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

Research output: Contribution to journalReview article

5 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)363-379
Number of pages17
JournalClinical Epidemiology
Volume10
DOIs
StatePublished - Apr 4 2018

Fingerprint

Apathy
Meta-Analysis
Stroke
Myocardial Infarction
Depression
Mortality
Confidence Intervals
Geriatrics
Cardiovascular Diseases
Independent Living
Vascular Diseases
Proportional Hazards Models
Language
Databases
Prospective Studies
Physicians

Keywords

  • Apathy
  • Cardiovascular disease
  • Depression
  • Meta-analysis
  • Myocardial infarction
  • Older people
  • Stroke

ASJC Scopus subject areas

  • Epidemiology

Cite this

@article{37178dfc9e5d4aa997c4009e0b64dd42,
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",
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.",
keywords = "Apathy, Cardiovascular disease, Depression, Meta-analysis, Myocardial infarction, Older people, Stroke",
author = "{ICARA Study Group} and Eurelings, {Lisa S.M.} and {van Dalen}, {Jan Willem} and {Ter Riet}, Gerben and {Moll van Charante}, {Eric P.} and Edo Richard and {van Gool}, {Willem A.} and Almeida, {Osvaldo P.} and Alexandre, {Tiago S.} and Baune, {Bernhard T.} and Horst Bickel and Francesco Cacciatore and Cyrus Cooper and {de Craen}, {Ton A.J.M.} and Degryse, {Jean Marie} and {Di Bari}, Mauro and Duarte, {Yeda A.} and Liang Feng and Nicola Ferrara and Leon Flicker and Maurizio Gallucci and Antonio Guaita and Harrison, {Stephanie L.} and Katz, {Mindy J.} and Lebr{\~a}o, {Maria L.} and Jason Leung and Lipton, {Richard B.} and Marta Mengoni and Ng, {Tze Pin} and Truls {\O}stbye and Francesco Panza and Letizia Polito and Dirk Sander and Vincenzo Solfrizzi and Syddall, {Holly E.} and {van der Mast}, {Roos C.} and Bert Vaes and Jean Woo and Kristine Yaffe and Sujuan Gao and Ho, {Suzanne C.} and Joan Lindsay and Aprille Sham and Simone Reppermund and Frederick Unverzagt",
year = "2018",
month = "4",
day = "4",
doi = "10.2147/CLEP.S150915",
language = "English (US)",
volume = "10",
pages = "363--379",
journal = "Clinical Epidemiology",
issn = "1179-1349",
publisher = "Dove Medical Press Ltd.",

}

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

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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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 -