Abstract
BACKGROUND: Cognitive impairment has become a major public health issue. Depressive symptoms and cognitive impairment are closely related disorders in the aging population. However, the effect of proactive health on the association between depressive symptoms and cognitive impairment was not clear. This study aimed to examine the mediating role of proactive health in the effect of depressive symptoms on cognitive impairment. METHODS: This population-based cross-sectional study recruited 3607 participants aged 60 and above from the China Health and Retirement Longitudinal Study. Direct relationships between depressive symptoms, proactive health, and cognitive impairment were analyzed using multiple logistic regression. The bootstrap method was used to test the mediating role of proactive health in the effect of depressive symptoms on cognitive impairment. RESULTS: After adjusting the confounders, participants in the depressive symptoms group (OR 1.223, 95% CI: 1.047-1.429) and depression group (OR 1.889, 95% CI: 1.399-2.551) had an increased risk of cognitive impairment, while those who had fair proactive health (OR 0.623, 95% CI: 0.458-0.873) and good proactive health (OR 0.454, 95% CI: 0.319-0.648) had a decreased risk of cognitive impairment. The mediation effect of proactve health accounted for 7.19% of the total effect regarding depressive symptoms with cognitive impairment. CONCLUSIONS: This study revealed that depressive symptoms not only directly influenced cognitive impairment among older adults but also indirectly via proactive health. Exercise should be encouraged among the older people to promote their participation in social activities, thereby improving their proactive health and ultimately preventing cognitive impairment.