Bladder antimuscarinics in older adults: as bad as portrayed?

The use of antimuscarinics for overactive bladder in older adults has been affected by the results of epidemiological cross-sectional studies which have found an association between their use and the risk of an incident dementia diagnosis. Since the publication of earlier studies with high media exposure, later reports have resulted in conflicting findings, some shedding doubt upon initial results. This expert update reviews some of these conflicts and the results of studies which have assessed cognition in older adults, both with and without cognitive impairment. There is a need for a re-evaluation of current clinical guidelines in the light of these newer, and in some cases older, but ignored, studies.