Association of Apathy With Risk of Incident Dementia: A Systematic Review and Meta-analysis.
van Wanrooij, Lennard L
Moll van Charante, Eric P
van Gool, Willem A
American Medical Association
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van Dalen, J. W., van Wanrooij, L. L., Moll van Charante, E. P., Brayne, C., van Gool, W. A., & Richard, E. (2018). Association of Apathy With Risk of Incident Dementia: A Systematic Review and Meta-analysis.. JAMA psychiatry, 75 (10), 1012-1021. https://doi.org/10.1001/jamapsychiatry.2018.1877
Importance: Fear of dementia is pervasive in older people with cognitive complaints. Much research is devoted to finding prognostic markers for dementia risk. Studies suggest apathy in older people may be prodromal to dementia and could be a relevant, easily measurable predictor of increased dementia risk. Evidence is however fragmented and methods vary greatly between studies. Objective: To systematically review and quantitatively synthesize the evidence for an association between apathy in dementia-free older individuals and incident dementia. Data sources: Two reviewers conducted a systematic search of Medline, Embase and PsychINFO databases. Study selection: Inclusion criteria were 1) prospective cohort studies, 2) in general populations or memory clinic patients without dementia, 3) with clear definitions of apathy and dementia, 4) reporting on the relation between apathy and incident dementia. Data extraction and synthesis: PRISMA and MOOSE guidelines were followed. Data were extracted by one reviewer and checked by a second. Main outcomes and measures: Main outcomes were pooled crude risk ratios (RR) and maximally adjusted reported hazard ratios (HR) and odds ratios (OR) using DerSimonian-Laird random effects models. Results: After screening 2031 titles and abstracts, 16 studies were included. Studies included populations with subjective cognitive complaints (n=2), mild cognitive impairment (n=11), cognitive impairment no dementia (n=1) or mixed cognitive and no cognitive impairment (n=2). Apathy was present in 1470/7299 (20.1%) participants. Follow-up ranged 1.2-5.4 years. In studies using validated apathy definitions (n=12), the combined RR of dementia for patients with apathy was 1.81 (95%CI=1.32-2.50, I2=76%, n=12), the HR 2.39 (95%CI=1.27-4.51, I2=90%, n=7) and the OR 17.14 (95%CI=1.91-154.0, I2=60%, n=2). Subgroup-analyses, meta-regression and individual study results suggested the association between apathy and dementia weakened with increasing follow-up time, age and cognitive impairment. Meta-regression adjusting for apathy definition and follow-up time explained 95% of heterogeneity in mild cognitive impairment. Conclusions and relevance: Memory clinic patients with apathy have an approximately doubled risk of dementia. Moderate publication bias may have inflated some of these estimates. Apathy deserves more attention as a relevant, cheap, non-invasive and easily measureable predictor of incident dementia with high clinical relevance since particularly these vulnerable patients may forgo health care.
Humans, Dementia, Memory Disorders, Aged, Aged, 80 and over, Female, Male, Apathy, Prodromal Symptoms, Cognitive Dysfunction
External DOI: https://doi.org/10.1001/jamapsychiatry.2018.1877
This record's URL: https://www.repository.cam.ac.uk/handle/1810/280449