Interrelationships of Depression with Cognitive Function and Their Association with Quality of Life in Older Adults with Hypertension: National Survey Findings from a Network Perspective

OBJECTIVES: Depression and cognitive decline are common and frequently co-occur among older adults with hypertension, but their symptom-level relationships are poorly understood. This study explored interrelationship between depressive symptoms and cognitive function as well as their associations with quality of life (QoL) in a national hypertension sample from China. METHODS: Depression, cognitive function, and global QoL were assessed utilizing Chinese versions of the 10-item Center for Epidemiological Studies Short Depression Scale (CESD-10), Mini-Mental State Examination, and World Health Organization Quality of Life-brief version (WHOQOL-BREF), respectively. We identified central symptoms and bridge symptoms based on centrality strength and bridge strength indexes, while symptoms having links to QoL were analyzed via flow network analysis. RESULTS: The study included 4,683 older adults. The prevalence of depression (CESD-10 total score ≥10) and cognitive impairment (MMSE total score <24) were 28.5% (95% CI = 27.2-29.8%) and 19.9% (95% CI = 18.8-21.1%), respectively. "Feeling blue/depressed" (CESD3) and "language" (Lan) were emerged as the most influential symptoms within the network model. "Naming" and "Language" were identified as most important bridge symptoms. Finally, "sleep disturbances" (CESD10) and "hopelessness" (CESD5) exhibited the strongest negative association with QoL. CONCLUSIONS: Targeting central and bridge symptoms (e.g., depressed emotions, language, and naming ability) may provide pathways for addressing both depression and cognitive decline among older adults with hypertension. Moreover, improving sleep quality and alleviating hopelessness could help increase QoL in this population.