Joint Associations of Cardiometabolic Multimorbidity and Depressive Symptoms on Cognitive Function Among Chinese Middle-Aged and Older Adults

Purpose: Cognitive decline in middle-aged and older adults globally is a pressing health concern, linked to two significant factors: cardiometabolic multimorbidity (CMM) and depressive symptoms. This study aimed to investigate the independent, joint, and interactive effects of CMM and depressive symptoms on cognitive function in Chinese middle-aged and older adults. Patients and Methods: A total of 341 middle-aged and older adults were enrolled from the memory clinic at Qianhai Shekou Free Trade Zone Hospital in Shenzhen between May 2022 and June 2025 for this cross-sectional study. A composite z-score, computed based on performance on the Trail Making Test-A (TMT-A), Trail Making Test-B (TMT-B), and Animal Verbal Fluency Test (AFT), served as the measure of global cognition. CMM describes a constellation of at least two cardiometabolic diseases, including diabetes, stroke, and heart disease. Assessment of depressive symptoms was conducted using the Center for Epidemiological Studies-Depression Scale (CES-D). Linear regression was used. Results: This study enrolled 341 individuals over 45 years of age. The sample had a mean age of 62.4 years (SD 9.1), and 52.8% were male. A significant link was observed between CMM and lower global cognitive scores ( β = − 0.37, 95% CI = − 0.57 to − 0.17). A higher number of CMDs was positively associated with the severity of cognitive impairment ( β=− 1 .08, 95% CI=− 0 .28 to − 0.08). Depressive symptoms were inversely associated with cognitive scores ( β=− 0 .66, 95% CI=− 1 .03 to − 0.30). Participants with co-existing CMM and depressive symptoms exhibited the lowest cognitive scores ( β=− 1 .31, 95% CI=− 2 .11 to − 0.52) relative to those without either condition. This pattern remained consistent in all subgroups. Conclusion: In this cross-sectional study, the association between co-existing CMM and depressive symptoms and poorer cognitive function highlights the need for integrated management of physical and mental health to preserve cognition in Chinese middle-aged and older adults. Keywords: cardiometabolic multimorbidity, depressive symptoms, cognitive function, middle-aged and older adults