How do you approach balancing the treatment of urinary incontinence with anticholinergic medications with the use of cholinesterase inhibitors in dementia?

This is a great question and speaks to the importance of shared decision-making and understanding the context of individual patients. Ultimately, it would be best to avoid anticholinergic medications in our patients living with dementia. Medications with anticholinergic properties increase the risk of confusion, sedation, falls, etc. Additionally, they counteract the purpose of cholinesterase inhibitors, which are being prescribed to increase the usable acetylcholine in the brain synapses. With that said, urinary incontinence and urinary symptoms generally can have a strong negative impact on our patients' quality of life. It can prevent them from engaging in activities and disrupt sleep, both of which can lead to worsening mood and cogniti...