Huijun Liu, Xiange Zhang, Ming Yang, Jiayi Sun, Juanjuan Peng, Wangquan Xu, Yueli Song, Guixia Fang
The First Clinical Medical College, Anhui Medical University, Hefei, 230032, China.
School of Health Management, Anhui Medical University, Meishan Road No.81, Hefei, Anhui, 230032, China.
BMC Geriatr. 2025 Apr 5;25(1):223. doi: 10.1186/s12877-025-05871-3.
The incidence of depression and cognitive dysfunction is high in the elderly population, which incurs serious social burden. In recent years, an increasing number of studies have found that poor sleep quality and impaired daily activities in the elderly are also closely related to these two diseases.To explore the mediating role of sleep quality and daily activity ability in the elderly's cognition and depression. It extends upon existing research and provides evidence for new areas of intervention that may ameliorate and delay cognitive decline in the elderly.
Data were collected from a representative sample of 5,470 (aged 60 years and above) in Anhui Province from the 2019 Anhui Health and Life Expectancy Survey(AHLS). Cognitive function was assessed by the Mini-Mental State Examination(MMSE), depression symptoms by the Patient Health Questionnaire(PHQ-9), physical function by the Barthel Index for Activities of Daily Living, and sleep quality by the Pittsburgh Sleep Quality Index(PSQI). Descriptive analysis was conducted for the distribution of various covariates and results. Pearson correlation analysis was employed to test the relationship between depression symptoms, cognition, poor sleep quality and daily living ability of the elderly. The structural equation model was used to explore the link between depression and cognition in the older adults, and to test mediating effects of daily activity and sleep disturbance on depression and cognition.
Among all participants, the average cognitive score was 21.51 (SD = 6.10), and the incidence of depression symptoms was 31.6%. Depression symptoms had a significant direct impact on cognition (β= -0.075, 95%CI=-0.099, -0.050). Depression symptoms was related to poor sleep quality and daily living ability (β = 0.420, 95%CI = 0.409, 0.447; β=-0.161, 95%CI=-0.163, -0.113). Cognition was also related to both factors (β=-0.042, 95%CI=-0.070, -0.024; β = 0.143, 95%CI = 0.112, 0.173). The ability of daily living was related to poor sleep quality (β=-0.049, 95%CI=-0.079, -0.027). Poor sleep quality and daily living ability mediated the relationship between depression symptoms and cognition (β=-0.020, 95% CI=-0.025, -0.014; β=-0.020, 95%CI=-0.030, -0.010).
This study found that depression symptoms in the older adults was significantly related to cognitive function. Older adults with depression symptoms are more likely to have cognitive impairment. In addition, poor sleep quality and the ability of daily living can play a mediating role between depression and cognition. In the future, the society should pay attention to the mental health of the elderly to avoid depression. They should also pay attention to the impact of their sleep quality and daily activity ability, so as to better maintain cognitive function.
老年人群中抑郁症和认知功能障碍的发病率很高，这带来了严重的社会负担。近年来，越来越多的研究发现，老年人睡眠质量差和日常活动能力受损也与这两种疾病密切相关。本研究旨在探讨睡眠质量和日常活动能力在老年人认知和抑郁中的中介作用，扩展现有研究，并为改善和延缓老年人认知衰退的新干预领域提供证据。
数据来自2019年安徽省健康与预期寿命调查（AHLS）中5470名（60岁及以上）具有代表性的样本。认知功能通过简易精神状态检查表（MMSE）评估，抑郁症状通过患者健康问卷（PHQ-9）评估，身体功能通过日常生活活动能力巴氏指数评估，睡眠质量通过匹兹堡睡眠质量指数（PSQI）评估。对各种协变量和结果的分布进行描述性分析。采用Pearson相关分析来检验老年人抑郁症状、认知、睡眠质量差和日常生活能力之间的关系。使用结构方程模型来探讨老年人抑郁与认知之间的联系，并检验日常活动和睡眠障碍对抑郁和认知的中介作用。
在所有参与者中，平均认知得分为21.51（标准差=6.10），抑郁症状的发生率为31.6%。抑郁症状对认知有显著的直接影响（β=-0.075，95%置信区间=-0.099，-0.050）。抑郁症状与睡眠质量差和日常生活能力有关（β=0.420，95%置信区间=0.409，0.447；β=-0.161，95%置信区间=-0.163，-0.113）。认知也与这两个因素有关（β=-0.042，95%置信区间=-0.070，-0.024；β=0.143，95%置信区间=0.112，0.173）。日常生活能力与睡眠质量差有关（β=-0.049，95%置信区间=-0.079，-0.027）。睡眠质量差和日常生活能力介导了抑郁症状与认知之间的关系（β=-0.020，95%置信区间=-0.025，-0.014；β=-0.020，95%置信区间=-0.030，-0.010）。
本研究发现老年人的抑郁症状与认知功能显著相关。有抑郁症状的老年人更有可能出现认知障碍。此外，睡眠质量差和日常生活能力在抑郁和认知之间起中介作用。未来，社会应关注老年人的心理健康以避免抑郁。还应关注其睡眠质量和日常活动能力的影响，以便更好地维持认知功能。
