OBJECTIVE To evaluate cognitive processing in elderly women with urge incontinence as compared to continent cohorts by measuring performance on neuropsychological tests of working memory, attention and inhibition. To measure speed of information processing, intensity of bladder filling sensation, and urine volume at a first desire (FDV) and strong desire to void (SDV), and level of attentional demands. METHODS Test measures included Operation and Reading Span, Wisconsin Card-Sorting, Stroop Color Reading, Map Planning, and Maze Speed tests. A Likert scale measured bladder filling sensation intensity at FDV and SDV. An Attentional Demands Survey measured perceived attentional demands. RESULTS Women with urge incontinence had a mean severity index of 4.71 ± 2.7 with 84% demonstrating urge incontinence and 16% with mixed urge/stress incontinence. They experienced a FDV and a SDV to void at a lower bladder filling intensity with significantly smaller volumes of urine in the bladder compared to controls. Incontinent women also perceived significantly higher attentional demands but were not significantly different than controls on tests of executive function. CONCLUSIONS While observations from neuroimaging provide evidence of differences between women with urge incontinence and controls in regional brain activity, efforts need to be made to decipher how these differences in metabolic activity relate to the fluid operations that create thoughts, decisions, and behavior.