To evaluate the association between lower urinary tract symptoms and early neurological decline, and to determine whether LUTS can serve as a clinical biomarker for underlying neurocognitive dysfunction.

A cross-sectional analytical study was conducted over a 6-month period at a tertiary care center. Adults aged ≥50 years presenting with LUTS were included. Patients underwent structured evaluation including symptom assessment using validated questionnaires (IPSS/OABSS), cognitive screening using the Mini-Mental State Examination (MMSE), and neurological assessment where indicated. LUTS severity was categorized into mild, moderate, and severe. Statistical analysis included correlation studies and multivariate regression to identify independent associations between LUTS severity and cognitive impairment.

A total of 256 patients (mean age 61.2 ± 9.8 years; 59% male) were included.
Moderate to severe LUTS were present in 68% of patients
Cognitive impairment (MMSE <24) was identified in 34%
Patients with severe LUTS had a significantly higher prevalence of cognitive impairment compared to those with mild symptoms (48% vs 18%, p < 0.01)
On multivariate analysis:
Severe LUTS (OR 2.9)
Urgency urinary incontinence (OR 2.4)
Age >65 years (OR 3.1)
were independently associated with cognitive impairment (p < 0.05).

The findings demonstrate a significant association between LUTS severity and early cognitive decline. The bladder, being under complex central and peripheral neural control, may act as a functional “sentinel organ,” reflecting early neurological dysfunction before overt clinical manifestations. Routine evaluation of LUTS may therefore offer an opportunity for early detection of neurocognitive disorders.

Lower urinary tract symptoms may serve as a potential clinical biomarker for early neurological decline. Incorporating cognitive screening in patients presenting with significant LUTS could facilitate timely diagnosis and multidisciplinary management.
Recognizing LUTS as more than a urological complaint may enable early identification of neurodegenerative conditions, improving patient outcomes through earlier intervention.
“Sometimes, the first sign of a failing brain is not memory loss — it’s the bladder.”