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However, the impact of PTSD and depression on cognitive functioning, especially among middle-aged urban adults, is not well understood. Cross-sectional data were analyzed from 1434 participants from the Healthy Aging in Neighborhoods of Diversity across the Life Span study. We used multivariable adjusted linear regression and structural equation models (SM) to test the association between PTSD, CES-D, and cognitive test scores. We found PTSD to be strongly associated with depressive symptoms despite adjustment for potential confounders. SM\u00a0with cognitive test scores as final outcomes\u00a0found Delayed Free Recall and List A immediate recall inversely associated with PTSD score, with TEs of\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009\u00b1\u2009SE\u2009\u2212\u20090.08398\u2009\u00b1\u20090.02654,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.002, and\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009\u00b1\u2009SE\u2009\u2212\u20090.10734\u2009\u00b1\u20090.02571,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001, respectively, and IEs of\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009\u00b1\u2009SE\u2009\u2212\u20090.06786\u2009\u00b1\u20090.02202,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.002, and\n                    <jats:italic>\u03b2<\/jats:italic>\n                    \u2009\u00b1\u2009SE\u2009\u2212\u20090.07625\u2009\u00b1\u20090.02140,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001, indicating that depressive symptoms significantly mediated the potential association of PTSD with poorer verbal memory. Other cognitive test scores showed\u00a0significant total or direct effects\u00a0(\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05), suggesting different pathways not including depressive symptoms as a mediator. At higher intima-media thickness (IMT) tertiles, PTSD score was strongly associated with total CES-D score. This study provides evidence of an association between PTSD and cognitive functioning among middle-aged urban adults, partially mediated through depressive symptoms in verbal memory, with IMT enhancing the association between PTSD and depressive symptoms.\n                  <\/jats:p>","DOI":"10.1007\/s11357-025-01825-0","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T21:52:45Z","timestamp":1757973165000},"page":"3275-3293","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Post-traumatic stress disorder, depressive symptoms, and cognitive function among middle-aged urban adults: Healthy Aging in Neighborhoods of Diversity across the Life Span study"],"prefix":"10.1007","volume":"48","author":[{"given":"Michael F.","family":"Georgescu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1050-4523","authenticated-orcid":false,"given":"May A.","family":"Beydoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert H.","family":"Pietrzak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind A.","family":"Beydoun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1683-3838","authenticated-orcid":false,"given":"Nicole","family":"Noren Hooten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele K.","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan B.","family":"Zonderman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"issue":"2","key":"1825_CR1","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1017\/S0033291715001981","volume":"46","author":"C Benjet","year":"2016","unstructured":"Benjet C, Bromet E, Karam EG, Kessler RC, McLaughlin KA, Ruscio AM, et al. 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