Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data.
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Eurelings Lisa Sm, van Dalen Jan Willem, Ter Riet Gerben, Moll van Charante Eric P, Richard Edo, van Gool Willem A, Almeida Osvaldo P, Alexandre Tiago S, Baune Bernhard T, Bickel Horst, Cacciatore Francesco, Cooper Cyrus, de Craen Ton Ajm, Degryse Jean-Marie, Di Bari Mauro, Duarte Yeda A, Feng Liang, Ferrara Nicola, Flicker Leon, Gallucci Maurizio, Guaita Antonio, Harrison Stephanie L, Katz Mindy J, Lebrão Maria L, Leung Jason, Lipton Richard B, Mengoni Marta, Ng Tze Pin, Østbye Truls, Panza Francesco, Polito Letizia, Sander Dirk, Solfrizzi Vincenzo, Syddall Holly E, van der Mast Roos C, Vaes Bert, Woo Jean, Yaffe Kristine, ICARA Study Group
Аннотация
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.