- Main
Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data
- Eurelings, Lisa SM;
- van Dalen, Jan Willem;
- Riet, Gerben ter;
- van Charante, Eric P Moll;
- 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;
- Gao, Sujuan;
- Ho, Suzanne C;
- Lindsay, Joan;
- Sham, Aprille;
- Reppermund, Simone;
- Unverzagt, Frederick W
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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