Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data

Abstract

BackgroundPrevious findings suggest that apathy symptoms independently of depressive symptoms measured using the Geriatric Depression Scale (GDS) are associated with cardiovascular disease (CVD) in older individuals.AimsTo study whether apathy and depressive symptoms in older people are associated with future CVD, stroke, and mortality using individual patient-data meta-analysis.MethodsMedline, Embase, and PsycInfo databases up to September 3, 2013, were systematically searched without language restrictions. We sought prospective studies with older (mean age ≥65 years) community-dwelling populations in which the GDS was employed and subsequent stroke and/or CVD were recorded to provide individual participant data. Apathy symptoms were defined as the three apathy-related subitems of the GDS, with depressive symptoms the remaining items. We used myocardial infarction (MI), stroke, and all-cause mortality as main outcomes. Analyses were adjusted for age, sex, and MI/stroke history. An adaptation of the Newcastle–Ottawa scale was used to evaluate bias. Hazard ratios were calculated using one-stage random-effect Cox regression models.ResultsOf the 52 eligible studies, 21 (40.4%) were included, comprising 47,625 older people (mean age [standard deviation] 74 [7.4] years), over a median follow-up of 8.8 years. Participants with apathy symptoms had a 21% higher risk of MI (95% confidence interval [CI] 1.08–1.36), a 37% higher risk of stroke (95% CI 1.18–1.59), and a 47% higher risk of all-cause mortality (95% CI 1.38–1.56). Participants with depressive symptoms had a comparably higher risk of stroke (HR 1.36, 95% CI 1.18–1.56) and all-cause mortality (HR 1.44, 95% CI 1.35–1.53), but not of MI (HR 1.08, 95% CI 0.91–1.29). Associations for isolated apathy and isolated depressive symptoms were comparable. Sensitivity analyses according to risk of bias yielded similar results.ConclusionOur findings stress the clinical importance of recognizing apathy independently of depressive symptoms, and could help physicians identify persons at increased risk of vascular disease.

A cardiovascular risk prediction model for older people: Development and validation in a primary care population

“…Physical activity was measured with the LASA physical activity questionnaire (LAPAQ) and defined as physically active according to the World Health Organization . Symptoms of apathy were measured with the three apathy items of the 15‐item Geriatric Depression Scare (GDS‐3A; range 0‐3 points, higher scores indicating more apathy) . CRP, LDL, ApoA1, ApoB, and APOE were measured in serum.…”

“…17,20 Symptoms of apathy were measured with the three apathy items of the 15item Geriatric Depression Scare (GDS-3A; range 0-3 points, higher scores indicating more apathy). 7 CRP, LDL, ApoA1, ApoB, and APOE were measured in serum. APOE genotype was included as a nominal variable.…”

“…This is partly explained by the diminished or even reversed associations between traditional risk factors and CVD in older persons . Moreover, potential other predictors of CVD in older people have been suggested, including an increased C‐reactive protein (CRP) as a marker for inflammation, symptoms of apathy, polypharmacy, cholesterol‐associated circulating apolipoproteins A1 and B, and gene variants of apolipoprotein E (APOE) …”

“…including an increased C-reactive protein (CRP) as a marker for inflammation, 3 symptoms of apathy, 7 polypharmacy, 8 cholesterol-associated circulating apolipoproteins A1 and B, and gene variants of apolipoprotein E (APOE). 9,10 While traditionally models predict a ten-year risk of CVD mortality, 4,11,12 older persons and their GPs favor models assessing risk of developing any major atherosclerotic event within a shorter time span.…”

Empirical support for the vascular apathy hypothesis: A structured review

“…The vascular apathy hypothesis then supposes that SVD can cause apathy by damaging these tracts. However, the relationship between vascular disease and apathy could well be bidirectional: A recent systematic review and meta‐analysis showed that apathy increases the risk of myocardial infarction by 21%, stroke by 37%, and even mortality by 47%. In the populations evaluated, these risks might additionally or alternatively be raised because of the participants' adverse health behaviors and low adherence to treatment regimens for vascular disease .…”