Anticholinergics are one of the mainstay medications for treatment of overactive bladder syndrome. This review is an assessment of the most current literature describing the cognitive adverse effects related to anticholinergic medication use in the elderly population. Anticholinergic medications are not without adverse drug effects because of their activity on receptors on multiple sites in the body. Many of these side effects, including constipation, dry mouth, and confusion, have been thought to be self-limited to the duration of medication exposure, but recent studies have shown an association between long-term anticholinergic medication use and an increased risk for irreversible cognitive changes such as dementia. Urologists should be aware of these recent studies in order to provide counseling about anticholinergic dose minimization, discontinuation of anticholinergics with any signs of cognitive decline, the potential risk of long-term cognitive effects, and balance these with the immediate benefits of decreasing incontinence and improvements in quality of life.