No link found between urinary incontinence and cognitive decline over 10 years

The presence of urinary incontinence (UI) is not associated with measures of cognitive performance across a 10-year period, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

UI often presents in older adults, with bothersome symptoms reported in over 24% of women aged at least 60 years. Patients with UI often experience adverse quality of life and physical and mental health outcomes and are at an increased risk of institutionalization.

Multiple comorbidities have been linked to UI, including depression, urinary tract infections, increased body mass index (BMI), diabetes, and death.² This has a significant adverse impact on health-related quality of life.

A link has been reported between UI and dementia, with a UI diagnosis often occurring within 1 year of a dementia diagnosis.¹ However, data about the association between UI and cognitive function remains limited, making it unclear if UI is an independent risk factor of cognitive decline.

Investigators conducted a study to determine the impact of UI on cognitive health. The study was a secondary analysis of data from the Health and Retirement Study (HRS), a longitudinal study that surveyed approximately 20,000 US individuals aged 50 years about health status, health care utilization, functional status, cognitive function, and finance information.¹

The Telephone Interview for Cognitive Status (TICS) was used to evaluate immediate and delayed recall, memory score (MScore), and dementia probability (DP) The secondary analysis included HRS respondents aged 58 to 67 years with 2 or more years of cognitive assessment data.

Participants completed the TICS at baseline, then biennially once aged 65 years. This allowed patients to complete at least 3 cognitive assessments.

Participants who responded “yes” when asked if they lost urine beyond their control were in the exposed cohort and were asked how many days in the last month they lost urine. Controls included women who responded “no” when asked if they lost urine beyond their control.¹

Mean biennial changes in each cognitive measure were reported as coprimary outcomes. MScore and DP were reported for associations with diabetes, chronic pain, BMI, traumatic brain injury, cancer diagnosis, and socioeconomic status. Covariates included sociodemographic information such as race, ethnicity, and education level.

There were 4213 participants included in the final analysis, with an average 5.9 follow-up biennial interviews among respondents. At baseline, MScores ranged from 0.623 to 8.723 and DP from under 0.001 to 0.988. Baseline MScores and DP were similar between patients with UI vs controls.¹

Significant cognitive declines were observed at 2-year intervals in both groups, with mean MScore reductions of −0.222 and −0.207 for UI patients and controls, respectively. Mean DP increases were 0.018 and 0.020, respectively.¹

Significant differences in cognitive decline were not observed across cohorts, with a mean difference of −0.015 for MScore and −0.002 for DP. MScore and DP trends also did not significantly differ among UI subgroups, such as those reporting less frequent UI and those with UI on most days.

These results indicated no association between UI when aged under 70 years and cognitive performance. Investigators concluded unmeasured anticholinergic use among UI patients may cause bias about accelerated cognitive decline.¹

References

1. High RA, Alvarez M, Champion B, et al. Longitudinal study of cognitive decline among women with and without urinary incontinence. Am J Obstet Gynecol. 2024;231:105.e1-8. doi:10.1016/j.ajog.2024.02.305
2. Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract. 2013;67(10):1015-33. doi:10.1111/ijcp.12164