The study analyzed depressive symptoms in 3,990 hospitalized geriatric patients with and without cognitive impairment (MMSE < 24 points) using the 15-item Geriatric Depression Scale (GDS) and network analysis. The most important symptom of depression was worthlessness in both groups. Symptom network structures differed significantly between groups. In the case of cognitive impairment, the feeling of emptiness had a smaller effect, the connection between the feeling of dissatisfaction and unhappiness was stronger, and the connection between the feeling of emptiness and boredom was weaker. Late-life depression often co-occurs with cognitive impairment, making it difficult to assess and treat. Differences in symptom networks highlight the need to tailor screening and intervention strategies for older adults.