Geriatric depression and dementia : needs and mobility patterns for seeking psychogeriatric care
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Date
2026-06-15
Authors
Γεωργίου, Ελένη-Ζαχαρούλα (Ελίζα)
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Abstract
The ageing of the global population has brought neurocognitive and old-age depressive disorders to the forefront of public health priorities. Cognitive impairment and late-life depression are now among the leading causes of disability and dependency worldwide. Although their biological underpinnings have been increasingly elucidated, substantial inequalities persist in detection, prevention, and management—particularly in low-resource settings and transitional regions such as Southeastern Europe (SEE). Greece, with one of the most rapidly ageing populations in Europe, faces a dual challenge of increasing prevalence and uneven service accessibility.
This thesis approaches brain health as a multidimensional construct encompassing biological, psychological, social, and structural determinants. Through complementary studies across local, regional, and global contexts, it examines how depressive and cognitive symptoms manifest, co-occur, and interact with systemic and environmental factors.
Aim: The overarching aim of this dissertation was to characterise the interplay between late-life depression and cognitive impairment, and to situate these findings within regional and global frameworks for brain-health equity. Specifically, the work sought to:
Present a scalable algorithm to assess modifiable dementia risk factors worldwide by region and income level.
Evaluate health-system determinants of brain health across Southeastern Europe.
Assess the prevalence and determinants of depressive symptoms and cognitive impairment in the general population of Greek older adults and in vulnerable older adults residing in low-resource settings.
Identify sociogeographical disparities in access to psychogeriatric services in rural and semi-urban Greece.
Materials and Methods: The thesis is organised into two empirical axes, reflecting a bidirectional analytical journey between context and evidence.
Axis I – Global and Regional Contexts: The SEE Brain Health Project mapped system-level determinants of brain health across thirteen Southeastern European countries based on the WHO Optimizing brain health across the life course position paper. The DEMETRA project developed an algorithmic model to estimate the contribution of modifiable dementia risk factors globally, stratified by geographical subregion and income level
Axis II – Population and Care Pathways in Greece: The HELΙAD study assessed depressive symptoms across the cognitive-ageing spectrum in a representative Greek cohort. The GEOCODE study investigated depressive and cognitive symptoms in vulnerable older municipal home-care users in rural and semi-urban regions, incorporating geospatial analysis of access to psychogeriatric care.
Results: Across both axes, consistent patterns emerged. At the global level, DEMETRA revealed substantial variation in modifiable dementia risk across regions and income groups, highlighting the influence of socioeconomic and health-system factors. At the regional level, the SEE Brain Health Project demonstrated marked heterogeneity in health-system capacity across Southeastern Europe, characterised by limited mental-health funding, workforce shortages, and fragmented care pathways, alongside emerging innovations in service delivery.
At the national level, findings from Greece indicated a high prevalence of depressive symptoms among older adults, frequently co-occurring with cognitive impairment. In HELIAD, approximately one in five participants reported clinically significant depressive symptoms, which were associated with lower cognitive performance. The GEO-CoDe study further highlighted high rates of under-recognised depression and cognitive impairment in older adults residing in rural and semi-urban areas of Western- Southern Greece, where social isolation, lower educational attainment, and barriers to healthcare access increased vulnerability.
Conclusions: This dissertation demonstrates that improving brain health in ageing populations requires multilevel strategies that integrate detection, prevention, and care. Locally, results support the need for routine screening of depressive and cognitive symptoms in primary and community settings and the development of telepsychogeriatric networks to address geographical inequities. Regionally, they advocate for coordinated policy efforts within Southeastern Europe through data harmonisation, workforce training, and cross-border collaboration. Globally, the DEMETRA framework provides a scalable model for monitoring modifiable dementia risk factors and guiding equitable intervention design.
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Keywords
Geriatric depression, Dementia, Cognitive ageing, Brain health, Southeastern Europe, Modifiable risk factors, Mobility patterns