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Eurelings LS, van Dalen JW, Ter Riet G, et al. Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data. Clin Epidemiol. 2018;10:363-379doi: 10.2147/CLEP.S150915.
Eurelings, L. S., van Dalen, J. W., Ter Riet, G., Moll van Charante, E. P., Richard, E., van Gool, W. A., Almeida, O. P., Alexandre, T. S., Baune, B. T., Bickel, H., Cacciatore, F., Cooper, C., de Craen, T. A., Degryse, J. M., Di Bari, M., Duarte, Y. A., Feng, L., Ferrara, N., Flicker, L., Gallucci, M., Guaita, A., Harrison, S. L., Katz, M. J., Lebrão, M. L., Leung, J., Lipton, R. B., Mengoni, M., Ng, T. P., Østbye, T., Panza, F., Polito, L., Sander, D., Solfrizzi, V., Syddall, H. E., van der Mast, R. C., Vaes, B., Woo, J., Yaffe, K. (2018). Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data. Clinical epidemiology, 10363-379. https://doi.org/10.2147/CLEP.S150915
Eurelings, Lisa Sm, et al. "Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data." Clinical epidemiology vol. 10 (2018): 363-379. doi: https://doi.org/10.2147/CLEP.S150915
Eurelings LS, van Dalen JW, Ter Riet G, Moll van Charante EP, Richard E, van Gool WA, Almeida OP, Alexandre TS, Baune BT, Bickel H, Cacciatore F, Cooper C, de Craen TA, Degryse JM, Di Bari M, Duarte YA, Feng L, Ferrara N, Flicker L, Gallucci M, Guaita A, Harrison SL, Katz MJ, Lebrão ML, Leung J, Lipton RB, Mengoni M, Ng TP, Østbye T, Panza F, Polito L, Sander D, Solfrizzi V, Syddall HE, van der Mast RC, Vaes B, Woo J, Yaffe K. Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data. Clin Epidemiol. 2018 Apr 04;10:363-379. doi: 10.2147/CLEP.S150915. eCollection 2018. PMID: 29670402; PMCID: PMC5894652.
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Clin Epidemiol. 2018 Apr 04;10:363-379. doi: 10.2147/CLEP.S150915. eCollection 2018.

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

Clinical epidemiology

Lisa Sm Eurelings, Jan Willem van Dalen, Gerben Ter Riet, Eric P Moll van Charante, Edo Richard, Willem A van Gool, Osvaldo P Almeida, Tiago S Alexandre, Bernhard T Baune, Horst Bickel, Francesco Cacciatore, Cyrus Cooper, Ton Ajm de Craen, Jean-Marie Degryse, Mauro Di Bari, Yeda A Duarte, Liang Feng, Nicola Ferrara, Leon Flicker, Maurizio Gallucci, Antonio Guaita, Stephanie L Harrison, Mindy J Katz, Maria L Lebrão, Jason Leung, Richard B Lipton, Marta Mengoni, Tze Pin Ng, Truls Østbye, Francesco Panza, Letizia Polito, Dirk Sander, Vincenzo Solfrizzi, Holly E Syddall, Roos C van der Mast, Bert Vaes, Jean Woo, Kristine Yaffe,

Affiliations

  1. Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands [email protected].
  2. Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
  3. Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands.
  4. Department of Psychiatry and Clinical Neurosciences, Royal Perth Hospital, University of Western Australia, Perth, Australia.
  5. Harry Perkins Institute for Medical Research, Western Australian Centre for Health & Ageing, Royal Perth Hospital, University of Western Australia, Perth, Australia.
  6. Department of Gerontology, Center for Biological and Health Sciences, Federal University of São Carlos, São Carlos, Brazil.
  7. Discipline of Psychiatry, Royal Adelaide Hospital, University of Adelaide, Adelaide, Australia.
  8. Department of Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
  9. Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
  10. Salvatore Maugeri Foundation, Scientific Institute of Telese Terme, Telese Terme, Italy.
  11. Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
  12. National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
  13. National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
  14. Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
  15. Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium.
  16. Institut de Recherche Santé et Société, Université Catholique de Louvain, Brussels, Belgium.
  17. Department of Experimental and Clinical Medicine, Research Unit of Medicine of Aging, University of Florence, Florence, Italy.
  18. Department of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
  19. Department of Medical-Surgical Nursing, University of São Paulo, São Paulo, Brazil.
  20. Department of Health Sciences and System Research, Duke NUS Medical School, National University of Singapore, Singapore.
  21. Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  22. Centre Medical Research, Western Australian Centre for Health & Ageing, University of Western Australia, Perth, Australia.
  23. Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.
  24. School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
  25. Cognitive Impairment Center, Health District of Treviso, Local Health Authority 9 of Treviso, Treviso, Italy.
  26. Interdisciplinary Geriatric Research Foundation, Treviso, Italy.
  27. Golgi Cenci Foundation, Abbiategrasso, Italy.
  28. Department of Epidemiology and Biostatistics, California Pacific Medical Center Research Institute, University of California, San Francisco, CA, USA.
  29. Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA.
  30. Department of Epidemiology, Faculty of Public Health, University of São Paulo, São Paulo, Brazil.
  31. Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong.
  32. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA.
  33. Center for Aging Research and Education, Duke NUS Medical School, Singapore.
  34. Duke Global Health Institute, Duke University, Durham, NC, USA.
  35. Department of Basic Medicine, Neuroscience, and Sense Organs, Neurodegenerative Disease Unit, Pia Fondazione Cardinale G Panico, University of Bari Aldo Moro, Tricase, Italy.
  36. Department of Neurology, Benedictus Krankenhaus Tutzing, Technische Universität München, Tutzing, Germany.
  37. Interdisciplinary Department of Medicine, Geriatric Medicine and Memory Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, University of Bari Aldo Moro, Bari, Italy.
  38. Department of Psychiatry, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium.
  39. Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands.
  40. Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
  41. Departments of Psychiatry and Neurology, University of California, San Francisco, CA, USA.

PMID: 29670402 PMCID: PMC5894652 DOI: 10.2147/CLEP.S150915

Abstract

BACKGROUND: Previous 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.

AIMS: To study whether apathy and depressive symptoms in older people are associated with future CVD, stroke, and mortality using individual patient-data meta-analysis.

METHODS: Medline, 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.

RESULTS: Of 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.

CONCLUSION: Our findings stress the clinical importance of recognizing apathy independently of depressive symptoms, and could help physicians identify persons at increased risk of vascular disease.

Keywords: apathy; cardiovascular disease; depression; meta-analysis; myocardial infarction; older people; stroke

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

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