Bladder Antimuscarinic Use and Cognitive Impairment in Adults Aged 75 Years or Older With Urinary Incontinence or Overactive Bladder Symptoms: A Population-Based Study.

PURPOSE: To examine associations of current bladder antimuscarinic use with cognitive impairment in adults aged ≥ 75 years with urinary symptoms. METHODS: We analyzed National Health and Nutrition Examination Survey 2011-2014 data. Current use was identified from medications reported during the previous 30 days. Cognitive impairment was defined as CERAD delayed recall < 5, animal fluency < 14, or digit symbol substitution test < 34 among available tests. Survey-weighted logistic models estimated overall and age-specific odds ratios (ORs); the primary model included demographic factors and KDM biological age acceleration. Missing KDM data were multiply imputed. RESULTS: Among 537 participants representing 8 735 786 US adults, 34 reported current use and 375 met the cognitive-impairment definition (weighted prevalence, 62.5%). The primary overall OR was 2.18 (95% confidence interval [CI], 0.93-5.07; p = 0.069). The use-by-age interaction was imprecise (interaction OR, 0.21; 95% CI, 0.03-1.33; p = 0.093). Among adults aged 75-79 years, 10 of 12 users and 130 of 210 nonusers were impaired (weighted, 82.03% vs. 52.37%); the adjusted OR was 7.18 (95% CI, 1.11-46.40; p = 0.039). Among adults in the public-use group ≥ 80 years, the OR was 1.18 (95% CI, 0.44-3.12; p = 0.733). CONCLUSIONS: The overall estimate was positive but imprecise, and the age-specific contrast rested on sparse exposure. Because NHANES lacks prior-use and discontinuation histories, results may reflect prescribing selection and do not support causal or age-threshold treatment inferences.