Association Between Cognitive Frailty and Depression: A Prospective Cohort Study of Adults Aged 45 Years and Older in China

Background: The interplay between cognitive frailty and depression remains inadequately understood, with a paucity of evidence from prospective cohort studies. Our study aims to elucidate the relationship between cognitive frailty and the risk of incident depression.

Methods: Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011, 2013, and 2015, subjects were classified according to cognitive frailty criteria established by an international consensus panel. Multiple logistic regression models were employed to examine the cross-sectional and longitudinal associations between frailty, cognitive impairment, cognitive frailty, and depression. Subgroup analyses and interaction tests were conducted to identify potential effect modifiers.

Results: In 2011, the study encompassed 4514 participants, with 2330 individuals followed up through 2015. Cross-sectional analyses revealed that participants classified in frailty, cognitive impairment, and cognitive frailty exhibited multivariable-adjusted odds ratios (ORs) for depression of 1.87 (95% CI 1.60-2.18; P < 0.001), 1.97 (95% CI 1.58-2.47; P < 0.001), and 3.38 (95% CI 2.66-4.29; P < 0.001), respectively, compared to no diseased group. Longitudinal analyses from 2011 to 2015 indicated that participants in frailty, cognitive impairment, and cognitive frailty had multivariable-adjusted ORs of 1.28 (95% CI 1.05-1.58; P = 0.0165), 1.39 (95% CI 1.01-1.91; P = 0.0411), and 1.57 (95% CI 1.05-2.35; P = 0.0273), respectively, for new-onset depression relative to no diseased group.

Limitations: The definition of depression relied solely on self-reported data.

Conclusion: In the middle-aged and elderly Chinese population, patients with cognitive frailty have a higher risk of depression than those with only frailty and cognitive impairment. This may suggest that health care providers should pay more attention to the mental health of those patients with cognitive frailty.