Relationship between depression, neuropsychiatric symptoms and cognitive profiles of the elderly in India: An assessment using the ICMR-MUDRA toolbox

India's aging population faces escalating cognitive decline and neuropsychiatric challenges. This cross-sectional study examined relationships between geriatric depression, neuropsychiatric symptoms and cognitive performance among 1,013 community-dwelling elderly participants (≥60 years) in Gorakhpur using the ICMR-MUDRA Toolbox. Multistage random sampling was employed. Depression was assessed using GDS-30, and neuropsychiatric symptoms were assessed using NPI-Brief. It was observed that geriatric depression was present in 63.3% of participants, while neuropsychiatric symptoms affected 78.5%, predominantly agitation (15%) and irritability (12%). Cognitive performance declined significantly across depression severity in attention, executive function, memory, language and visuospatial domains (P < 0.001). Adjusted regression revealed that mild depression was negatively associated with executive function and memory, while severe depression showed stronger associations with language and visuospatial abilities. Neuropsychiatric symptoms independently impacted cognitive domains. These findings highlight the need for integrated mental health screening and early intervention strategies within routine geriatric care in India.