Cognitive Change as an Early Warning for Late-Life Depression: Implications for Population Health Screening Strategies

Cognitive decline and late-life depression are intertwined public health challenges for aging populations globally. To inform effective prevention, the current study investigated the dynamic temporal associations between multidimensional cognitive functions and depressive symptoms. Using four waves of longitudinal data (2013-2020) from a large panel study of older adults, the current study employed an integrated framework combining optimized dynamic time warping, cross-lagged panel models, and network analysis to model complex, lagged relationships. Results provided strong empirical support for the "cognition-first" hypothesis, with declines in several cognitive domains-notably temporal orientation, calculation, and immediate recall-acting as significant upstream predictors of subsequent depressive symptoms. A modest but significant protective feedback effect from positive affect to cognitive maintenance was also identified, while negative affect showed no significant predictive role sample of older adults who were cognitively and emotionally healthy at baseline. These findings offer preliminary empirical support for a strategic shift in population health management from reactive treatment toward proactive prevention. Based on these results, the current study discusses a conceptual framework for integrating cognitive screening into primary care to identify at-risk older adults, an approach that warrants further investigation and validation. This proactive approach could enable timely, low-cost interventions aimed at promoting positive affect and cognitive resilience, offering a potentially cost-effective strategy to mitigate the long-term burden of mental illness and advance the goals of healthy aging.