{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T19:40:00Z","timestamp":1790192400360,"version":"4.1.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Aimed to investigate the risk factors associated with depression in community-dwelling older adults with cognitive frailty and to examine the mediating role of sleep quality in the relationship between activities of daily living (ADL) and depression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted using convenience sampling, enrolling older adults with cognitive frailty from six communities in Beijing from July 2023 to December 2023. Cognitive frailty was assessed using the Montreal Cognitive Assessment (MoCA) alongside with the Fried Frailty Phenotype, while depressive symptoms were measured with the Geriatric Depression Scale (GDS-15). Multivariate logistic regression analysis was used to identify risk factors influencing depression, and mediation analysis was employed to explore the mediating effect of sleep quality on the relationship between ADL and depression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 529 elderly participants with cognitive frailty, 128 (24.2%) were found to exhibit depressive symptoms. Multivariate logistic regression identified ADL [Mild Dependence: OR\u202f=\u202f176.729 (95% CI 32.427\u2013963.172), <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001; Moderate Dependence: OR\u202f=\u202f51.769 (95% CI 12.541\u2013213.697), <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001], loneliness [OR\u202f=\u202f13.821 (95% CI 6.095\u201331.338), <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001], and sleep quality [Suspected Insomnia: OR\u202f=\u202f7.310 (95% CI 2.316\u201323.074), <jats:italic>p<\/jats:italic>\u202f=\u202f0.001] were significantly associated with depression. Sleep quality was found to mediate the relationship between ADL and depression, accounting for 2.82% of the total effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dependence in ADL, loneliness, and poor sleep quality are potential risk factors of depression for cognitive frailty in aging adults. Moreover, sleep quality was found to mediate the relationship between ADL dependence and depressive symptoms.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnagi.2025.1541555","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:46:25Z","timestamp":1748583985000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Risk factors and mediation role of sleep quality for depression in cognitively frail older adults: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaoxing","family":"Lai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghua","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiazhen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaopeng","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1093\/gerona\/glv182","article-title":"Energetics of aging and frailty: the FRADEA study","volume":"71","author":"Abizanda","year":"2016","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3361","DOI":"10.3390\/ijerph19063361","article-title":"Health care utilization and out-of-pocket payments among elderly with cognitive frailty in Malaysia","volume":"19","author":"Alkhodary","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.neubiorev.2017.01.032","article-title":"Cooccurrence and bidirectional prediction of sleep disturbances and depression in older adults: Meta-analysis and systematic review","volume":"75","author":"Bao","year":"2017","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"236","DOI":"10.5455\/JPMA.301384","article-title":"Identifying the relationship among sleep, mental status, daily living activities, depression and pain in older adults: a comparative study in Yalova. Turkey","volume":"70","author":"Boga","year":"2020","journal-title":"J. Pak. Med. Assoc."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1177\/019394599802000305","article-title":"The oldest old, ADL, social network, and loneliness","volume":"20","author":"Bondevik","year":"1998","journal-title":"West. J. Nurs. Res."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1001\/jamapsychiatry.2018.4175","article-title":"Assessment of bidirectional relationships between physical activity and depression among adults: a 2-sample Mendelian randomization study","volume":"76","author":"Choi","year":"2019","journal-title":"JAMA Psychiatry"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1089\/rej.2011.1215","article-title":"Prognostic significance of the short physical performance battery in older patients discharged from acute care hospitals","volume":"15","author":"Corsonello","year":"2012","journal-title":"Rejuvenation Res."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.psychres.2011.01.016","article-title":"Quick and easy self-rating of generalized anxiety disorder: validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI","volume":"188","author":"Donker","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.ijnurstu.2010.09.008","article-title":"Loneliness and social support among nursing home residents without cognitive impairment: a questionnaire survey","volume":"48","author":"Drageset","year":"2011","journal-title":"Int. J. Nurs. Stud."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.amjoto.2011.10.009","article-title":"Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial","volume":"33","author":"Edelman","year":"2012","journal-title":"Am. J. Otolaryngol."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"944293","DOI":"10.3389\/fpsyt.2022.944293","article-title":"Perceived social support and associated factors among community-dwelling older adults with frailty and pre-frailty in Hangzhou, China","volume":"13","author":"Fang","year":"2022","journal-title":"Front. Psych."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.jamda.2016.09.015","article-title":"Cognitive frailty and adverse health outcomes: findings from the Singapore longitudinal ageing studies (SLAS)","volume":"18","author":"Feng","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"4291","DOI":"10.3390\/nu13124291","article-title":"Associated factors of sarcopenia in community-dwelling older adults: a systematic review and Meta-analysis","volume":"13","author":"Gao","year":"2021","journal-title":"Nutrients"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s12955-019-1194-x","article-title":"Association of physical activity, sedentary time, and sleep duration on the health-related quality of life of college students in Northeast China","volume":"17","author":"Ge","year":"2019","journal-title":"Health Qual. Life Outcomes"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"103454","DOI":"10.1016\/j.ijnurstu.2019.103454","article-title":"The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure: a secondary analysis of a randomised controlled trial","volume":"116","author":"Johansson","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1002\/mus.27692","article-title":"Pain, sleep, fatigue, and activities of daily living in patients with neuropathy","volume":"66","author":"Karam","year":"2022","journal-title":"Muscle Nerve"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.smrv.2013.08.002","article-title":"Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review","volume":"18","author":"Kendzerska","year":"2014","journal-title":"Sleep Med. Rev."