Depression, anxiety, and cognitive function in patients with ischemic cerebrovascular disease: a cross-sectional study based on the Montreal Cognitive Assessment.
Depression and anxiety are independently associated with cognitive impairment in patients with ischemic cerebrovascular disease, with delayed recall the most vulnerable domain, and the anxiety-cognition association is partially statistically accounted for by depression, though the cross-sectional data do not support directional inference.
Key Findings
Results
Cognitive impairment was highly prevalent in this hospital-based cohort of patients with predominantly ischemic cerebrovascular disease.
667 patients completed the MoCA, SDS, and SAS; mean age was 65.2 ± 16.2 years and 53.8% were male.
Prevalence of cognitive impairment was 45.3% (302/667) in the education-adjusted sensitivity analysis (MoCA <26, with a 1-point adjustment for ≤12 years of education).
Education data were available for 586/667 patients (87.9%).
A diagnostic review of 318 consecutive patients found that 90.9% had cerebrovascular pathology.
Results
MoCA total score was strongly inversely correlated with both depression and anxiety scores.
SDS: ρ = -0.652 (95% CI: -0.693 to -0.607, p < 0.001).
SAS: ρ = -0.559 (95% CI: -0.608 to -0.506, p < 0.001).
Spearman correlations were used to examine associations between mood symptoms and MoCA total and domain scores.
Results
Delayed recall was the cognitive domain most strongly associated with mood symptoms.
Composite vulnerability index was 0.295 for delayed recall.
It was followed by visuospatial/executive function (0.238) and attention (0.234).
The authors describe these as domain-specific patterns of association.
Results
Depression statistically accounted for about half of the association between anxiety and MoCA score.
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).
Bootstrap mediation analysis used 1,000 resamples.
The authors state the data do not support directional inference.
Results
Mood-cognition associations tended to be stronger in elderly patients, but the interaction was not statistically significant, and there was no sex difference.
Age × depression interaction (≥75 years): B = -0.0018, p = 0.089.
Sex × depression interaction: B = 0.045, p = 0.31 (not significant).
Subgroups were stratified by age (<60, 60-75, ≥75 years) and sex.
Conclusions
The authors conclude that depression and anxiety are independently associated with cognitive impairment in ischemic cerebrovascular disease and that elderly patients warrant particular attention.
Delayed recall was identified as the most vulnerable domain.
The anxiety-cognition association is only partially statistically accounted for by depression.
The cross-sectional design precludes causal or directional conclusions.
What This Means
This study looked at 667 hospital patients, most of whom had ischemic cerebrovascular disease (conditions where blood flow to the brain is reduced, such as stroke). Each patient completed a cognitive screening test (MoCA) and questionnaires on depression and anxiety. About 45% showed cognitive impairment on the education-adjusted analysis.
Patients with higher depression and anxiety scores tended to have lower cognitive scores. The link was strongest for delayed recall (remembering information after a delay), followed by visuospatial/executive function and attention. About half of the link between anxiety and poorer cognition was statistically explained by depression, suggesting the two mood symptoms overlap in how they relate to thinking ability. The associations appeared somewhat stronger in people aged 75 and older, but this difference was not statistically significant. There was no clear difference between men and women.
This research suggests that mood symptoms and cognitive problems often go together in these patients, which may support checking for both. Because all measurements were taken at one point in time, the study cannot show whether mood problems cause cognitive decline, the reverse, or whether other factors drive both. The mood measures were also self-reported questionnaires, so results should be interpreted cautiously.
Chen W, Zhuo Y. (2026). Depression, anxiety, and cognitive function in patients with ischemic cerebrovascular disease: a cross-sectional study based on the Montreal Cognitive Assessment.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1854573