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The mediating role of cardiovascular risk factors in the relationship between symptoms of apathy and incident cardiovascular disease in community-dwelling older individuals

Published online by Cambridge University Press:  06 November 2015

Lisa S. M. Eurelings ,
James Jaccard ,
Eric P. Moll van Charante ,
Piet Eikelenboom ,
Suzanne A. Ligthart ,
Willem A. van Gool  and
Edo Richard
Lisa S. M. Eurelings*
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
James Jaccard
Affiliation:
Silver School of Social Work, New York University, 1 Washington Square North, New York, 10003, USA
Eric P. Moll van Charante
Affiliation:
Department of General Practice, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, the Netherlands
Piet Eikelenboom
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands Department of Psychiatry, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, the Netherlands GGZ inGeest, PO Box 74077, 1070 BB, Amsterdam, the Netherlands
Suzanne A. Ligthart
Affiliation:
Department of General Practice, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
Edo Richard
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands Department of Neurology, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, the Netherlands
*
Correspondence should be addressed to: Lisa S. M. Eurelings, Academic Medical Center, department of Neurology, room H2-235, PO Box 22660, 1100 DD Amsterdam, the Netherlands. Phone: +31-20-5663446; Fax: +31-20-5669290. Email: [email protected].
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Abstract

Background:

In old age, both apathy and depression have been associated with an increased cardiovascular disease (CVD) risk. This study evaluated the mediating role of cardiovascular risk factors in the relationship of apathy and mood symptoms with incident CVD.

Methods:

Prospective cohort study of 1,790 community-dwelling older individuals (70–78 years) without a history of CVD or stroke. At baseline, apathy and mood symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), of which three items represent apathy symptoms. The mediational risk factors included were diabetes mellitus (DM), body mass index (BMI), current smoking, physical inactivity, systolic blood pressure, and total cholesterol. Incident CVD was evaluated after two years of follow-up. Data were analyzed using structural equation modeling (SEM).

Results:

Incident CVD occurred in 59 (3.3%) participants. Apathy symptoms had a significant estimated total effect on incident CVD, with increases of 2.2% for each unit increase in apathy score. Of this total effect, 22.7% was due to the mediational effects of physical inactivity (13.6%), current smoking (4.5%), and DM (4.5%). The remaining 77.3% was due to direct effects reflecting other mediational dynamics. No significant (in)direct effects of mood symptoms on incident CVD were found.

Conclusions:

Physical inactivity, smoking, and DM account for nearly one-fourth of the variation reflecting the link between apathy symptoms and incident CVD. This illustrates the relevance of unfavorable health behaviors and assessment of DM in older individuals with apathy. The majority of the effect of apathy symptoms on incident CVD is caused by other, yet unknown, factors.

Keywords

apathydepressioncardiovascular risk factorscardiovascular diseasestructural equation modeling
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 4 , April 2016 , pp. 669 - 679
Copyright
Copyright © International Psychogeriatric Association 2015 

