Overactive bladder (OAB) is a common urological condition characterised by symptoms of urgency, frequency and nocturia, with or without urge urinary incontinence, significantly impairing patients’ quality of life. Its prevalence increases with age and is further complicated in individuals with central nervous system (CNS)-related diseases, such as cerebrovascular accident (CVA), dementia and Parkinson’s disease (PD). Underlying neurological impairments often exacerbate bladder dysfunction, presenting unique diagnostic and therapeutic challenges. This study evaluated the long-term clinical efficacy and cognitive impact of medications for CNS-related OAB.

A retrospective cohort of 170 patients with cerebrovascular accident (CVA), dementia, or Parkinson’s disease (PD) was analyzed. Urinary symptoms were assessed with Overactive Bladder Symptom Score (OABSS) and Urgency Severity Score, and cognitive function with the Mini-Mental State Examination (MMSE). Outcomes were measured at baseline, 12, 24, and 36 months. OAB improvement was defined as a ≥3-point reduction in OABSS. A decline of more than 3 points in the MMSE score indicated cognitive deterioration.

In total, 170 patients with CNS-related OAB were included, with a mean follow-up duration of 16.9 months. A total of 79 patients reached 12 months, 56 reached 24 months, and 43 reached 36 months. Baseline characteristics differed significantly among subgroups; dementia patients were older, and had lower MMSE scores. Medication discontinuation was higher in dementia (69.8%) and PD (62.5%) compared with CVA (40%, p=0.002). Symptom improvement (12.4%) and global response assessment (GRA) scores at one year were modest and similar among groups. Severe cognitive impairment was associated with higher discontinuation, poorer symptom improvement (5.9%), lower GRA scores, and greater cognitive decline (25%, p=0.049) (Table 1). Among medications, solifenacin showed the highest discontinuation (77.8%, p=0.002), whereas tolterodine SR had the lowest (36.4%). Cognitive function remained generally stable across medications, but patients with cognitive deterioration had worse urinary outcomes and GRA scores (Table 2). Treatment discontinuation rates varied significantly by CNS condition, with higher rates observed in the dementia (69.8%) and PD (62.5%) groups than in the CVA group (40%, p = 0.002). However, the symptom improvement rates (12.4%) and GRA scores at one year were uniformly modest, showing no significant differences between such groups. Cognitive deterioration rates (3–9%) and mortality were also similar across these subgroups.

This study evaluated the long-term clinical outcomes and cognitive impacts of pharmacological treatments for CNS-related OAB. Results revealed that the cognitively intact patients experienced significantly higher improvements in OAB symptoms, whereas those with severe cognitive impairment had significantly lower GRA scores at one year and significantly higher cognitive deterioration. Treatment discontinuation rates varied significantly by CNS condition, with higher rates observed in patients with dementia or PD than in those with CVA. Patients experiencing MMSE decline by ≥3 points demonstrated significantly worse treatment outcomes in both OABSS and USS and obtained significantly worse MMSE and GRA scores after treatment.

The findings of this study highlight the need to assess the baseline cognitive function to determine long-term clinical outcomes and OAB medication adherence in patients treated for CNS-related OAB. While the medication types demonstrated similar efficacy, patient tolerability varied significantly, highlighting the need for personalised management plans. Regular cognitive monitoring and careful medication selection based on patient characteristics are essential to optimise treatment effectiveness and improve the quality of life of this vulnerable population, especially in patients with dementia and low baseline MMSE scores.