Serum Sodium and Cognition in Older Community-Dwelling Men

Clin J Am Soc Nephrol. 2018 Mar 7;13(3):366-374. doi: 10.2215/CJN.07400717. Epub 2018 Feb 8.


Background and objectives: Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently unknown. We determined whether lower normal serum sodium is associated with cognitive impairment and risk of cognitive decline in community-dwelling older men.

Design, setting, participants, & measurements: Five thousand four hundred thirty-five community-dwelling men aged ≥65 years who participated in Osteoporotic Fractures in Men, a cohort study with a median follow-up for cognitive function of 4.6 years, were included in this analysis. Multivariable logistic regression was used to examine the association between baseline fasting serum sodium levels and the odds of prevalent cognitive impairment (cross-sectional analysis; modified Mini-Mental Status [3MS] score <1.5 SD [<84] below or Trail Making Test Part B time >1.5 SD above the mean [>223 seconds]) and cognitive decline (prospective analysis [n=3611]; decrease in follow-up 3MS score or increase in Trails B time >1.5 SD of the mean score/time change [>9 or >67 seconds]).

Results: Participants were aged 74±6 years with a fasting mean serum sodium level of 141±3 mmol/L. Fifteen percent (n=274), 12% (n=225), and 13% (n=242) had prevalent cognitive impairment in tertiles 1, 2, and 3, respectively. After adjustment, lower serum sodium was associated with prevalent cognitive impairment (tertile 1 [126-140 mmol/L] versus tertile 2 [141-142 mmol/L], odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.06 to 1.61). Fourteen percent (n=159), 10% (n=125), and 13% (n=159) had cognitive decline in tertiles 1, 2, and 3, respectively. Lower serum sodium was also associated with cognitive decline (tertile 1 versus tertile 2, OR, 1.37; 95% CI, 1.06 to 1.77). Tertile 3 (143-153 mmol/L) was additionally associated with cognitive decline. Results were similar in sensitivity analyses according to clinical cut-offs and by quartiles.

Conclusions: In community-dwelling older men, serum sodium between 126-140, and 126-140 or 143-153 mmol/L, are independently associated with prevalent cognitive impairment and cognitive decline, respectively.

Keywords: Aging; Cognition; Cognitive Dysfunction; Cross-Sectional Studies; Fasting; Follow-Up Studies; Independent Living; Logistic Models; Osteoporotic Fractures; Prevalence; Prospective Studies; Sodium; Trail Making Test; cognitive; electrolytes; hyponatremia.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognition*
  • Cognitive Dysfunction / epidemiology*
  • Follow-Up Studies
  • Humans
  • Hyponatremia / blood*
  • Hyponatremia / psychology*
  • Independent Living
  • Male
  • Neuropsychological Tests
  • Prevalence
  • Sodium / blood*
  • United States / epidemiology


  • Sodium