Traitement anticholinergique de l’hyperactivité vésicale de la personne âgée et ses impacts sur la cognition. Revue de la littérature

Kerdraon, J.; Robain, G.; Jeandel, C.; Artus, P. Mongiat; Gamé, X.; Fatton, B.; Scheiber-Nogueira, M.C.; Vetel, J. M.; Marès, P.; Petit, Anne-Cécile; Amarenco, G.

doi:10.1016/j.purol.2014.06.003

Cited by 23 publications

(8 citation statements)

References 32 publications

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“…As a result of its prolonged release formulation and its 7–9-hr half-life, fesoterodine can be taken daily as a single dose without the risk of accumulation of the active ingredient 18. Finally, fesoterodine has a very low risk of crossing the blood-brain barrier19 and has no significant effect on cognitive function, which has been confirmed in clinical trials 10,20,21…”

Section: Second Casementioning

confidence: 78%

<p>Urinary Urgency: A Symptom In Need Of A Cure</p>

Salvatore

Espuña‐Pons

Tubaro

2019

RRU

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Urgency, defined as “a sudden, compelling desire to pass urine which is difﬁcult to defer”, is not always reported by patients with overactive bladder, and is not usually described in these words. Urgency is known to have a strong negative impact on patients’ quality of life and requires attention from healthcare professionals, as they play a key role in establishing the diagnosis and in deciding, together with the patient, the most appropriate treatment. This topic was debated during the symposium “Urinary Urgency: A Symptom in Need of a Cure?”, held at the 11th Annual Meeting of the European Urogynaecology Association (EUGA) in October 2018 in Milan, Italy. The presentation of two clinical cases, those of a young, active woman and a retired teacher, illustrated the importance of this cornerstone symptom and demonstrated how fesoterodine may represent an important option in the management of this condition. The experts concluded that the physician should not leave urgency undeclared or untreated; that the patient should be involved in the choice of treatment; and that fesoterodine, which offers flexible dosing and has proven, consistent positive results on urgency episodes and urgency urinary incontinence, with very low/no risk of impairment of cognitive function, appears to be one of the good choices in the treatment of this symptom.

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Section: Second Casementioning

confidence: 78%

<p>Urinary Urgency: A Symptom In Need Of A Cure</p>

Salvatore

Espuña‐Pons

Tubaro

2019

RRU

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“…Trospium and fesoterodine were reported to have significantly lower CNS penetration than other anticholinergic agents in an in vitro study [55]. The relatively high molecular weight and low lipophilicity of fesoterodine, hydrophilic trospium, and the active metabolite of fesoterodine, 5-hydroxymethyl tolterodine, suggest that only very small amounts may cross the BBB [55,66,67]. A study also reported the effects of taking fesoterodine for 12 weeks in older patients with urge incontinence and revealed no deterioration in cognitive function when subjects were assessed by the mean Mini-Mental Status Examination (MMSE) [68].…”

Section: Anticholinergicsmentioning

confidence: 99%

Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

2020

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Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

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“…Antimuscarinic agents cross the BBB via passive diffusion according to their lipophilicity and molecular weight. 34 – 38 Some antimuscarinics are removed from the brain via an active transport mechanism facilitated by Pgp, which limits the levels of drugs in the brain. The BBB can be impaired by different causes, including aging, medication, or systemic diseases (inflammatory; neurodegenerative diseases, such as Alzheimer’s, Parkinson’s disease, and multiple sclerosis; vascular conditions; neoplasia; brain edema; meningitis; and trauma).…”

Section: Dealing With Oab In Patients At Risk Of Cognitive Impairmentmentioning

confidence: 99%

“…It has the highest molecular weight of the antimuscarinics and low lipophilicity ( Table 1 ); moreover, the active moiety of fesoterodine, 5-HMT, is pumped out of the brain by Pgp, an efflux transporter. 7 , 33 , 38 , 40 – 42 Trospium is a quaternary amine and a hydrophilic molecule that does not cross the BBB.…”

Section: Dealing With Oab In Patients At Risk Of Cognitive Impairmentmentioning

confidence: 99%

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Dealing with complex overactive bladder syndrome patient profiles with focus on fesoterodine: in or out of the EAU guidelines?

Heesakkers¹,

Pons²,

Toozs‐Hobson³

et al. 2017

RRU

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Overactive bladder (OAB) syndrome is a common, complex, and challenging condition. To assist the management of these patients, the European Association of Urology (EAU) updates its guidelines annually. This review reports the presentations from the symposium titled “Dealing with complex OAB patient profiles: in or out of the EAU guidelines?” held at the 32nd EAU Annual Congress in March 2017 in London. The symposium focused on three groups of OAB patients: women who may also suffer pelvic organ prolapse, stress urinary incontinence, the genitourinary syndrome of menopause (GSM); patients at risk of cognitive impairment; and elderly patients. The aim of the symposium was to determine how the 2017 EAU guidelines can best assist physicians, as well as to assess the benefits of fesoterodine in these patients. The EAU guidelines recommend antimuscarinic agents (grade A) for the medical treatment of OAB. In women, OAB is correlated with GSM, both of which are underdiagnosed and undertreated. Fesoterodine decreases OAB symptoms and the associated limitation of physical activity. A combination of fesoterodine and vaginal estrogens is appropriate for OAB associated with GSM. In patients at risk of cognitive impairment, prescribers should pay particular attention to the choice of medication. Fesoterodine is a Pgp substrate with limited ability to cross the blood–brain barrier, which may explain the lack of negative effects on the central nervous system observed in clinical trials of this agent. OAB should not be regarded as a normal consequence of aging. Fesoterodine has been extensively investigated in the elderly, and is the only anticholinergic drug licensed for OAB in this population, rated B (beneficial) according to the Fit for the Aged classification for lower-urinary-tract symptoms. The EAU guidelines are a valuable resource for physicians managing patients with OAB, and the pharmacological properties of fesoterodine offer credible clinical advantages in these three patient groups.

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Traitement anticholinergique de l’hyperactivité vésicale de la personne âgée et ses impacts sur la cognition. Revue de la littérature

Cited by 23 publications

References 32 publications

<p>Urinary Urgency: A Symptom In Need Of A Cure</p>

<p>Urinary Urgency: A Symptom In Need Of A Cure</p>

Cognitive Function and Urologic Medications for Lower Urinary Tract Symptoms

Dealing with complex overactive bladder syndrome patient profiles with focus on fesoterodine: in or out of the EAU guidelines?

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