Association between depressive symptoms and cognitive performance in middle-aged and older adults across digital...

Depression and cognitive problems are common in older adults and are often associated with social isolation. This study compared depression and cognitive function between older adults with digital inclusion and those with digital exclusion.

Data were derived from the 2020 wave of the China Health and Retirement Longitudinal Study. Depression was evaluated using the Center for Epidemiologic Studies Depression Scale-10 items. Cognitive function was assessed with episodic memory and executive function tests. Propensity score matching was employed to match the digital inclusion and exclusion groups after controlling for covariates. Network analysis was used to examine the difference in the interaction of symptoms between both groups.

In total, 9436 eligible participants were included in the analyses, with 4718 in the digital inclusion and 4718 in the digital exclusion groups. Participants in the digital inclusion group exhibited higher levels of global cognition, including executive function (z = -23.08; p < 0.001) and episodic memory (z = -26.34; p < 0.001), compared with those in the digital exclusion group. In contrast, participants in the digital exclusion group displayed more severe depression (z = 11.15; p < 0.001) compared with those in the digital inclusion group. Both groups had similar most central symptom of "Feeling blue" (EI: 1.16 in digital inclusion; 1.11 in digital exclusion) and bridge symptoms, including "Orientation" (bridge EI: 0.21 in digital inclusion; 0.17 in digital exclusion), "Delayed memory" (bridge EI: 0.18 in digital inclusion; 0.14 in digital exclusion) and "Hopelessness" (bridge EI: 0.16 in digital inclusion; 0.24 in digital exclusion).

Digital exclusion is significantly associated with more severe depressive symptoms and cognitive impairment among older adults. The central and bridge symptoms should be prioritized in developing treatment strategies for older adults with depression and cognitive decline.