From dysphoria to anhedonia: age-related shift in the link between cognitive and affective symptoms

Depression in aging shows heterogeneous symptoms across cognitive, affective, and neurobiological domains. Traditional categorical diagnoses may not capture these complex patterns, prompting a shift toward dimensional or domain-based approaches. We examined whether the symptoms that bridge cognition and affect differ by age and explored their associations with brain structure.

Data from 756 young (≤45 years) and 1,230 older (≥65 years) adults from the Cambridge Centre for Ageing and Neuroscience were analyzed. Cognition was assessed using the Addenbrooke's Cognitive Examination-Revised, and depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale. Graphical LASSO was used to construct cognitive-affective networks, testing for age-related differences in strength and bridging centrality measures. Building on these findings, we further examined the association between bridging symptoms, cognition, and gray matter volume (GMV).

Symptom strength centrality was similar across age groups. However, significant age-related differences emerged in bridging symptoms. Specifically, the primary bridging symptom differed, with dysphoria in young adults and anhedonia in older adults. Follow-up analyses showed that cognition mediated the link between GMV and anhedonia, but not dysphoria, particularly in older adults.

Cognitive-affective bridging symptoms differ with age, with anhedonia replacing dysphoria as the key bridge in older adults. This shift was linked to age-related differences in the relationship between GMV, cognition, and depressive symptoms. These results highlight the need to target different symptoms to alleviate cognitive-affective manifestations across the lifespan.