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References

Alexopoulos, G. S., Meyers, B. S., Young, R.C., Campbell, S., Silbersweig, D. and Charlson, M. (1997). “Vascular depression” hypothesis. Archives of General Psychiatry, 54, 915–922. doi:10.1001/archpsyc.1997.01830220033006.CrossRefGoogle ScholarPubMed
Ariyo, A. A., Haan, M., Tangen, C. M., Rutledge, J. C., Cushman, M., Dobs, A. and Furberg, C. D. (2000). Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Circulation, 102, 1773–1779. doi:10.1161/01.CIR.102.15.1773.Google Scholar
Becker, S. and Zimmermann-Stenzel, M. (2009). No sports = no exercise?–sports, overweight and physical activity in the 50–70 age group in Baden–Württemberg. Zeitschrift für Gerontologie und Geriatrie, 42, 20–27. doi:10.1007/s00391-008-0568-.Google Scholar
Bisoendial, R. J., Boekholdt, S. M., Vergeer, M., Stroes, E. S. G. and Kastelein, J. J. P. (2010). C-reactive protein is a mediator of cardiovascular disease. European Heart Journal, 31, 2087–2091. doi:10.1093/eurheartj/ehq238.CrossRefGoogle ScholarPubMed
Bruce, D. G., Nelson, M. E., Mace, J. L., Davis, W. A., Davis, T. M. and Starkstein, S. E. Apathy in older patients with type 2 diabetes. American Journal Geriatric Psychiatry, 23, 615–621. doi: 10.1016/j.jagp.2014.09.010.CrossRefGoogle Scholar
Cataldo, J. K. (2007). Clinical implications of smoking and aging: breaking through the barriers. Journal of Gerontological Nursing, 33, 32–42.Google Scholar
Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W. and Kelley, K. W. (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. Nature Reviews Neuroscience, 9, 46–56. doi:10.1038/nrn2297.Google Scholar
De Miranda Azevedo, R., Roest, A. M., Hoen, P. W. and de Jonge, P. (2014). Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis. Psychological Medicine, 44, 2689–2703. doi: 10.1017/S0033291714000063.Google Scholar
Duivis, H. E., Vogelzangs, N., Kupper, N., de Jonge, P. and Penninx, B. W. (2013). Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the Netherlands Study of Depression and Anxiety (NESDA). Psychoneuroendocrinology, 38, 1573–1585. doi: 10.1016/j.psyneuen.2013.01.002.CrossRefGoogle ScholarPubMed
Eurelings, L. S. M., Ligthart, S. A., Van Dalen, J. W., Moll van Charante, E. P., Van Gool, W. A. and Richard, E. (2014). Apathy is an independent risk factor for incident cardiovascular disease in the older individual: a population-based cohort study. International Journal of Geriatric Psychiatry, 29, 454–463. doi:10.1002/gps.4026.Google Scholar
Eurelings, L. S. M., Richard, E., Eikelenboom, P., van Gool, W. A. and Moll van Charante, E. P. (2015). Low-grade inflammation differentiates between symptoms of apathy and depression in community-dwelling older individuals. International Psychogeriatrics, 27, 639–647. doi: 10.1017/S1041610214002683.Google Scholar
Joynt, K. E., Whellan, D. J. and O’Connor, C. M. (2003). Depression and cardiovascular disease: mechanisms of interaction. Biological Psychiatry, 54, 248–261. doi:10.1016/S00063223(03)00568-7.Google Scholar
Kannel, W. B. (2002). Coronary heart disease risk factors in the elderly. The American Journal of Geriatric Cardiology, 11, 101–107. doi: 10.1111/j.1076-7460.2002.00995.x.CrossRefGoogle ScholarPubMed
Lamers, F., Vogelzangs, N., Merikangas, K. R., de Jonge, P., Beekman, A. T. and Penninx, B. W. (2013). Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry, 18, 692–699. doi: 10.1038/mp.2012.144.Google Scholar
Landes, A. M., Sperry, S. D., Strauss, M. E. (2005). Prevalence of apathy, dysphoria, and depression in relation to dementia severity in Alzheimer´s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 342–349. doi: 10.1176/appi.neuropsych.17.3.342.Google Scholar
Lesher, E. L. and Berryhill, J. S. (1994). Validation of the geriatric depression scale-short form among inpatients. Journal of Clinical Psychology, 50, 256–260. doi: 10.1002/1097-4679(199403)50:2<256::AID-JCLP2270500218>3.0.CO;2-E.Google Scholar
Levy, M. L. et al. (1998). Apathy is not depression. Journal of Neuropsychiatry & Clinical Neurosciences, 10, 314–319.Google Scholar
Ligthart, S. A. et al. (2012). Association of vascular factors with apathy in community-dwelling elderly individuals. Archives of General Psychiatry, 69, 636–642. doi:10.1001/archgenpsychiatry.2011.1858.CrossRefGoogle ScholarPubMed
Marijnissen, R. M. et al. (2011). Depressive symptom clusters are differentially associated with general and visceral obesity. Journal of the American Geriatrics Society, 59, 67–72. doi: 10.1111/j.1532-5415.2010.03228.x.Google Scholar
Marijnissen, R. M. et al. (2013). Association between metabolic syndrome and depressive symptom profiles–sex-specific? Journal of Affective Disorders, 151, 1138–1142. doi: 10.1016/j.jad.2013.07.029.CrossRefGoogle ScholarPubMed
Marin, R. S., Firinciogullari, S. and Biedrzycki, R. C. (1993). The sources of convergence between measures of apathy and depression. Journal of Affective Disorders, 28, 7–14.CrossRefGoogle ScholarPubMed
Marin, R. S., Firinciogullari, S. and Biedrzycki, R. C. (1994): Group differences in the relationship between apathy and depression. Journal of Nervous and Mental Disease, 182, 235–239.Google Scholar
Meijer, A. et al. (2013). Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. The British Journal of Psychiatry, 203, 90–102. doi: 10.1192/bjp.bp.112.111195.CrossRefGoogle ScholarPubMed
Meng, L., Chen, D., Yang, Y., Zheng, Y. and Hui, R. (2012). Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies. Journal of Hypertension, 30, 842–851. doi:10.1097/HJH.0b013e32835080b7.Google Scholar
Mezuk, B., Eaton, W. W., Albrecht, S. and Golden, S. H. (2008). Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care, 31, 2383–2390. doi:10.2337/dc08-0985.Google Scholar
Mitchell, J., Mathews, H. F. and Yesavage, J. A. (1993). A multidimensional examination of depression among the elderly. Research on Aging, 15, 198–219. doi:10.1177/0164027593152004.Google Scholar
Neidrick, T. J., Fick, D. M. and Loeb, S. J. (2012). Physical activity promotion in primary care targeting the older adult. Journal of the American Academy of Nurse Practitioners, 24, 405–416. doi:10.1111/j.1745-7599.2012.00703.x.CrossRefGoogle ScholarPubMed
Onyike, C. U. et al. (2007). Epidemiology of apathy in older adults: the cache county study. American Journal of Geriatric Psychiatry, 15, 365–375.Google Scholar
Richard, E. et al. (2009). Prevention of dementia by intensive vascular care (PreDIVA): a cluster-randomized trial in progress. Alzheimer Disease and Associated Disorders, 23, 198–204. doi:10.1097/WAD.0b013e31819783a4.Google Scholar
Robert, P. et al. (2009). Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104. doi:10.1016/j.eurpsy.2008.09.001.Google Scholar
Stel, V. S., Smit, J. H., Pluijm, S. M. F., Visser, M., Deeg, D. J. H. and Lips, P. (2004). Comparison of the LASA physical activity questionnaire with a 7-day diary and pedometer. Journal of Clinical Epidemiology, 57, 252–258. doi:10.1016/j.jclinepi.2003.07.008.CrossRefGoogle ScholarPubMed
Strine, T. W. et al. (2008). The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. General Hospital Psychiatry, 30, 127–137. doi:10.1016/j.genhosppsych.2007.12.008.Google Scholar
Sugawara, N. et al. (2011). Ankle brachial pressure index as a marker of apathy in a community-dwelling population. International Journal of Geriatric Psychiatry, 26, 409–414. doi: 10.1002/gps.2541.Google Scholar
Van der Mast, R. C. et al. (2008).Vascular disease and apathy in old age. The Leiden 85-Plus Study. International Journal of Geriatric Psychiatry, 23, 266–271. doi: 10.1002/gps.1872.Google Scholar
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Tables S1

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