Inter-relationship between cognitive performance and depressive symptoms and their association with quality of life in older adults: A network analysis based on the 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Wei Bai; Juan Zhang; Robert D Smith; Teris Cheung; Zhaohui Su; Chee H Ng; Qinge Zhang; Yu-Tao Xiang

doi:10.1016/j.jad.2022.09.159

Inter-relationship between cognitive performance and depressive symptoms and their association with quality of life in older adults: A network analysis based on the 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS)

J Affect Disord. 2023 Jan 1:320:621-627. doi: 10.1016/j.jad.2022.09.159. Epub 2022 Oct 5.

Authors

Wei Bai¹, Juan Zhang², Robert D Smith³, Teris Cheung⁴, Zhaohui Su⁵, Chee H Ng⁶, Qinge Zhang⁷, Yu-Tao Xiang⁸

Affiliations

¹ Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
² Faculty of Education, University of Macau, Macao SAR, China.
³ Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.
⁴ School of Nursing, Hong Kong Polytechnic University, Hong Kong, SAR, China.
⁵ Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, USA.
⁶ Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia. Electronic address: cng@unimelb.edu.au.
⁷ The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China. Electronic address: zqe81@126.com.
⁸ Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China. Electronic address: xyutly@gmail.com.

PMID: 36206885
DOI: 10.1016/j.jad.2022.09.159

Abstract

Background: Depressive symptoms and cognitive impairment are common psychiatric conditions and often co-occur in older adults. Network analysis has been widely used in exploring the inter-connections between psychiatric symptoms. The aim of this study was to explore the network model of depressive symptoms and cognitive performance, and their association with quality of life in people aged 65 years or above based on the 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Method: Global cognitive performance, depressive symptoms, and global quality of life (QoL) were measured using the validated Chinese version of the Mini Mental State Examination (MMSE), the 10-item Center for Epidemiologic Studies Short Depression Scale (CES-D), and the World Health Organization Quality of Life-brief version (WHOQOL-BREF), respectively. Central symptoms and bridge symptoms were identified via strength and bridge strength, respectively. The flow network was used to identify symptoms directly related to QoL. Network stability was examined using the case dropping bootstrap method.

Results: A total of 9023 participants were included in the network analysis. CESD3 "Feeling blue/depressed", CESD4 "Everything was an effort", and At_C "Attention and Calculation" were the central (influential) symptoms that had the highest strength value. Three bridge symptoms (i.e., Nam "Naming", CESD2 "Difficulty with concentrating", and Lan "Language") were also identified. CESD10 "Sleep disturbances" had the strongest direct connection to QoL.

Conclusions: This exploratory study highlights the inter-relationships between cognitive performance and depressive symptoms in older adults in the general population. Interventions targeting bridge symptoms have the potential to alleviate depressive and cognitive symptoms in this population. Furthermore, improving sleep quality in older adults may reduce the negative impact of depression and cognition decline on QoL.

Keywords: Cognition; Depression; Network analysis; Older adults; Quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China / epidemiology
Cognition
Cognitive Dysfunction* / epidemiology
Depression / epidemiology
Depression / psychology
Health Status
Humans
Quality of Life* / psychology