Association between urinary flow rate andcognition in the elderly: a cross-sectional study

Jiandong Liu; Yifan Li; Dan Xia

doi:10.32604/cju.2026.087823

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Association between urinary flow rate andcognition in the elderly: a cross-sectional study

Jiandong Liu^#, Yifan Li^#, Dan Xia^*
Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
# These authors have contributed equally to this work
* Corresponding Author: Dan Xia. Email: xiadan@zju.edu.cn

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.087823

Received 23 June 2026; Accepted 22 September 2026; Published online 29 September 2026

Abstract

Background: Urinary abnormalities and cognitive impairment are common in older adults, but their relationship remains incompletely understood. We examined the association between urinary flow rate (UFR) and cognitive performance in this population.
Methods: We analyzed data from 2700 participants aged ≥60 years in the 2011–2014 U.S. National Health and Nutrition Examination Survey (NHANES). Cognitive performance was assessed using the Digit Symbol Substitution Test (DSST), Animal Fluency Test (AFT), and the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) immediate- and delayed-recall tests. Multivariable linear regression evaluated associations between UFR and cognitive scores, and segmented regression assessed potential nonlinear threshold effects.
Results: The mean age was 69.58 years, and 51.48% were women. In the fully adjusted model, higher UFR was associated with higher DSST scores (β = 1.77, 95% CI: 0.74–2.81; p = 0.0008). Participants in the highest UFR tertile had a 2.41-point higher DSST score than those in the lowest tertile (β = 2.41, 95% CI: 0.90–3.92; p = 0.0018; p for trend = 0.0051). Segmented regression identified inflection points of 1.46 mL/min for AFT, 1.30 mL/min for DSST, 0.69 mL/min for CERAD immediate recall, and 0.80 mL/min for CERAD delayed recall. Below these points, higher UFR was significantly associated with better cognitive scores, whereas no significant associations were observed above them. The UFR–DSST association was stronger among participants with BMI ≤ 30 kg/m² (p for interaction = 0.0106).
Conclusions: Lower UFR was associated with poorer cognitive performance in older adults, with a nonlinear pattern. Prospective longitudinal and mechanistic studies are needed to confirm these findings and clarify their clinical relevance.