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Vascular disease and apathy symptoms in the very old: A cross-sectional and longitudinal meta-analysis of individual participant data

Lookup NU author(s): Dr Andrew KingstonORCiD, Professor Dame Louise Robinson, Professor Ngaire Kerse

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

© 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. Objectives: Previous findings suggest a vascular foundation underlying apathy, but transdiagnostic and prospective evidence on vascular apathy is scarce. This study examines the association between vascular disease and the presence and development of apathy symptoms in the very old. Methods: Four cohorts of the Towards Understanding Longitudinal International older People Studies (TULIPS)-consortium were included in a two-staged, individual participant data meta-analysis using generalized linear mixed models. Vascular disease was defined as a history of any clinical atherosclerotic pathology (angina pectoris, myocardial infarction, intermittent claudication, transient ischemic attack, stroke or related surgeries) and was related to apathy symptoms as repeatedly measured by the Geriatric Depression Scale (GDS-3A ≥2) over a maximum of 5 years. Results: Of all 1868 participants (median age 85 years old), 53.9% had vascular disease and 44.3% experienced apathy symptoms. Participants with vascular disease had a 76% higher risk of apathy symptoms at baseline (odds ratio (OR) 1.76, 95% confidence interval (CI) 1.32–2.35), irrespective of depressive symptoms and only partially explained by stroke. Conversely, there was no association of vascular disease with the occurrence of apathy symptoms longitudinally, both in those with apathy at baseline (OR 1.00, 95% CI 0.84–1.20) and without (OR 0.96, 95% CI 0.84–1.09). Conclusions: Vascular disease in the very old is associated with apathy symptoms cross-sectionally, but not proven longitudinally, independent of depressive symptoms. These findings query a vascular cause underlying apathy symptoms. However, the consistency of our cross-sectional findings in direction and magnitude across the TULIPS-consortium do emphasize international relevance of the interplay of vascular factors and apathy in advanced age, which meaning needs further unravelling.


Publication metadata

Author(s): van der Klei VMGTH, Poortvliet RKE, Bogaerts JMK, Blom JW, Mooijaart SP, Teh R, Muru-Lanning M, Palapar L, Kingston A, Robinson L, Kerse N, Gussekloo J

Publication type: Article

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2022

Volume: 37

Issue: 12

Print publication date: 01/12/2022

Online publication date: 19/10/2022

Acceptance date: 16/10/2022

Date deposited: 04/01/2023

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley and Sons Ltd

URL: https://doi.org/10.1002/gps.5831

DOI: 10.1002/gps.5831


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Funding

Funder referenceFunder name
Dunhill Medical Trust
Biotechnology and Biological Sciences Research Council
Health Research Council of New Zealand
Medical Research Council
National Heart Foundation of New Zealand
Ministerie van Volksgezondheid, Welzijn en Sport
Ministry of Health, New Zealand
Newcastle Hospitals Healthcare Charity
NIHR Biomedical Research Centre at Newcastle upon Tyne Hospitals NHS Foundation Trust
Oakley Mental Health Foundation, New Zealand
New Zealand National Centre for Research Excellence for Māori research

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