Part II | Vascular risk factors for depression and apathy 111 6 Another methodological issue is the use of many different proxies for SSVD. The use of a broad array of SSVD proxies has negative consequences for the comparability of the research and precludes meta-analysis to estimate the magnitude of associations found. Nonetheless, generalizability increases when increasing levels of apathy are associated with widely different proxies for SSVD. Finally, of the many different apathy scales that were employed, the AES and the NPI apathy subscale were the only tools that are well-validated 36 37, which is why we cannot rule out that the use of the other apathy scales may have negatively affected the quality of the results reported. Conclusion The studies published to date show that WMH, cerebral microbleeds, cardiovascular disease, hypertension and ABI are associated with apathy in the general population. However, as most studies were cross-sectional in nature, the directions of the associations remain unclear and might be reciprocal/bidirectional. Finally, although the hypothesis of vascular apathy is supported by the available literature, more prospective evidence is needed.
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