ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neuroinflammation and Neuropathy
This article is part of the Research TopicStroke Research in the Elderly: Addressing Ageism and PrognosticationView all 15 articles
The Association of Eight-Year Trajectories in Total, Cognitive-Affective, and Somatic Depressive Symptoms with Incident Stroke: A 10-Year Follow-Up Study Using HRS and ELSA Cohorts
Provisionally accepted
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Background: Earlier research has documented an association between depressive symptomatology and heightened stroke risk. However, prior work largely assessed depressive manifestations at isolated time points and failed to differentiate symptom subtypes. This investigation seeks to characterize the longitudinal progression of depressive symptoms via repeated measurement and explore their link to stroke risk by considering total depressive symptoms alongside cognitive-affective and somatic dimensions. Methods: This prospective cohort study included individuals aged ≥45 years from the Health and Retirement Study (HRS) in the United States and the English Longitudinal Study of Ageing (ELSA) in the United Kingdom, excluding those with a history of stroke during the exposure period.Participants comprised individuals aged ≥45 years, sourced from the Health and Retirement Study (HRS) in the United States and the English Longitudinal Study of Ageing (ELSA) in the United Kingdom, excluding those with prior stroke during the exposure window. Depressive symptoms were measured using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D) across four biennial assessments. Individuals were categorized into five distinct depressive symptom trajectories: consistently low, decreasing, fluctuating, increasing, and consistently high, based on assessment scores. Over a subsequent decade of follow-up, incident strokes were identified through self-reported physician diagnoses. The analyses incorporated adjustments for demographic factors (sex, age, etc.), health-related behaviors (smoking, drinking, etc.), and health status covariates (hypertension, diabetes, etc.).Analyses incorporated adjustments for demographic factors, health-related behaviors, and health status covariates. Cox proportional hazards regression models generated hazard ratios (HRs) and 95% confidence intervals (CIs) to evaluate links between trajectories of total depressive symptoms, cognitive-affective and somatic subtypes, and stroke occurrence. Results: The final cohort included 10,011 participants (63.3% female; mean age 60.2 years). During the 10-year follow-up, 720 incident strokes were recorded. Analyses demonstrated that, after adjusting for the aforementioned demographic and health-related confounders, relative to the consistently low trajectory, participants with fluctuating (HR = 1.24, 95% CI: 1.01-1.52), increasing (HR = 1.31, 95% CI: 1.03-1.67), and
Keywords: cognitive-affective depressive symptoms, Cohort Studies, Dynamic trajectories, Follow-Up Studies, Mid-to-late life depression, Risk factors, somatic depressive symptoms, Stroke
Received: 27 Oct 2025; Accepted: 15 Dec 2025.
Copyright: © 2025 Zhang, Chen, Ye, Wang, Fan, Zhang, Bao, Li and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Huanan Li
Jingui Wang
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