Exploring the Association Between Overactive Bladder (OAB) and Cognitive decline: mediation by depression in elderly adults,   a NHANES weighted analysis

Overactive bladder (OAB) is a prevalent condition among older adults and may be linked to cognitive health. This study explored a relationship between OAB and cognitive health among adults aged 60 ≥ years in the United States, using NHANES 2011-2014. A cross-sectional analysis was conducted using a nationally representative sample of 2,324 (45.95% male, 54.05% female), within 755 individuals have OAB. Cognitive health was assessed using the Consortium to Establish a Registry for Alzheimer's Disease-Word Learning (CERAD W-L), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). OAB was defined by a score more than 3 on the Overactive Bladder Syndrome Symptom Score (OABSS). Depression incidence was also recorded. Weighted linear regression models adjusted for demographic, behavioral factors, and comorbidities (e.g., diabetes, kidney disease etc.), were employed to examine the independent association between cognitive health and OAB. The results indicated that cognitive scores were significantly lower in the OAB group compared to the non-OAB group across all cognitive tests (p<0.001). The incidence of depression was significantly higher in the OAB group (15%) compared to the non-OAB group (6.05%) (p<0.001). Regression analysis revealed that a 14% decrease in cognitive health z-scores in patients with OAB (β=-0.14, CI (95%) [-0.22, -0.06]). Furthermore, depression was found to mediate 34.56% of the association between OAB and cognitive health relationship [CI (95%): 0.20, 0.69]. This negative association was robust in subgroups by demographics, behavioral factors, and comorbidities. This study's findings, supported by mediation analysis, smoothed curve analysis, and sensitivity analysis, suggest that lower cognitive health is significantly associated with OAB, and depression plays an important mediating role in this association.