Cognitive performance in relation to hydration status and water intake among older adults, NHANES 2011–2014



Risks of dehydration and cognitive decline increase with advancing age, yet the relation between dehydration, water intake, and cognitive performance among older adults remains understudied.


Using data from the 2011–2014 cycles of the Nutrition and Health Examination Survey (NHANES), we tested if calculated serum osmolarity (Sosm) and adequate intake (AI) of water among women (n = 1271) and men (n = 1235) ≥ 60 years old were associated with scores of immediate and delayed recall, verbal fluency, and attention/processing speed. Sosm was categorized as < 285 (hyperhydrated), 285–289, 290–294, 295–300, or > 300 (dehydrated) mmol/L. AI of water was defined as ≥ 2 L/day for women and ≥ 2.5 L/day for men.


Women with Sosm between 285 and 289 mmol/L scored 3.2–5.1 points higher on the Digit Symbol Substitution test (DSST) of attention/processing speed than women in other Sosm categories (P values < 0.05). There was evidence of a curvilinear relationship between DSST scores and Sosm among women and men (P values for quadratic terms < 0.02). Meeting an alternative AI on water intake of ≥ 1 mL/kcal and ≥ 1500 mL, but not the sex-specific AI, was associated with scoring one point higher on a verbal fluency test (P = 0.02) and two points higher on the DSST (P = 0.03) among women. Significant negative associations between dehydration or inadequate water intake and test scores were not observed among men.


Hydration status and water intake were moderately associated with attention/processing speed among females. Future work should consider the effects of both dehydration and overhydration on cognitive function and investigate potential sex differences in cognitive responses to hydration status.

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Correspondence to Hilary J. Bethancourt or Asher Y. Rosinger.

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Bethancourt, H.J., Kenney, W.L., Almeida, D.M. et al. Cognitive performance in relation to hydration status and water intake among older adults, NHANES 2011–2014. Eur J Nutr (2019) doi:10.1007/s00394-019-02152-9

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  • Dehydration
  • Water intake
  • Cognitive performance
  • Older adults
  • Serum osmolarity
  • Serum osmolality