Inter‐Relationships Between Depressive Symptoms and Cognition Among Older Adults in India: A Network Analysis of a Nationally Representative Sample

BACKGROUND: Depression and cognitive impairment frequently co-occur in older adults. Network analysis can elucidate inter-relationship between psychiatric disturbances at the symptom level. This study examined the network structure of depressive symptoms and impaired cognitive function among adults aged 60 years or older in India. METHODS: Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Cognitive function was evaluated across six domains: Memory, Orientation, Retrieval fluency, Arithmetic function, Executive function, and Object naming. Central symptoms and bridge symptoms were identified using Expected Influence (EI) and Bridge EI, respectively. A flow network was employed to identify symptoms directly associated with cognitive impairment. RESULTS: In this study, 29 224 participants were included. The prevalence of depression (CESD-10 total score ≥ 4) was 27.46% (95% CI: 26.95%-27.97%), while the prevalence of cognitive impairment was 15.55% (95% CI: 15.13%-15.97%). CESD2 ("Felt depressed") emerged as the most central symptom, followed by Ari ("Arithmetic function") and Ori ("Orientation"). Moreover, CESD8 ("Everything was an effort"), CESD2 ("Felt depressed"), and CESD7 ("Bothered by things") served as bridge nodes linking the communities of depressive symptoms and cognitive functions. The flow network indicated that the strongest connections to cognitive impairment were observed for CESD1 ("Trouble focusing"), CESD3 ("Could not get going"), and CESD10 ("Felt unhappy"). CONCLUSION: This study documented the inter-relationship between particular depressive symptoms and impaired cognition among older adults in India. The central symptoms and bridge symptoms identified in this study should be tested in intervention studies aiming to improve depression and cognition among older adults.