You are correct that anticholernergic drugs have been associated with an increased risk of dementia. I believe though that people need to weigh the risk of dementia against the very rule and pervasive problems that someone with small fiber neuropathy potentially faces. Obviously, there is pain and sensory issues which can be harsh but there is also the very real danger of autonomic neuropathy.

Many people with small fiber neuropathy experience some level of autonomic neuropathy. These range from cardiovascular complaints ( palpitations / arrhythmias, POTS, more generalized higher beat, exercise intolerance, etc.) to gastrointestinal issues ( constipation, diarrhea, gastroparesis, GERD, etc.), to other more miscellaneous issues ( sweating problems, other organ issues). Let me be clear: autonomic neuropathy can kill you. Cardiac Autonomic Neuropathy kills people all the time. Whenever you hear people dying from "complications of diabetes", one of the big ones is cardiac autonomic neuropathy triggering an episode of sudden cardiac death. As for Enteric Neuropathy ( GI neuropathy), constipation and diarrhea are a pain but gastroparesis can really negatively impact health.

If the M1R antagonists ( pirenzepine, oxybutynin, etc.) can trigger small fiber nerve regeneration, regrowing these nerves would have the potential of halting the progression of the neuropathy and reversing these symptoms. On balance, I would take halting the progression and/or reversing the sensory and autonomic neuropathic symptoms of this disease for an increased risk of dementia. In addition, if you get to a good place with your neuropathy, there is no indication that you would need to keep the dosage the same which might ameliorate somewhat the risk of developing dementia. Just my two cents.

Thank you so much for your sensible reply. I had also heard of the dementia risk and I'm more than willing to take the risk because it also might no cause dementia so again thanks for your sensible reply. A doctor had prescribed oxybutynin 5mg oral dosage but at a little over 4 weeks my feet began to swell, I quit for a few days and my swelled feet went down I then tried 1/2 of the 5mg pill but again after a few more weeks my feet again swelled badly. I think trans dermal is suppose to side step some of the swelling while applying the medicine directly to the effected nerves for better repair of the nerves but I would need a trans dermal gel for that. That's why I was asking about trans dermal delivery. Does anyone think trans dermal will sidestep the swelling feet problem? Also I've found an online supplier for pirenzepine but Its hard to trust foreign pharmaceutical suppliers. I'm not so much afraid of the medicine not being the correct medicine as much as I am afraid of them simply taking the money and just not sending anything therefore costing more time in getting relief and I read some where that the closer to the onset of the neuropathy the medicine is applied the better the chances the medicine will work, I don't know if this is true or not. perhaps others here may know more about this. I have used aldaychemist (an india based company) with great success for other needs but they don't carry pirenzepine. It would be of great help if anyone knows of a legit foreign supplier of pirenzepine. Its not on any US banned list or anything so it shouldn't be a problem. And I might mention that towards the end of the 6 to 7 weeks total I used the oxybutynin my fingers started getting a very slight electrical sensation to touch where before there was no sensation at all so I know this stuff does do something. Sorry for the long post but thanks again for an encouraging reply and also thanks for your and everyone else's time in reading this.

Sorry about the above post. I typed it very fast then when I went back to read the actual post I realized I didn't put it in paragraphs or anything. I realized this when I gave myself a headache trying to read my own post.
I found a supplier of Pirenzepine but its for Pirenzepine hydrochloride when most articles written about this subject states Pirenzepine dihydrochloride. Does anyone know if Pirenzepine hydrochloride will work as well as Pirenzepine dihydrochloride? This is the most important info I need to know at the moment.
If the order goes through I will post a link or at least the name of the pharmacy for others to consider as a supplier for themselves. If its allowed to give out that information on this forum
Thanks a ton for all the help so far.

Just curious if you found a supplier happy and if you have tried the pirenzepine.. definitely interested

No I haven't tried the pirenzepine yet. I found through a google search websites offering pirenzepine but in hydrochloride form not in dihydrochloride form that seems to be the form most of the studies are based on. I was thinking of taking the chance of ordering and not getting anything therefore losing my money and or if getting anything and its not fake as most are these days I would pass the website name on so others may benefit. But first I have to make sure I wont be breaking any laws before I do. I don't think this medicine would be on the schedule controlled list as its for peptic ulcers but again I must make sure. But again I have to figure out the whole hydrochloride vs dihydrochloride thing.
But to add again I am very sure the pirenzepine will work because I was experiencing such good results with oxubutin my doctor prescribed until my feet started swelling and I had to stop taking it. Please see post no 18 to see the question I have about the hydrochloride vs dihydrochloride thing.

I doubt this will matter. The active species is pirenzepine; whether it comes as the hydrochloride or the dihydrochloride should not make a difference.

Trandermal delivery of oxybutynin ends up in your blood stream. The oxybutnin patch is to treat bladder spasms. The only way to treat the spasms is to get the medication into your blood stream. Consequently, the oxybutynin medication can get to areas of your body where there is no direct application of a gel or a patch.

Two other examples of transdermal delivery systems are smoking patches (to deliver nicotine) and the contraceptive patch ( to deliver contraceptive medication).