southeast in revenues from
its licensed intellectual property.
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