中樞神經相關膀胱過動症之藥物治療：長期療效與認知功能安全性分析

李雨霜、李宇坤、劉民慶、張天霖、張嘉峰、江元宏、郭漢崇

佛教慈濟醫療財團法人花蓮慈濟醫院泌尿科

Long-term Clinical Efficacy and Cognitive Impact of Medications for Overactive Bladder Related to the Central Nervous System

Yu-Shuang Lee, Yu-Khun Lee, Min-Ching Liu, Tien-Lin Chang, Jia-Fong Jhang, Yuan-Hong Jiang, Hann-Chorng Kuo

Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan

Purpose: This study aimed to evaluate the long-term clinical efficacy and cognitive impact of pharmacological treatments for overactive bladder (OAB) in patients with central nervous system (CNS)-related diseases, such as cerebrovascular accident (CVA), dementia, and Parkinson’s disease (PD).

Materials and Methods: A retrospective cohort of 170 patients with CVA, dementia, or PD was analyzed. Urinary symptoms were assessed using the Overactive Bladder Symptom Score (OABSS) and Urgency Severity Score (USS), while cognitive function was monitored 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, and cognitive deterioration was defined as a decline of more than 3 points in the MMSE score.

Results: The study included 170 patients with a mean follow-up of 16.9 months. Medication discontinuation rates varied significantly by CNS condition, with higher rates observed in the dementia (69.8%) and PD (62.5%) groups compared with the CVA group (40%, p = 0.002). While the overall symptom improvement rate (12.4%) and Global Response Assessment (GRA) scores at one year were modest across all groups, baseline cognitive status was a critical determinant of outcomes. Cognitively intact patients experienced significantly greater improvements in OAB symptoms, whereas those with severe cognitive impairment had significantly lower GRA scores, higher discontinuation rates, and a higher incidence of cognitive deterioration (25%, p = 0.049). Among the medications, solifenacin showed the highest discontinuation rate (77.8%, p = 0.002), while tolterodine SR had the lowest (36.4%). Furthermore, patients who experienced a significant MMSE decline (≥ 3 points) demonstrated significantly worse treatment outcomes in OABSS, USS, and GRA scores.

Conclusion: 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.