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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 363-379 |
| Number of pages | 17 |
| Journal | Clinical Epidemiology |
| Volume | 10 |
| DOIs | |
| State | Published - Apr 4 2018 |
Fingerprint
Keywords
- Apathy
- Cardiovascular disease
- Depression
- Meta-analysis
- Myocardial infarction
- Older people
- Stroke
ASJC Scopus subject areas
- Epidemiology
Cite this
Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality : A systematic review and meta-analysis of individual participant data. / ICARA Study Group.
In: Clinical Epidemiology, Vol. 10, 04.04.2018, p. 363-379.Research output: Contribution to journal › Review article
}
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.
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
UR - http://www.scopus.com/inward/record.url?scp=85047727792&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047727792&partnerID=8YFLogxK
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 -