Vascular risk factors for depression and apathy | Part II 108 Three studies examined associations between hypertension and apathy 9 30 43, two of which found a significant link with systolic blood pressure 9 43, and the other with the diastolic (but not systolic) blood pressure 30. This latter study 30 also examined the association between WMH and apathy by neuroimaging, of which the results are presented in section ‘Neuroimaging and apathy’. In their large-scale study, Ligthart et al. 9 foundanodds ratio (OR) of 1.28 in their participants with cardiovascular disease (1.09-1.52; p=0.004). The number of cardiovascular pathologies in another large and prospective study 29 was found to be associated with apathy at baseline and with incident apathy during follow-up. Finally, ABI was associated with apathy 43, but arterial stiffness (CFPWV) was not 44. Neuroimaging and apathy The ten studies using MRI or DTI are presented in Table 2. Of the three studies examining the association between WMH and apathy, the two cross-sectional studies found a significant association 30 48 whereas the (smaller) casecontrol study did not 49. Again, a meta-analysis and quantitative estimation of the WMH and apathy association was not possible, because of the large differences in the studies’ research designs, the methods of ascertaining WMH (number or volume), and apathy scales used. It needs to be noted here, that with 4354 participants the study by Van Grool et al. 48 would have largely outweighed the findings of the other studies in any metaanalysis, since the other studies had much smaller samples. Mean white matter diffusivity (MD) was associated with apathy in specific areas in the small-scale study by Cacciari et al. 45, but not in the study by Moonen et al. 50. Other DTI measures (fractional anisotropy (FA); axial diffusivity (AD) and radial diffusivity (RD) were not associated with apathy 50. Evaluating the data of 802 participants, Xu et al. 51 found the participants who had suffered a single cerebral microbleed to show significantly more apathy than participants without cerebral microbleeds. Of the three studies examining looking at cortical thickness and apathy, two studies found an association between apathy and a reduced thickness of the temporal lobe 31 32. No associations were reported for apathy and the entorhinal cortex, the orbitofrontal cortex, or the middle frontal gyrus 47, while no association or even an inverse association was found between apathy and the anterior cingulate 32 47. However, in a model in which apathy was adjusted for depressive symptom severity, apathy was found to be associated with a more rapid reduction of the anterior cingulate cortex during follow-up 47.
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