Depression, anxiety, and cognitive function in patients with ischemic cerebrovascular disease: a cross-sectional study based on the Montreal Cognitive Assessment

Abstract

Depression and anxiety are highly prevalent in patients with ischemic cerebrovascular disease and have been linked to cognitive impairment, but their differential effects across specific cognitive domains remain poorly characterized. Evidence using statistical mediation analysis to examine associations among anxiety, depression, and cognition is limited. In this hospital-based cross-sectional study, 667 patients (predominantly with ischemic cerebrovascular disease; a diagnostic review of 318 consecutive patients revealed that 90.9% had cerebrovascular pathology) completed the Montreal Cognitive Assessment (MoCA), Self-Rating Depression Scale (SDS), and Self-Rating Anxiety Scale (SAS). Cognitive impairment was defined as MoCA <26, with a 1-point education adjustment for ≤12 years of education applied in sensitivity analyses (available for 586/667 patients, 87.9%). Spearman correlations examined associations between mood symptoms and MoCA total and domain scores. Bootstrap mediation analysis (1,000 resamples) tested the statistical mediation the anxiety-cognition relationship by depression. Subgroup analyses were stratified by age (<60, 60–75, ≥75 years) and sex. Among 667 participants (mean age 65.2 ± 16.2 years; 53.8% male), the prevalence of cognitive impairment was 45.3% (302/667) in the education-adjusted sensitivity analysis. MoCA total score was inversely correlated with SDS ( ρ = −0.652, 95% CI: −0.693 to −0.607, p < 0.001) and SAS ( ρ = −0.559, 95% CI: −0.608 to −0.506, p < 0.001). Domain-specific patterns of association showed delayed recall was most strongly associated with mood symptoms (composite vulnerability index 0.295), followed by visuospatial/executive function (0.238) and attention (0.234). Mediation analysis showed that 49.5% of the statistical association between anxiety and MoCA was accounted for by depression (indirect effect = −0.153, 95% CI: −0.201 to −0.105, p < 0.001). Subgroup analyses using interaction terms showed stronger mood-cognition associations in the elderly (≥75 years: age × depression interaction B = −0.0018, p = 0.089), while sex × depression interaction was not significant ( B = 0.045, p = 0.31). Depression and anxiety are independently associated with cognitive impairment in patients with ischemic cerebrovascular disease, with delayed recall being the most vulnerable domain. The anxiety-cognition association is partially statistically accounted for by depression, but the data do not support directional inference. Elderly patients warrant particular attention.