Frontiers in Psychiatry · Oct 30, 2026
Joint Associations of Cardiometabolic Multimorbidity and Depression with Cognitive Impairment in Middle-Aged and Older Adults: A Multicenter Cross-Sectional Study
By Yan Wang, Rong Zhao, Hao Zhang et al.
Introduction:Cardiometabolic multimorbidity (CMM) and depressive symptoms are common in middle-aged and older adults and may be jointly associated with cognitive impairment. This study examined their independent and combined associations with cognitive impairment and explored whether these associations differed by sex and BMI. Methods:This multicenter cross-sectional study included 1,436 middle-aged and older adults aged ≥45 years from the baseline survey of the Chronic Cardiovascular Disease Health Cohort of the First People's Hospital of Bengbu. Cognitive impairment was assessed using the MMSE with education-adjusted cutoff scores, and depressive symptoms were measured using the CESD-10. CMM was defined as the coexistence of at least two conditions among type 2 diabetes, heart disease, and stroke. Binary logistic regression was used to examine the independent and joint associations of CMM and depressive symptoms with cognitive impairment, with covariates progressively adjusted according to the Social Ecological Model. Subgroup analyses by sex and BMI, interaction tests, and sensitivity analyses using a broader CMM definition were performed. Results :Among 1,436 participants, 333 (23.19%) had cognitive impairment. In separate covariate-adjusted analyses, adjustment for age produced the greatest attenuation in the CMM–cognitive impairment association (OR decreased from 1.985 to 1.377, 95% CI: 0.907-2.091; P=0.134). In models that adjusted for other covariates individually, the CMM association remained significant. After full adjustment, CMM alone (OR=1.629, 95% CI: 1.043-2.519) and depressive symptoms alone (OR=2.112, 95% CI: 1.481-3.012) were associated with cognitive impairment; their co-occurrence had the highest odds (OR=2.905, 95% CI: 1.964-4.294). This association remained significant after adjustment for age, sex, and BMI (OR=2.801, P<0.001). Sex-stratified analyses showed broader significant associations among men, but the joint exposure-by-sex interaction was not significant (P=0.395). Among participants with BMI≥24 kg/m ² , all three exposure groups were significantly associated with cognitive impairment; however, BMI interaction was not significant (P=0.890). Sensitivity analyses using the broader CMM definition yielded consistent results. Conclusion :Cognitive health management in midlife/older adults may benefit from comprehensive assessment and risk stratification. Assessment should integrate cardiometabolic, depressive, and cognitive factors, not focus solely on one disease or subgroup. Older CMM-alone adults warrant priority screening, though age is not the sole stratifier.