The mediating and moderating effects of depression on the relationship between cognitive function and difficulty in activities of daily living among postmenopausal women

Cognitive function and depression impact critically the daily functioning of menopausal women. This study aimed to explore the mediating and moderating effects of depressive symptoms on the association between cognitive function and activities of daily living (ADL) difficulty in postmenopausal women.A total of 2,596 postmenopausal women from the China Health and Retirement Longitudinal Study completed the Chinese version of the Mini-Mental State Examination, basic ADL (BADL) and instrumental ADL (IADL) scales, and 10-item Short-Form Center for Epidemiological Studies Depression. We constructed structural equation modeling to examine the association between cognitive function, depressive symptoms, and BADL/IADL difficulty.The prevalence of BADL/IADL difficulty in postmenopausal women was 22.5% and 31.5%, respectively. After adjustments for demographic and health-related covariates, cognitive decline (contributed by four cognitive dimensions with different weights) was significantly associated with BADL/IADL difficulty (contributed by six-item daily activities with different weights). Depressive symptoms mediated and explained 28.8% and 23.2% of cognitive function associations with BADL and IADL difficulty, respectively. The Johnson-Neyman technique identified a threshold of eight and four for depressive symptoms, beyond which the protective effect of cognitive function on BADL and IADL emerged.Depressive symptoms mediated and moderated the association between cognition and BADL/IADL difficulty in postmenopausal women. Compared with BADL, IADL may be more sensitive to changes in cognitive function. More strength should be put on developing comprehensive intervention techniques focusing on simultaneous intervention of multidimensional cognitive function and depression to maintain and improve the quality of life of postmenopausal women.Video Summary:http://links.lww.com/MENO/A741 .