The treatment of neurogenic lower urinary tract dysfunction in persons with spinal cord injury: An open label, pilot study of anticholinergic agent vs. mirabegron to evaluate cognitive impact and efﬁcacy

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-021-00413-6 · Published: May 20, 2021

Simple Explanation

The study investigates whether switching from anticholinergic (AC) medication to mirabegron improves cognitive function in older individuals with spinal cord injury (SCI) who have neurogenic lower urinary tract dysfunction (NLUTD). It also assesses if mirabegron is as effective and safe as AC agents for managing NLUTD symptoms. The study found that switching to mirabegron improved memory and executive function without adverse effects on bowel or cardiovascular function, and it also improved NLUTD symptoms.

Study Duration

6 months

Participants

20 older (>60 y/o) persons with SCI

Evidence Level

Not specified

Key Findings

1
Switching from anticholinergics to mirabegron significantly improved short-term and delayed memory (WMS-IV Story A/B) and executive function (TEXAS) in older persons with SCI.
2
Mirabegron was superior to anticholinergics in treating NLUTD symptoms, with improvements observed in Neurogenic Bladder Symptom Score (NBSS) subscores and decreased incontinence frequency.
3
No adverse effects on bowel or cardiovascular function were observed when switching from anticholinergics to mirabegron.

Research Summary

This pilot study aimed to evaluate the cognitive impact and efficacy of replacing anticholinergic (AC) agents with mirabegron for neurogenic lower urinary tract dysfunction (NLUTD) in older persons with spinal cord injury (SCI). The study found that switching from AC to mirabegron resulted in significant improvements in memory and executive function, as well as improved NLUTD symptoms, without adverse effects on bowel or cardiovascular function. The results suggest that mirabegron may be a preferable alternative to AC agents for managing NLUTD in older SCI patients to preserve cognitive function.

Practical Implications

Clinical Practice

Consider mirabegron as a first-line treatment option for NLUTD in older SCI patients to minimize cognitive risks associated with anticholinergic use.

Future Research

Conduct larger, longer-term studies to confirm the cognitive benefits of mirabegron and to objectively compare its efficacy with anticholinergics using urodynamic studies.

Patient Care

Monitor cognitive function and NLUTD symptoms when switching from anticholinergics to mirabegron to optimize patient outcomes.

Study Limitations

1
Potential practice effects on cognitive tests
2
Small sample size of the pilot study
3
Lack of assessment of education level, which may influence Stroop test performance

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