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Updated: May 19, 2026

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
Published on: April 26, 2024
Depressive and insomnia symptoms and incident dementia risk: A 12-year study in U.S. older adults
Sofia Liu1, Zixuan He2, Claire Wang1
1School of Nursing, Johns Hopkins University, Baltimore, MD, 21205, USA.
Background:
Depressive and insomnia symptoms are common in late life and have each been associated with increased dementia risk. However, their co-occurrence and potential combined effects on cognitive outcomes remain understudied. We examined the independent and joint associations of time-varying depressive and insomnia symptoms with incident dementia among community-dwelling older adults.
Methods:
Data were drawn from 13 rounds (2011-2023) of the National Health and Aging Trends Study (NHATS). Participants (N = 6226) without dementia at baseline were followed for up to 12 years. Depressive symptoms and insomnia symptoms were self-reported and classified as neither-symptom, depressive-only, insomnia-only, or co-occurring. Incident dementia was determined using self/proxy reports, cognitive testing, and the AD8. Survey-weighted Cox proportional hazards and competing-risk models estimated hazard ratios (HRs).
Results:
Co-occurring symptoms were associated with higher dementia hazard than neither (HR = 1.37; 95% confidence interval [CI]: 1.23-1.53) and insomnia-only (HR = 1.25; 95% CI: 1.03-1.51) but did not differ from depression-only (HR = 0.94; 95% CI: 0.84-1.05). Age modified associations (p = 0.019), with contrasts more apparent before age 75 and the depression-only group showing higher dementia hazard than the co-occurring group at age ≥ 75.
Conclusion:
Findings support joint assessment of mood and sleep symptoms to identify older adults at elevated dementia risk and suggest that depressive symptoms may be more informative than insomnia symptoms for risk stratification in later life, with heterogeneity by age.
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