Chughtai et al The favorable safety proﬁle above is solidiﬁed by data are available today, and with continuing rigorous clinical showing that darifenacin is not associated with impairment trials, relief of symptoms can potentially be achieved for of cognitive function, either in older or younger patients. even the elderly patient population with OAB. This question has not been looked at speciﬁcally in any other antimuscarinic agent. Kay et al (2006) looked directly at cognitive function in 150 healthy subjects older than 60 years. Design included randomization to darifenacin, oxybutynin ER, or placebo in a multicenter, double-blind, double-dummy, parallel-group, 3-week study. Doses administered were oxybutynin ER 10 mg once daily, increasing to 15 mg then 20 mg by week 3 and darifena- cin 7.5 mg daily in weeks 1 and 2, then 15 mg in week 3. The primary end point was accuracy on the Name-Face Association Test (delayed recall) at week 3. They found darifenacin had no signiﬁcant effects on memory versus placebo, while oxybutynin ER caused signiﬁcant memory deterioration, comparable to brain aging of 10 years. This study did have some limitations. These included 9 subjects who dropped from the darifenacin group, 6 from the oxy- butynin group and 1 from the placebo group, which may have affected results. Also the study did use a higher dose of oxybutynin ER, up to 20 mg, while the darifenacin group only had 1 dose increase. There may have been differences in the group before starting treatment: the darifenacin group was slightly younger, has fewer females, and exhibited lower starting scores. Lastly, the duration examined was only 2 weeks. The side effect proﬁle of darifenacin is associated with a higher degree of constipation compared to oxybutynin, tolterodine, and trospium. Darifenacin at 7.5 mg has 14.8% rate of constipation compared to 21.3% with the 15 mg dose as per the product information insert. In addition, darifenicin has a 20.2% incidence of dry mouth at 7.5 mg and 35% at the 15 mg dose. These are important side effect proﬁles which may guide therapy especially in patients already suffering from pre-existing constipation or dry mouth. Discussion OAB has a signiﬁcant impact on patient health and quality of life and is common in elderly patients. Once proper evalua- tion has ruled out complex causes of OAB, many treatment options are available including behavioral and medical ther- apy. Ideally, therapy should begin with non-pharmacologic or behavioral therapy. Medical therapy should be considered if necessary. In the majority of the elderly population with OAB, a muscarinic receptor antagonist should be able to provide substantial relief from the symptoms of OAB, with a minimal side effect proﬁle. With the variety of agents that 508 Disclosures disclose. None of the authors has any conflicts of interest to References Anderson RU, et al. 2006. 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