TY - JOUR
T1 - Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality
T2 - A systematic review and meta-analysis of individual participant data
AU - ICARA Study Group
AU - Eurelings, Lisa S.M.
AU - van Dalen, Jan Willem
AU - Ter Riet, Gerben
AU - Moll van Charante, Eric P.
AU - Richard, Edo
AU - van Gool, Willem A.
AU - Almeida, Osvaldo P.
AU - Alexandre, Tiago S.
AU - Baune, Bernhard T.
AU - Bickel, Horst
AU - Cacciatore, Francesco
AU - Cooper, Cyrus
AU - de Craen, Ton A.J.M.
AU - Degryse, Jean Marie
AU - Di Bari, Mauro
AU - Duarte, Yeda A.
AU - Feng, Liang
AU - Ferrara, Nicola
AU - Flicker, Leon
AU - Gallucci, Maurizio
AU - Guaita, Antonio
AU - Harrison, Stephanie L.
AU - Katz, Mindy J.
AU - Lebrão, Maria L.
AU - Leung, Jason
AU - Lipton, Richard B.
AU - Mengoni, Marta
AU - Ng, Tze Pin
AU - Østbye, Truls
AU - Panza, Francesco
AU - Polito, Letizia
AU - Sander, Dirk
AU - Solfrizzi, Vincenzo
AU - Syddall, Holly E.
AU - van der Mast, Roos C.
AU - Vaes, Bert
AU - Woo, Jean
AU - Yaffe, Kristine
AU - Gao, Sujuan
AU - Ho, Suzanne C.
AU - Lindsay, Joan
AU - Sham, Aprille
AU - Reppermund, Simone
AU - Unverzagt, Frederick W.
N1 - Funding Information:
AG019181). The BELFRAIL study (B40320084685) is funded by an unconditional grant from Fondation Louvain. Fondation Louvain is the support-group unit of the Université Catholique de Louvain, which is in charge of developing education and research projects for the university by collecting gifts from corporations, foundations, and alumni. The Treviso Longeva study was supported by Regione del Veneto (grant DGR 13/12/2002, 3604, project number 76), Fondazi-one Cassamarca, Fondazione Veneto Banca, the Province of Treviso, and the Municipality of Treviso. The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under grant numbers R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576. The Osteoporotic Fractures in Men (MrOS) study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the grant numbers U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The National Heart, Lung, and Blood Institute (NHLBI) provides funding for the MrOS Sleep ancillary study Outcomes of Sleep Disorders in Older Men under the grant numbers R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. The Einstein Aging Study is supported by the National Institute on Aging (NIA) grant P01 AGO3949. The De Leiden 85-Plus study was supported by several unrestricted grants from the Netherlands Organisation of Scientific Research (ZonMw) and the Ministry of Health, Welfare, and Sports. Dr Eurel-ings received an Academic Medical Center PhD Scholarship (2011/1190). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Funding Information:
The Sydney Memory and Ageing Study was supported by the National Health and Medical Research Council (NHMRC; grants 350833, 510175, and 510124) and the Australian Research Council (DP0774213, DP0773584, and LP0669645). The Health, Well-Being, and Aging Study – Brazil was supported by the Foundation of Research Support of São Paulo (FAPESP; grants 1999/05125-7, 2005/54947-2, and 2009/53778-3). The Intervention Project on Cerebrovascular Diseases and Dementia in the Ebersberg District was supported by the Allgemeine Ortskrankenkasse Bayern, the German Stroke Foundation, Bayer Vital GmbH, Berlin-Chemie AG, Organon Pharmaceuticals, Ratiopharm GmbH, Sanofi Synthelabo GmbH, and Teva Pharmaceutical Industries Ltd. The Mr Os and Ms Os Study was supported by The Hong Kong Jockey Club Charities Trust and The SH Ho Centre for Gerontology and Geriatrics. The Singapore Longitudinal Ageing Studies were sponsored by the Biomedical Research Council (grants 03/1/21/17/214 and 08/1/21/19/567). The Hertfordshire Cohort Study was sponsored by the Medical Research Council UK. The Hong Kong Old-Old Study was sponsored by the Croucher Foundation and Hong Kong Health Services Research (grant 411009). The Health in Men Study was sponsored by the National Health and Medical Research Council (grants 279408, 379600, 403963, 513823, 540403, 540504, 540405, 634492, 1021416, 1045710, and 1060557). The Canadian Study of Health and Aging was initially funded through the Canadian federal government’s Seniors’ Independence Research Program (1998). The program funds were administered by the National Health Research and Development Program of Health Canada. Supplementary funding was administered by the Medical Research Council of Canada. After 1998, funding for the core study was obtained from the Canadian Institutes for Health Research (grant MOP-42530) and supplementary funding for the caregiver component was provided under grant MOP-43945. Throughout the study, additional funding was obtained for supplementary components and for personnel funding from provincial governments, research granting agencies, and the private sector. Funding from the pharmaceutical industry contributed to the collection and analysis of biological samples, to the caregiver substudy, to personnel support via training awards, and access to provincial health care plan data. Support was also provided by the Pfizer Corporation Inc, Bayer Canada Inc, Janssen-Ortho Inc, and Merck Frosst Canada & Co. The study was coordinated through the University of Ottawa, which provided administrative support and facilities for the coordinating center, and the Division of Aging and Seniors, Health Canada. The Insufficienza Cardiaca negli Anziani Residenti a Dicomano study was funded by Regione Toscana. The Selenium and Cognitive Decline Study was supported by the National Institutes of Health/National Institute on Aging (grant R01
Publisher Copyright:
© 2018 Eurelings et al.
PY - 2018/4/4
Y1 - 2018/4/4
N2 - 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.
AB - 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.
KW - Apathy
KW - Cardiovascular disease
KW - Depression
KW - Meta-analysis
KW - Myocardial infarction
KW - Older people
KW - Stroke
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U2 - 10.2147/CLEP.S150915
DO - 10.2147/CLEP.S150915
M3 - Review article
AN - SCOPUS:85047727792
VL - 10
SP - 363
EP - 379
JO - Clinical Epidemiology
JF - Clinical Epidemiology
SN - 1179-1349
ER -