老年人的冷漠和抑郁症状与心肌梗死、中风及死亡率：个体参与者数据的系统评价和荟萃分析
Apathy and depressive symptoms in older people and incident myocardial infarction, stroke, and mortality: a systematic review and meta-analysis of individual participant data.
作者信息
Eurelings Lisa Sm, van Dalen Jan Willem, Ter Riet Gerben, Moll van Charante Eric P, Richard Edo, van Gool Willem A, Almeida Osvaldo P, Alexandre Tiago S, Baune Bernhard T, Bickel Horst, Cacciatore Francesco, Cooper Cyrus, de Craen Ton Ajm, Degryse Jean-Marie, Di Bari Mauro, Duarte Yeda A, Feng Liang, Ferrara Nicola, Flicker Leon, Gallucci Maurizio, Guaita Antonio, Harrison Stephanie L, Katz Mindy J, Lebrão Maria L, Leung Jason, Lipton Richard B, Mengoni Marta, Ng Tze Pin, Østbye Truls, Panza Francesco, Polito Letizia, Sander Dirk, Solfrizzi Vincenzo, Syddall Holly E, van der Mast Roos C, Vaes Bert, Woo Jean, Yaffe Kristine
机构信息
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
Clin Epidemiol. 2018 Apr 4;10:363-379. doi: 10.2147/CLEP.S150915. eCollection 2018.
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 one-stage 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.
背景
先前的研究结果表明，使用老年抑郁量表（GDS）测量的冷漠症状独立于抑郁症状，与老年人的心血管疾病（CVD）相关。
目的
使用个体患者数据荟萃分析，研究老年人的冷漠和抑郁症状是否与未来的心血管疾病、中风及死亡率相关。
方法
系统检索截至2013年9月3日的Medline、Embase和PsycInfo数据库，无语言限制。我们寻找针对年龄较大（平均年龄≥65岁）的社区居住人群的前瞻性研究，这些研究使用了老年抑郁量表，并记录了随后发生的中风和/或心血管疾病，以提供个体参与者数据。冷漠症状被定义为老年抑郁量表中与冷漠相关的三个子项目，抑郁症状则为其余项目。我们将心肌梗死（MI）、中风和全因死亡率作为主要结局。分析对年龄、性别和心肌梗死/中风病史进行了校正。采用纽卡斯尔-渥太华量表的改编版来评估偏倚。使用单阶段随机效应Cox回归模型计算风险比。
结果
在52项符合条件的研究中，纳入了21项（40.4%），包括47625名老年人（平均年龄[标准差]74[7.4]岁），中位随访时间为8.8年。有冷漠症状的参与者发生心肌梗死的风险高21%（95%置信区间[CI]1.08 - 1.36），中风风险高37%（95%CI 1.18 - 1.59），全因死亡率风险高47%（95%CI 1.38 - 1.56）。有抑郁症状的参与者中风风险（风险比1.36，95%CI 1.18 - 1.56）和全因死亡率风险（风险比1.44，95%CI 1.35 - 1.53）同样较高，但心肌梗死风险不高（风险比1.08，95%CI 0.91 - 1.29）。孤立的冷漠症状和孤立的抑郁症状的关联相似。根据偏倚风险进行的敏感性分析得出了类似结果。
结论
我们的研究结果强调了独立于抑郁症状识别冷漠的临床重要性，并有助于医生识别血管疾病风险增加的人群。
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