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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: l.s.eurelings@amc.nl.
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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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Tables S1

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