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Dry but Forgetful

Kyle B. Womack, MD; Kenneth M. Heilman, MD

Arch Neurol. 2003;60:771-773.

Background  Anticholinergic drugs are known to produce or enhance cognitive deficits. Tolterodine tartrate is marketed as a bladder-selective anticholinergic drug that is reported to be free of significant cognitive adverse effects.

Objective  To describe a 46-year-old woman who had memory loss and abnormal memory test results that improved when she discontinued tolterodine therapy.

Results  While taking tolterodine, the patient's score on the delayed free recall portion of the Hopkins Verbal Learning Test–Revised was at the first percentile. One month after discontinuing tolterodine therapy, this test was administered a second time using an alternative form and she showed marked improvement scoring above the 75th percentile.

Conclusions  Tolterodine therapy caused cognitive dysfunction in our patient. It is possible that cognitive dysfunction is a common result of tolterodine treatment, but in the absence of testing, remains undiagnosed. Alternatively, our patient may have had aberrant metabolism of this drug or an increased sensitivity as a result of incipient Alzheimer disease.

From the Department of Neurology, University of Florida College of Medicine, and the Neurology Service, Department of Veterans Affairs Medical Center, Gainesville. Dr Womack is now with the Departments of Neurology and Psychiatry, University of Texas Southwestern Medical Center at Dallas.

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