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

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

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