Overactive bladder medicine and precise cognitive testing.

To the Editor: Janos et al. (1) argued in a recent editorial that multiple cognitive tests should be administered to assess the effects of overactive bladder (OAB) treatment on cognition, and criticised a recent study we conducted (2) for relying on a single measure, the Name-Face Association Test (NFA; 3). In fact, we measured multiple cognitive domains using tests from two state-of-the-art computerised test batteries, but chose NFA as the primary outcome test based on its relevance in everyday life; normative base of tens of thousands of people from around the world; demonstrated sensitivity to the effects of ageing, trauma and subtle neurological impairment; and demonstrated sensitivity to anti-cholinergic drug effects. We specifically chose Delayed Recall as the primary outcome measure on NFA because a wealth of data gathered over more than three decades demonstrates that this cognitive domain is the most vulnerable to the effects of anti-muscarinic drugs. Whereas NFA measures statistically significant differences in cognitive performance between 25and 35 year-old normal cohorts, as well as those 35 and 45, 45 and 55 years and so on throughout the life span (3) the two measures specifically recommended by Janos et al. for OAB studies, the Time and Change Test and Mini-Mental State Exam, are simply dementia screening instruments, entirely inappropriate for measuring cognitive change in normal adults at any age. Janos et al. appropriately pay homage to the wisdom of their parental generation, but that does not require a return to the simple and imprecise cognitive assessment techniques of earlier generations.