Abstract
Depressive symptoms are recognized as risk factors for cognitive impairment with intricate underlying biological mechanisms. We explored the link between depressive symptoms and cognitive impairment onset; we also assessed how this association is influenced by educational levels. This study included 5843 individuals aged ≥45 years, comprising 27,908 observations from 2006 to 2020. Based on repeated measurements of each participant, we estimated the association between depressive symptoms and cognitive impairment onset after a 2-year follow-up by using generalized estimating equations. The incidence rate was 9.4% among those individuals without depressive symptoms, which was in contrast with a rate of 21.0% among those individuals experiencing depressive symptoms. The odds ratio (OR) (95% confidence interval [CI]) for the association between depressive symptoms and cognitive impairment onset in the overall sample was 1.61 (1.47-1.76). This association was more pronounced among individuals with higher educational levels. Specifically, the OR (95% CI) of the association between depressive symptoms and cognitive impairment was highest among individuals with a college education (2.60 [1.78-3.81]), and the association was lowest among individuals with elementary or no education levels (1.45 [1.28-1.63]). Our findings highlight the idea that although individuals with higher educational backgrounds exhibit a diminished risk of cognitive impairment, the detrimental impacts of depressive symptoms on cognitive performance are particularly more pronounced within this group.