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e208056","DOI":"10.1212\/WNL.0000000000208056","article-title":"Association between sleep quantity and quality in early adulthood with cognitive function in midlife","volume":"102","author":"Leng","year":"2024","journal-title":"Neurology"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1249208","DOI":"10.3389\/fpubh.2023.1249208","article-title":"Association between activities of daily living and depressive symptoms among older adults in China: evidence from the CHARLS","volume":"11","author":"Liu","year":"2023","journal-title":"Front. Public Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12877-022-02855-5","article-title":"The mediation role of sleep quality in the relationship between cognitive decline and depression","volume":"22","author":"Liu","year":"2022","journal-title":"BMC Geriatr."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1097\/00003727-198811000-00008","article-title":"Assessing social networks among elderly populations","volume":"11","author":"Lubben","year":"1988","journal-title":"Fam. Community Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.jad.2010.11.033","article-title":"Age-and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis","volume":"136","author":"Luppa","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.jad.2022.08.032","article-title":"Association between frailty and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms","volume":"316","author":"Ma","year":"2022","journal-title":"J. Affect. Disord."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/978-3-030-33330-0_2","article-title":"Tools for assessing frailty in older people: general concepts","volume":"1216","author":"Martin","year":"2020","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","year":"2005","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"411","DOI":"10.5604\/12321966.1232774","article-title":"Motor assessment in Parkinson\u2019s disease","volume":"24","author":"Opara","year":"2017","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"993","DOI":"10.3233\/JAD-170963","article-title":"Different cognitive frailty models and health- and cognitive-related outcomes in older age: from epidemiology to prevention","volume":"62","author":"Panza","year":"2018","journal-title":"J. Alzheimers Dis."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"104112","DOI":"10.1016\/j.ijnurstu.2021.104112","article-title":"Prevalence of cognitive frailty among community-dwelling older adults: a systematic review and meta-analysis","volume":"125","author":"Qiu","year":"2022","journal-title":"Int. J. Nurs. Stud."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"14057","DOI":"10.1038\/s41598-024-65095-0","article-title":"Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life","volume":"14","author":"Ren","year":"2024","journal-title":"Sci. Rep."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1186\/s12877-021-02525-y","article-title":"Cognitive frailty is a robust predictor of falls, injuries, and disability among community-dwelling older adults","volume":"21","author":"Rivan","year":"2021","journal-title":"BMC Geriatr."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"M366","DOI":"10.1093\/gerona\/56.6.m366","article-title":"Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF)","volume":"56","author":"Rubenstein","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/s0022-3999(00)00095-7","article-title":"Athens insomnia scale:validation of an instrument based on ICD-10 criteria","volume":"48","author":"Soldatos","year":"2020","journal-title":"J. Psychosom. Res."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"19","DOI":"10.23750\/abm.v91i2-S.9226","article-title":"Barthel index: creation and validation of two cut-offs using the BRASS index","volume":"91","author":"Strini","year":"2020","journal-title":"Acta Biomed"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1111\/ggi.14322","article-title":"An update on cognitive frailty: its definition, impact, associated factors and underlying mechanisms, and interventions","volume":"22","author":"Sugimoto","year":"2022","journal-title":"Geriatr Gerontol Int"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1177\/0898264316673511","article-title":"Social isolation, depression, and psychological distress among older adults","volume":"30","author":"Taylor","year":"2018","journal-title":"J. Aging Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1186\/s12874-016-0267-3","article-title":"No rationale for 1 variable per 10 events criterion for binary logistic regression analysis","volume":"16","author":"van Smeden","year":"2016","journal-title":"BMC Med. Res. Methodol."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1111\/phn.13266","article-title":"Risk factors for social isolation in older adults: a systematic review and meta-analysis","volume":"41","author":"Wang","year":"2024","journal-title":"Public Health Nurs."},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1605678","DOI":"10.3389\/ijph.2023.1605678","article-title":"The mediating role of depression in association between Total sleep time and instrumental activities of daily living in China","volume":"68","author":"Wu","year":"2023","journal-title":"Int. J. Public Health"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"102830","DOI":"10.1016\/j.nicl.2021.102830","article-title":"Cognitive impairment and depression: meta-analysis of structural magnetic resonance imaging studies","volume":"32","author":"Zackov\u00e1","year":"2021","journal-title":"Neuroimage Clin."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"88","DOI":"10.70252\/ODDB8638","article-title":"Sleep and risk for metabolic syndrome, hypertension, diabetes and obesity among community-dwelling older adults","volume":"15","author":"Zendels","year":"2021","journal-title":"Int. J. Exerc. Sci."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s12877-021-02711-y","article-title":"The association between sleep quality and psychological distress among older Chinese adults: a moderated mediation model","volume":"22","author":"Zhang","year":"2022","journal-title":"BMC Geriatr."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1016\/j.jad.2020.05.090","article-title":"Assessment of geriatric depression Scale's applicability in Longevous persons based on classical test and item response theory","volume":"274","author":"Zhang","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e5994","DOI":"10.1002\/gps.5994","article-title":"Management of cognitive frailty: a network meta-analysis of randomized controlled trials","volume":"38","author":"Zhang","year":"2023","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"101793","DOI":"10.1016\/j.ctcp.2023.101793","article-title":"Validity and reliability of the physical activity and social support scale among Chinese established adults","volume":"53","author":"Zou","year":"2023","journal-title":"Complement. Ther. Clin. Pract."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jad.2022.09.118","article-title":"Association of depression with cognitive frailty: a systematic review and meta-analysis","volume":"320","author":"Zou","year":"2023","journal-title":"J. Affect. Disord."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2025.1541555\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:46:25Z","timestamp":1748583985000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2025.1541555\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":45,"alternative-id":["10.3389\/fnagi.2025.1541555"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2025.1541555","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"article-number":"1541555"}}