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Apathy was associated with cardiovascular disease in older population

September 27, 2013 / Author:  / Reviewed by: Chris Galloway, M.D. Beth Bolt, RPh

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(dailyRx News) While depression has been linked to health problems, researchers have paid less attention to apathy. In recent studies, however, apathy has also been linked to health issues.

Although apathy, or loss of interest, is a symptom of depression, people with apathy are not necessarily depressed. Both depression and apathy can be related to different health problems, and they may require different treatments.

A recent study showed that apathy was linked to cardiovascular disease in older patients, depression in these older patients was not. Neither of these conditions was associated with stroke.

According to the researchers, recognizing when an older individual presents with apathy symptoms is important, since apathy was found to be a risk factor for incident cardiovascular disease.

"Talk to your doctor if you experience loss of interest."

This recent study, which examined whether symptoms of depression or apathy were associated with cardiovascular disease or stroke incidence, was conducted by Edo Richard, MD, PhD, of the University of Amsterdam in the Netherlands, and colleagues.

The study included 1,810 individuals between the ages of 70 and 78 with no history of cardiovascular disease, stroke or any other conditions that could interfere with the two-year follow-up, such as alcoholism, cancer or dementia.

The researchers assessed depression and apathy using questions from a common test known as the 15-item Geriatric Depression Scale (GDS-15). GDS-15 consists of 15 questions in which patients answer yes or no. Three of the questions are related to apathy symptoms, and they were part of the GDS-3A test. The other 12 questions assess depression symptoms, and they were part of the GDS-12D test.

The three questions of the GDS-3A test to screen apathy included the following:

  1. Have you dropped many of your activities and interests?
  2. Do you prefer to stay at home, rather than going out and doing new things?
  3. Do you feel full of energy? 

The researchers defined participants as having apathy or depression if they had a score of two or more in GDS-3A or GDS-12D test, respectively.

The researchers found that 1,387 participants did not have symptoms of apathy or depression, while 281 had apathy, 266 had depression and 124 had both.

Each of the participants was followed up with for cardiovascular disease and stroke incidence after two years. 

The researchers reported that during those two years, cardiovascular disease events occurred in 62 participants, of whom 22 had apathy and 14 had depression. Stroke occurred in 55 participants, of whom 7 had apathy and 12 had depression. 

The researchers also calculated the odds of the occurrence of the disease (cardiovascular disease or stroke) given that someone presented with either apathy or depression symptoms.

They found that someone who had apathy had about 2.6 times higher odds of having cardiovascular disease than someone without apathy, while the odds of cardiovascular disease in someone with depression were about 1.5 times higher than someone without depression.

Additionally, someone with depression had about 0.74 times the odds of having cardiovascular disease, and 1.74 times higher odds of having stroke.

Based on these odds, the researchers concluded that apathy was associated with cardiovascular disease. However, the association between depression and cardiovascular disease, and that between apathy or depression and stroke, was not evident.

The researchers suggested that apathy symptoms may be caused by cardiovascular disease. Another possible explanation is that patients with apathy may not take care of their health and thus become vulnerable to cardiovascular disease.

This study accounted for the potential influence of demographics (age, sex, level of education) and cardiovascular risk factors (high blood pressure, high cholesterol, obesity, smoking, inactivity). The same conclusions were attained without considering these factors.

It can be easy to mistake apathy for depression. Nonetheless, this study suggests that it is important to differentiate between them because they are related to different problems. In this case, apathy appeared to be a marker for cardiovascular disease, but depression did not.

The authors proposed that recognition of apathy should lead to the implementation of strategies to prevent cardiovascular disease in this group of people who may otherwise not appear to be at risk for cardiovascular disease.

“This study, like other recent studies looking at psychosocial aspects of health, highlights that there are other factors in people’s lives that may be affecting health adversely," Carla Perissinotto, MD, Assistant Clinical Professor in the Division of Geriatrics in the Department of Medicine at University of California, San Francisco, told dailyRx News.

"In cardiovascular health, physicians usually think only of the traditional risk factors — for example blood pressure, cholesterol and obesity. But there seem to be other factors, such as apathy, or loneliness, which is the work I did, that are equally as important to focus on. This means that patients need to make sure to talk about these other parts of their live that may be adversely affecting their health,” Dr. Perissinotto said.

This study was published on September 18 in The International Journal of Geriatric Psychiatry. The authors had no disclosures to make.