The hidden burden of depressive symptoms on functional autonomy in cognitive decline

BACKGROUND: Cognitive decline involves a progressive loss of higher mental functions and may lead to impairment of independence in daily activities. Depressive symptoms represent a potential factor that can worsen functional decline. OBJECTIVE: To evaluate the impact of depressive symptoms on basic and instrumental autonomy in patients with cognitive decline. METHODS: A retrospective analysis was conducted on the medical records of 148 patients attending the Neuropsychology Clinic of the IRCCS Centro Neurolesi Bonino Pulejo. Patients were divided into two groups with and without depressive symptoms according to the Geriatric Depression Scale. The Milan Overall Dementia Assessment (MODA), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) were administered. Between-group comparisons were performed using the Mann-Whitney U test and permutation-based regression analysis, controlling for age, sex, and MODA. Correlations were assessed using Spearman's rho coefficient. RESULTS: Patients with depressive symptoms showed lower ADL and IADL scores compared with those without depressive symptoms. These differences remained significant after adjustment for demographic and cognitive variables. The severity of depressive symptoms were strongly associated with reduced functional autonomy. CONCLUSIONS: The findings highlight the importance of early diagnosis and targeted interventions for depressive symptoms to improve patient management in everyday life. Clinical trial registration: www.clinicaltrials.gov identifier is NCT07287410.