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How to manage overactive bladder in elderly individuals with dementia? A combined use of donepezil, a central acetylcholinesterase inhibitor, and propiverine, a peripheral muscarine receptor antagonist


Sakakibara, Ryuji, Ogata, Takeshi, Uchiyama, Tomoyuki, Kishi, Masahiko, Ogawa, Emina, Isaka, Shigeo, Yuasa, Joji, Yamamoto, Tatsuya, Ito, Takashi, Yamanishi, Tomonori, Awa, Yusuke, Yamaguchi, Chiharu, Takahashi, Osamu


Journal of the American Geriatrics Society, Volume: 57, No.: 8, Pages.: 1515-1517

Year of Publication



Although urinary incontinence inevitably occurs in advanced stages of dementia of any etiology, urinary urgency or frequency, also called an overactive bladder (OAB), occurs more commonly in dementia with Lewy bodies (DLB) and vascular dementia than it does in Alzheimer’s disease (AD). Acetylcholinesterase (AChE) inhibitors for dementia and anticholinergics for OAB have been widely used, although a combination of these medications is believed to be contradictory. Thus, there have been no established regimens to treat a patient who has dementia and OAB together. Twenty-six cognitively impaired older individuals were prospectively recruited. The patients were started on 20mg per day of propiverine hydrochloride, a peripheral muscarinic receptor antagonist, for OAB. At the first assessment, the patients showed a mean nighttime urinary frequency of 3.1 times and a daytime frequency of 5.9 times, and urinary incontinence was observed in 14 of 26 patients. Urinary incontinence occurred more than once a day in 11 patients, more than once a week in two, and more than once a month in one. At the second assessment, none of the patients had discontinued the propiverine treatment because of dry mouth, constipation, delusion, or agitation. The patients showed a mean night time frequency of 2.5 times and a daytime frequency of 5.7 times, and urinary incontinence was observed in 12 of 26 patients. Although the current study was a pilot study, it calls for an experimental study to determine whether the combined use of a “central” AChE inhibitor and a “peripheral” muscarine receptor antagonist would be pharmacologically sound as site-directed therapy, because many elderly patients and their caregivers seek medical care for dementia and OAB together. This combination therapy therefore could become an option in patients who suffer from dementia and OAB together. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Bibtex Citation

@article{Sakakibara_2009, doi = {10.1111/j.1532-5415.2009.02369.x}, url = {}, year = 2009, month = {aug}, publisher = {Wiley-Blackwell}, volume = {57}, number = {8}, pages = {1515--1517}, author = {Ryuji Sakakibara and Takeshi Ogata and Tomoyuki Uchiyama and Masahiko Kishi and Emina Ogawa and Shigeo Isaka and Joji Yuasa and Tatsuya Yamamoto and Takashi Ito and Tomonori Yamanishi and Yusuke Awa and Chiharu Yamaguchi and Osamu Takahashi}, title = {{HOW} {TO} {MANAGE} {OVERACTIVE} {BLADDER} {IN} {ELDERLY} {INDIVIDUALS} {WITH} {DEMENTIA}? A {COMBINED} {USE} {OF} {DONEPEZIL}, A {CENTRAL} {ACETYLCHOLINESTERASE} {INHIBITOR}, {AND} {PROPIVERINE}, A {PERIPHERAL} {MUSCARINE} {RECEPTOR} {ANTAGONIST}}, journal = {Journal of the American Geriatrics Society} }


acetylcholinesterase, acetylcholinesterase inhibitor, alzheimer’s disease, bladder, cholinergic blocking drugs, dementia, dementia with lewy bodies, donepezil, drug therapy, elderly individuals, hydrochloride, incontinence, overactive, overactive bladder, peripheral muscarine receptor antagonists, propiverine

Countries of Study


Types of Dementia

Dementia (general / unspecified), Lewy-Body

Types of Study

Cohort Study

Type of Outcomes

Prevention and/or management of co-morbidities

Type of Interventions

Pharmaceutical Interventions, Treatment/prevention of co-morbidities or additional risks

Pharmaceutical Interventions



Urinary Tract Infection Prevention / Treatment