The effect of oral medications on fMRI brain activation: A randomized, double blind, controlled pilot trial of older women with overactive bladder

Rachel A. High, Zhaoyue Shi, Jill M. Danford, Erin T. Bird, Christof Karmonik, Rose Khavari

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


INTRODUCTION AND AIM: Observational studies have associated oral anticholinergic medications for overactive bladder (OAB) with cognitive impairment. This is the first pilot trial to compare the effects of two classes of OAB medications on brain activity in women. We evaluated the effect of anticholinergic versus non-anticholinergic (Non-Ach) interventions on regional brain activation during a cognitive task.

METHODS: Twelve cognitively normal women seeking OAB therapy were recruited to a randomized, double-blind, parallel, controlled pilot trial. Whole-brain regional activity at baseline and 29 ± 1 days postintervention was assessed with functional magnetic resonance imaging during a working memory task. Average activation strength by region was compared after anticholinergic, beta-3 agonist, or placebo. Two-way ANOVA compared effects of group and time on average activation strength in anticholinergic versus Non-Ach (beta-3 agonists or placebo) groups.

RESULTS: The mean (SD) age and body mass index of 12 women were 61 (7) years and 36 (7) kg/m 2. Baseline depression and learning scores differed in the anticholinergic group (n = 3) versus the Non-Ach group (n = 9). Right mamillary body activation postintervention was higher after Non-Ach exposure (F 4.9, p < 0.04). In the full sample of participants at follow-up, there was less activation of the right middle frontal gyrus (p = 0.02), superior frontal gyrus (p < 0.01), and supramarginal (p < 0.01) gyrus.

CONCLUSION: Activation strength in brain regions underlying working memory was lower over time, and recognition scores improved. A powered trial is needed to adequately evaluate for differential effects of OAB oral medications on regional brain activation.

Original languageEnglish (US)
Pages (from-to)1035-1042
Number of pages8
JournalInternational Urogynecology Journal
Issue number5
StatePublished - May 2023


  • Anticholinergic
  • Beta agonist
  • Cognition
  • Incontinence
  • Memory
  • Overactive bladder
  • Urinary Bladder, Overactive/diagnostic imaging
  • Humans
  • Cholinergic Antagonists/adverse effects
  • Brain/diagnostic imaging
  • Magnetic Resonance Imaging
  • Pilot Projects
  • Female
  • Aged

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology


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