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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
Authors: Eurelings, L.S.M.
van Dalen, J.W.
Ter Riet, G.
Moll van Charante, E.P.
Richard, E.
van Gool, W.A.
Almeida, O.P.
Alexandre, T.S.
Baune, B.T.
Bickel, H.
Cacciatore, F.
Cooper, C.
de Craen, T.A.J.M.
Degryse, J.-M.
Di Bari, M.
Duarte, Y.A.
Feng, L. 
Ferrara, N.
Flicker, L.
Gallucci, M.
Guaita, A.
Harrison, S.L.
Katz, M.J.
Lebrão, M.L.
Leung, J.
Lipton, R.B.
Mengoni, M.
Ng, T.P.
Østbye, T.
Panza, F.
Polito, L.
Sander, D.
Solfrizzi, V.
Syddall, H.E.
van der Mast, R.C.
Vaes, B.
Woo, J.
Yaffe, K.
Gao, S.
Ho, S.C.
Lindsay, J.
Sham, A.
Reppermund, S.
Unverzagt, F.W.
ICARA Study Group.
Keywords: Apathy
Cardiovascular disease
Myocardial infarction
Older people
Issue Date: 2018
Publisher: Dove Medical Press Ltd
Citation: Eurelings, L.S.M., van Dalen, J.W., Ter Riet, G., Moll van Charante, E.P., Richard, E., van Gool, W.A., Almeida, O.P., Alexandre, T.S., Baune, B.T., Bickel, H., Cacciatore, F., Cooper, C., de Craen, T.A.J.M., Degryse, J.-M., Di Bari, M., Duarte, Y.A., Feng, L., Ferrara, N., Flicker, L., Gallucci, M., Guaita, A., Harrison, S.L., Katz, M.J., Lebrão, M.L., Leung, J., Lipton, R.B., Mengoni, M., Ng, T.P., Østbye, T., Panza, F., Polito, L., Sander, D., Solfrizzi, V., Syddall, H.E., van der Mast, R.C., Vaes, B., Woo, J., Yaffe, K., Gao, S., Ho, S.C., Lindsay, J., Sham, A., Reppermund, S., Unverzagt, F.W., ICARA Study Group. (2018). 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 10 : 363-379. ScholarBank@NUS Repository.
Rights: Attribution-NonCommercial 4.0 International
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. © 2018 Eurelings et al.
Source Title: Clinical Epidemiology
ISSN: 11791349
DOI: 10.2147/CLEP.S150915
Rights: Attribution-NonCommercial 4.0 International
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