Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data

Autor(es)

Eurelings, Lisa S. M. ^[1] ; van Dalen, Jan Willem ^[1] ; ter Riet, Gerben ^[2] ; van Charante, Eric P. Moll ^[2] ; Richard, Edo ^{[1, 3]} ; van Gool, Willem A. ^[1] ; Grp, ICARA Study

Afiliação do(s) autor(es)

^[1] Univ Amsterdam, Acad Med Ctr, Dept Neurol, 9 Meibergdreef, NL-1100 DD Amsterdam - Netherlands

^[2] Univ Amsterdam, Acad Med Ctr, Dept Gen Practice, Amsterdam - Netherlands

^[3] Radboud Univ Nijmegen, Med Ctr, Dept Neurol, Donders Inst Brain Cognit & Behav, Nijmegen - Netherlands

• Tipo de documento: Artigo de Revisão
• Fonte: CLINICAL EPIDEMIOLOGY; v. 10, p. 363-379, 2018.
• Citações Web of Science: 8

Resumo

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 onestage 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. (AU)

• Processo FAPESP: 09/53778-3 - Estudo longitudinal sobre as condições de vida e saúde dos idosos do município de São Paulo: Estudo SABE
• Beneficiário: Maria Lúcia Lebrão
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 99/05125-7 - As condicoes de saude dos idosos na america latina e caribe.
• Beneficiário: Ruy Laurenti
• Modalidade de apoio: Auxílio à Pesquisa - Regular
• Processo FAPESP: 05/54947-2 - Estudo SABE - 2005: saúde, bem-estar e envelhecimento: estudo longitudinal sobre as condições de vida e saúde dos idosos no município de São Paulo
• Beneficiário: Ruy Laurenti
• Modalidade de apoio: Auxílio à Pesquisa - Temático