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Article Open Access

Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis

  • Authors:
    • Hui Zhang
    • Yahong Wang
  • View Affiliations / Copyright

    Affiliations: Department of Anesthesiology, First Affiliated Hospital of Huzhou University, Huzhou First People's Hospital, Huzhou, Zhejiang 313099, P.R. China
    Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 185
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    Published online on: September 30, 2025
       https://doi.org/10.3892/br.2025.2063
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Abstract

Neurogenic lower urinary tract dysfunction (NLUTD) is common in individuals with neurological disorders, leading to bladder overactivity and incontinence. Anticholinergic medications are frequently prescribed for symptom control, but concerns exist regarding potential cognitive impairments. The present systematic review and meta‑analysis aimed to evaluate the short‑term cognitive effects of anticholinergics in patients with NLUTD. PubMed, Embase, Cochrane Library and Scopus (inception to February 2025) were searched for randomized controlled trials and observational studies assessing short‑term cognitive outcomes in patients with NLUTD treated with anticholinergics. Study characteristics, anticholinergic type/dosage, and standardized cognitive measures were extracted. A random‑effects model was used to calculate pooled effect sizes (standardized mean differences, SMDs), and heterogeneity was assessed via the Q‑statistic, τ², and precision interval analysis. A total of three studies involving 139 participants (22 comparisons) met inclusion criteria. The overall pooled SMD for cognitive performance was ‑0.33 (95% CI: ‑0.72 to 0.06; P=0.10), indicating a non‑significant trend toward negative cognitive effects. Subgroup analyses showed notable impairments in memory, executive function and attention, while global measures exhibited minimal change. Heterogeneity was high (Q=162.25; P<0.001), likely due to differences in patient populations, anticholinergic agents and cognitive assessments. Although short‑term use of anticholinergic medications may negatively impact certain cognitive domains in patients with NLUTD, the pooled effect was not statistically significant under a random‑effects model. These findings emphasize the importance of cautious agent selection and the need for further, larger‑scale studies to clarify long‑term cognitive safety. Future research should also assess alternative therapies, such as β3‑adrenergic agonists, which have notably fewer adverse central effects.
View Figures

Figure 1

PRISMA flow diagram of study
selection. The study selection process is illustrated, detailing
the number of studies identified, screened, and excluded at each
stage, along with the final inclusion of studies in the
meta-analysis.

Figure 2

(A) Forest plot displaying SMDs and
95% CIs for each cognitive outcome assessed across 22 comparisons
from three studies. Each square represents the point estimate of an
individual outcome, with square size proportional to its weight.
Horizontal lines indicate the 95% CI. Cognitive domains include
executive function, attention, memory, visuospatial performance and
global cognition. The red diamond at the bottom represents the
pooled SMD under a random-effects model, with its width reflecting
the 95% CI. (B) Summary table comparing the pooled effect estimates
under fixed-effects and random-effects models. The random-effects
model was prioritized due to substantial heterogeneity. The
prediction interval under the random-effects model is also
reported, indicating the range within which true effects of future
studies may lie. SMDs, standardized mean differences; CI,
confidence interval.

Figure 3

Sensitivity analysis: Effect of study
removal on overall results. This plot shows the stability of the
pooled effect size by sequentially removing individual studies. The
consistency of the effect size suggests the robustness of the
meta-analytic findings.

Figure 4

Subgroup analysis of cognitive
domains. The forest plot displays the pooled effect sizes for
different cognitive domains, including attention, memory, executive
function, visuospatial performance and global cognition. Diamonds
represent pooled standardized mean differences within each
subgroup. CI, confidence interval.

Figure 5

Funnel plot of standard error by
standardized mean differences. The funnel plot assesses publication
bias by plotting the standard error against the effect size for
individual studies. Asymmetry indicates potential bias, further
analyzed using Begg's and Egger's tests.

Figure 6

Distribution of true effects
(precision interval analysis). This plot shows the distribution of
true effect sizes with a mean effect of -0.33 and a 95% confidence
interval of -0.72 to 0.06. The precision interval extends from
-2.17 to 1.51, reflecting uncertainty due to between-study
variability.

Figure 7

Moderator analysis: Regression of sex
(%) on standardized mean differences. The regression plot
illustrates the relationship between the proportion of male
participants and the observed effect size. The positive slope
suggests that higher male representation is associated with reduced
cognitive decline.

Figure 8

Moderator analysis: Regression of age
on standardized mean differences. The regression plot shows the
relationship between mean participant age and cognitive effect
sizes. The positive slope indicates that younger participants
experience greater cognitive impairments compared with older
individuals.
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Copy and paste a formatted citation
Spandidos Publications style
Zhang H and Wang Y: Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis. Biomed Rep 23: 185, 2025.
APA
Zhang, H., & Wang, Y. (2025). Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis. Biomedical Reports, 23, 185. https://doi.org/10.3892/br.2025.2063
MLA
Zhang, H., Wang, Y."Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis". Biomedical Reports 23.6 (2025): 185.
Chicago
Zhang, H., Wang, Y."Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis". Biomedical Reports 23, no. 6 (2025): 185. https://doi.org/10.3892/br.2025.2063
Copy and paste a formatted citation
x
Spandidos Publications style
Zhang H and Wang Y: Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis. Biomed Rep 23: 185, 2025.
APA
Zhang, H., & Wang, Y. (2025). Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis. Biomedical Reports, 23, 185. https://doi.org/10.3892/br.2025.2063
MLA
Zhang, H., Wang, Y."Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis". Biomedical Reports 23.6 (2025): 185.
Chicago
Zhang, H., Wang, Y."Short‑term cognitive effects of anticholinergics in patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‑analysis". Biomedical Reports 23, no. 6 (2025): 185. https://doi.org/10.3892/br.2025.2063
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