Cognitive burden and polypharmacy in elderly Japanese patients treated with anticholinergics for an overactive bladder.

This study aimed to investigate the cognitive burden and polypharmacy in elderly patients treated with anticholinergics for an overactive bladder. We conducted a retrospective study of patients with an overactive bladder receiving treatment at two hospitals in Japan (Nara Medical University Hospital and Saiseikai Nara Hospital). Prescription data were collected from the medical records of the patients registered between January 2013 and April 2014. The Anticholinergic Cognitive Burden Scale was used to estimate the severity of the anticholinergic effects on the cognition of each patient. We collected the prescription data of 584 and 246 patients from the Nara Medical University Hospital and Saiseikai Nara Hospital, respectively. The mean daily total Anticholinergic Cognitive Burden score ranged between 3 and 4 (3.59 ± 1.16 at Nara Medical University Hospital vs 3.32 ± 0.78 at Saiseikai Nara Hospital, P < 0.01). At both hospitals, the mean number of prescriptions was >5 in patients ≥75 years (5.95 ± 4.43 and 5.64 ± 3.90 at Nara Medical University Hospital and Saiseikai Nara Hospitals, respectively). Our findings suggest that 10%-20% of elderly patients (≥65 years) receiving treatment with anticholinergics for an overactive bladder are in a state of polypharmacy. The total anticholinergic cognitive burden of each patient mainly depends on the anticholinergics being used for treating the overactive bladder. Especially for elderly patients with a high risk of adverse effects, including cognitive impairment, careful attention needs to be paid during selection of drugs for treating patients with an overactive bladder.

Temporary cognitive impairment related to administration of newly developed anticholinergic medicines for overactive bladder: two case reports.

BACKGROUND: Cognitive impairment is one of the side effects of using anticholinergic medicines for overactive bladder; however, its incidence has not been fully reported. We experienced two elderly Japanese patients with overactive bladder who had temporary cognitive impairment caused by anticholinergic medicines. CASE PRESENTATION: The first case was a 79-year-old female patient to whom imidafenacin (0.2 mg) was administered daily to control her frequent micturition and urgency. She was taking the following medicines: etizolam, triazolam, captopril, bisoprolol, and amlodipine besylate. Her Hasegawa dementia rating scale-revised was impaired from 26/30 to 17/30 and recovered to 25/30 after the imidafenacin treatment was stopped. The second case was an 82-year-old female patient to whom imidafenacin (0.2 mg) was administered daily for frequent micturition and urgency. She was taking the following medicines: losartan potassium and clenbuterol. Her Hasegawa dementia rating scale-revised decreased from 28/30 to 19/30 and recovered to 24/30 after the imidafenacin treatment was stopped. In our patients who were taking multiple medicines, there is a possibility that medicines other than anticholinergics may have caused cognitive impairment. We need to keep in mind that many elderly people take multiple medicines because of comorbidity. CONCLUSIONS: Anticholinergic medicines can cause cognitive impairment in elderly people, and attention should be paid to cognition when elderly overactive bladder patients are treated with anticholinergic medicines.

[Clinicopathological study of the 1973 who classification and the WHO/ISUP classification in pTa bladder carcinoma].

PURPOSE: To compare the usefulness of the World Health Organization (WHO) 1973 classification with the WHO/International Society of Urological Pathology (ISUP) classification in pTa bladder tumors. MATERIALS AND METHODS: A retrospective analysis was performed on 132 patients (107 men and 25 women; mean age 69 years) with a initial diagnosis of pTa bladder carcinoma. Median follow-up were 67 months. On the WHO 1973 classification, histopathological evaluation of initial diagnostic specimens revealed 51 cases with grade1, 68 cases with grade 2, 13 cases with grade3. All histological slides were examined by one genitourinary pathologist blinded with respect to clinical outcome and were classified according to the WHO/ISUP classification. Disease progression was defined as up stage (> or = pT1). Actual probability of progression-free and recurrence-free survival rate were estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Univariate and multivariate analyses were done using Cox regression analysis. The independent variables were multiplicity, histopathological grade, and adjuvant intravesical therapy. The dependent variable was disease progression and recurrence. RESULTS: The tumors were reclassified as low grade carcinoma in 77 and high grade carcinoma in 55. During the follow-up, 68 patients experience recurrence, 14 patients experienced disease progression. On the WHO 1973 classification, the risk of recurrence was significantly lower in patients with grade 1 compared to those with grade3 (p = 0.007). On the WHO/ISUP classification, the risk of recurrence and disease progression were significantly lower in patients with low grade compared to those with high grade (p = 0.003, P = 0.01). After adjustment for tumor multiplicity and adjuvant therapy, the relative risks of recurrence and progression in the low grade carcinoma versus the high grade carcinoma was 2.0 (95% confidence intervals 1.26-3.31), 5.6 (95% confidence intervals 1.54-20.48). CONCLUSIONS: In pTa bladder carcinoma, the WHO/ISUP classification was more useful prognostic factor than the WHO 1973 classification.

[Clinical study of radical prostatectomy for prostate cancer from a single institution].

PURPOSE: To investigate the outcomes for single institution with prostate cancer treated with radical prostatectomy (RP). MATERIALS AND METHODS: A retrospective analysis was performed on 406 patients who underwent RRP from January 1991 to December 2005 for cT1-3N0M0 prostate cancer. To evaluate the change of the patient background, we divided the 15 years into the 5 periods whose span was 3 years each and examined. Biochemical recurrence was defined as a prostate-specific antigen (PSA) of > or = 0.2 ng/ml. Clinical recurrence was defined as metastases or local recurrence. Actual probability of cancer specific mortality was estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Preoperative parameters analyzed were patient age, preoperative PSA, clinical stage, Gleason score, and Neoadjuvant hormonal therapy. Multivariate analyses (logistic regression and Cox proportional hazard model) for the dependent variables (organ-confined prostate cancer, clinical recurrence free survival and cancer specific mortality) were performed. Perioperative complications between cT1/2 with cT3 were compared. RESULTS: The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Median follow-up and median patient age were 55 month and 69 year. Of the 406 men, 35 (8.6%) developed clinical recurrence, 15 men (3.7%) died from prostate cancer within the follow-up period. For pT0/2, pT3a, pT3b and pN +, the 10-yr cancer specific survival rate was 100%, 92%, 81% and 67%, respectively. Preoperative PSA (p < 0.0001), clinical stage (p = 0.004), Gleason score (p < 0.0001) and neoadjuvant hormone therapy (p = 0.0003) are predictive variables for organ confined prostate cancer. Preoperative PSA (p = 0.002) and clinical stage (p = 0.03) are prognostic variables for cancer specific mortality. There was significant difference in surgery time (p = 0.04) and blood loss (p = 0.0007) in cT1/2 cases compared with cT3 cases. CONCLUSION: The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Neoadjuvant hormone therapy prior to prostatectomy was a significant improvement in the organ confined rates. However neoadjuvant hormone therapy did not improve patient prognosis. Preoperative PSA and clinical stage are prognostic variable for cancer specific mortality.