Special considerations should be made when selecting medications for the treatment of lower urinary tract symptoms (LUTS) in older patients especially those over 65 years old. This review summarizes the relationship between current treatments for LUTS and cognitive impairment. Although the recently reported association between dementia and tamsulosin is debatable, the effects of α-blockers and pharmacokinetics are not reported in this context. Five-alpha reductase inhibitors appear to affect mood. However, the association between the development of dementia and cognitive impairment is unlikely. Anticholinergic agents, other than trospium, fesoterodine, and imdafenacin have a relatively high distribution in the central nervous system. In particular, oxybutynin is reported to cause cognitive impairment. Several animal studies on the blood-brain barrier permeability of oxybutynin support this. Therefore, care must be taken when they are used in older patients (65 years and older). Beta-3 agonists are an alternative to, or may be used in combination with, anticholinergic drugs for patients with an overactive bladder (OAB). Several phase 2 and 3 clinical studies report high tolerability and efficacy, making them relatively safe for OAB treatment. However, there is a possibility that cognitive function may be affected; thus, long-term study data are required. We have reviewed studies investigating the correlation of urologic medications with cognitive dysfunction and have provided an overview of drug selection, as well as other considerations in older patients (65 years and older) with LUTS. This narrative review has focused primarily on articles indexed in PubMed, Google Scholar, Scopus, and Embase databases. No formal search strategy was used, and no meta-analysis of data was performed.

中文翻译：

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下尿路症状的认知功能和泌尿科药物。

选择用于治疗老年患者（尤其是65岁以上患者）的下尿路症状（LUTS）的药物时应特别考虑。这篇综述总结了当前治疗LUTS与认知障碍之间的关系。尽管最近报道的痴呆症与坦索罗辛之间的关联值得商bat，但在这种情况下尚未报道α-受体阻滞剂和药代动力学的作用。五-α还原酶抑制剂似乎会影响情绪。但是，痴呆症的发展与认知障碍之间的联系不太可能。除Trospium，Fesoterodine和Imdafenacin以外的抗胆碱能药物在中枢神经系统中的分布相对较高。特别地，据报道奥昔布宁引起认知障碍。关于奥昔布宁的血脑屏障通透性的一些动物研究支持这一点。因此，在老年患者（65岁及65岁以上）中使用时必须小心。对于患有膀胱过度活动症（OAB）的患者，Beta-3激动剂可以替代抗胆碱能药物或与抗胆碱能药物联用。几项2期和3期临床研究报告了高耐受性和疗效，使其对于OAB治疗相对安全。但是，有可能影响认知功能。因此，需要长期的研究数据。我们回顾了研究泌尿科用药与认知功能障碍之间关系的研究，并概述了LUTS的老年患者（65岁及以上）的药物选择以及其他注意事项。这篇叙述性评论主要侧重于在PubMed，Google Scholar，Scopus和Embase数据库中建立索引的文章。没有使用正式的搜索策略，也没有进行数据的荟萃分析。