Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data
Lisa SM Eurelings,1,* Jan Willem van Dalen,1,* Gerben ter Riet,2 Eric P Moll van Charante,2 Edo Richard,1,3 Willem A van Gool1 On behalf of the ICARA Study Group 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2Department of General Practice, A...
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Dove Medical Press
2018-04-01
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Series: | Clinical Epidemiology |
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Online Access: | https://www.dovepress.com/apathy-and-depressive-symptoms-in-older-people-and-incident-myocardial-peer-reviewed-article-CLEP |
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author | Eurelings LSM van Dalen JW ter Riet G Moll van Charante EP Richard E van Gool WA |
author_facet | Eurelings LSM van Dalen JW ter Riet G Moll van Charante EP Richard E van Gool WA |
author_sort | Eurelings LSM |
collection | DOAJ |
description | Lisa SM Eurelings,1,* Jan Willem van Dalen,1,* Gerben ter Riet,2 Eric P Moll van Charante,2 Edo Richard,1,3 Willem A van Gool1 On behalf of the ICARA Study Group 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 3Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands *These authors contributed equally to this work 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, older people, depression, cardiovascular disease, meta-analysis, stroke, myocardial infarction |
first_indexed | 2024-12-14T08:13:52Z |
format | Article |
id | doaj.art-fabd2f23061743e8b0f07e7312c260cd |
institution | Directory Open Access Journal |
issn | 1179-1349 |
language | English |
last_indexed | 2024-12-14T08:13:52Z |
publishDate | 2018-04-01 |
publisher | Dove Medical Press |
record_format | Article |
series | Clinical Epidemiology |
spelling | doaj.art-fabd2f23061743e8b0f07e7312c260cd2022-12-21T23:10:01ZengDove Medical PressClinical Epidemiology1179-13492018-04-01Volume 1036337937556Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant dataEurelings LSMvan Dalen JWter Riet GMoll van Charante EPRichard Evan Gool WALisa SM Eurelings,1,* Jan Willem van Dalen,1,* Gerben ter Riet,2 Eric P Moll van Charante,2 Edo Richard,1,3 Willem A van Gool1 On behalf of the ICARA Study Group 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 3Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands *These authors contributed equally to this work 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, older people, depression, cardiovascular disease, meta-analysis, stroke, myocardial infarctionhttps://www.dovepress.com/apathy-and-depressive-symptoms-in-older-people-and-incident-myocardial-peer-reviewed-article-CLEPapathyolder peopledepressioncardiovascular diseasemeta-analysisstrokemyocardial infarction |
spellingShingle | Eurelings LSM van Dalen JW ter Riet G Moll van Charante EP Richard E van Gool WA 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 apathy older people depression cardiovascular disease meta-analysis stroke myocardial infarction |
title | Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data |
title_full | Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data |
title_fullStr | Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data |
title_full_unstemmed | Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data |
title_short | Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data |
title_sort | apathy and depressive symptoms in older people and incident myocardial infarction stroke and mortality a systematic review and meta analysis of individual participant data |
topic | apathy older people depression cardiovascular disease meta-analysis stroke myocardial infarction |
url | https://www.dovepress.com/apathy-and-depressive-symptoms-in-older-people-and-incident-myocardial-peer-reviewed-article-CLEP |
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