Do you still routinely prescribe anticholinergics for OAB in patients over 70 without baseline cognitive impairment given the concern for dementia in recent studies?

No, except Trospium. Beta-3 agonists are still first line.

In patients >70, I generally favor a β3-agonist first because of the growing observational association between cumulative anticholinergic exposure and dementia.

Anticholinergics are not absolutely contraindicated, but I would avoid chronic oxybutynin and favor a lower CNS-penetrating agent such as trospium, while minimizing total anticholinergic burden.

I try very hard not to prescribe anticholinergic medications for OAB in patients over 65 without cognitive impairment. I also ask younger patients if they have a family history of early cognitive decline, and if they do, I encourage them not to start anticholinergics. I do tell all patients that the data shows there is an increased risk of cognitive impairment, but that not all patients who take an anticholinergic will develop cognitive impairment. If the patient doesn't have coverage for a beta...

I usually prescribe Trospium for my BPH patients with OAB, which doesn't cross the BBB

A systematic review of 18 studies (5 RCTs, 13 observational) found no cognitive decline in any of the 6 trospium studies, in patients with or without baseline cognitive impairment—contrasting with oxybutynin (decline in 5/8 studies) and tolterodine (4/7). Only trospium and darifenacin were consistently free of cognitive signal.

The SUFU white paper on OAB anticholinergics and dementia recommends that when an ...

No, in patients over 70, I do not routinely prescribe anticholinergics as first-line for OAB, even if cognition is normal at baseline. In practice, trospium is the only anticholinergic that I prescribe regularly to patients of any age given concerns about new-onset dementia. I follow the SUFU White Paper from 2022 (Zillioux et al., PMID 36066046) for recommendations regarding medication risk and dementia: chronic use (>3 months) is likely associated with an increased risk of new-onset dementia, ...