Depressive symptoms in hospitalized geriatric patients with and without cognitive impairment: a cross-sectional network analysis approach

Background: Late-life depression is common and often co-occurs with cognitive impairment, complicating its assessment and clinical management. Network analysis allows for a nuanced understanding of how individual depressive symptoms interact. This study examines differences in the network structure of depressive symptoms in geriatric patients with and without cognitive impairment. Methods: We included monocentric cross-sectional data of 3,990 hospitalized geriatric inpatients whose depressive symptoms were rated using the 15-item Geriatric Depression Scale (GDS). Patients were stratified into an unimpaired and impaired cognition group depending on the Mini-Mental State Examination (MMSE) (cut-off < 24 points). Network analyses were estimated separately for both groups using regularized logistic regression models. A network comparison test was conducted for group comparison. Results: Our study showed that worthlessness was the most central depressive symptom. However, the network structures differed notably between the two groups, with less impact of feeling empty when cognitive impairment is present, as well as a stronger association between feeling unsatisfied and unhappy, and a weaker connection between feeling empty and bored. Conclusion: These differences highlight the need for clinicians and public health professionals to adapt their screening and intervention strategies to take into account the subtle presentation of depressive symptoms in older adults according to cognitive status.