19 1 Vascular risk factors for depression and apathy Amsterdam (LASA) in which depression as assessed at baseline is monitored and related to the incidence of stroke during a 9-year follow-up. We deemed this relevant as several studies have shown, albeit not consistently, that depression is a risk factor for stroke, 49 and because depression is not (yet) included as a well-established risk factor in stroke prevention guidelines 50. Of note here is that previous studies may have been limited by the measures they used to diagnose depression and/or stroke. And, even though cardiac disease is one of the main risk factors for stroke, none explored whether this putative risk is conditional upon the presence of cardiac disease. Our study tries to overcome these shortcomings by including cardiac disease as effect modifier, by taking depression severity and chronicity into account, and finally by assessing stroke using a composite measure based on self-report data, medical records of GPs and death certificates. In Chapter 3 the research question we posed was whether the risk of depression on future stroke is conditional upon depressive symptoms related to underlying vascular disease and not upon depressive symptoms associated with high neuroticism? This study was again conducted as part of LASA, extending the study reported on in Chapter 2. We now assume that vascular depression, defined as depression etiologically linked to vascular disease, increases the risk of stroke, where depression that is etiologically related to high neuroticism does not. If confirmed, the presence of underlying (silent) vascular disease could confound the association between depressive symptoms and stroke, which would then explain the differences observed in populations with cardiac disease and without cardiac disease. The objective of the study presented in Chapter 4 was to explore whether neuroticism and vascular disease interact as risk factors for depression? Since higher levels of neuroticism and vascular disease often co-occur in individuals coping with late-life depression, not only the impact of each of these vulnerability factors but also their interactions are of interest. We will be examining the presence and nature of such interactions in a population-based survey called the Nijmegen Biomedical Study (NBS). Since neuroticism aggravates the impact of life events and has been related to a poorer adherence to (vascular) treatment we expect to find a positive interaction by which neuroticism exacerbates the impact of vascular disease on depression Part II In the second part of this thesis, the focus is on associations between cerebrovascular disease and apathy. In the study reported in Chapter 5 our aim was to elucidate whether apathy after remitted depression is related to cerebral small vessel disease (CSVD)? We anticipated to find associations between the severity of apathy and vascular risk factors and diseases in adults with a remitted depressive disorder who participated in the Netherlands Study of Depression and Anxiety (NESDA) and the Netherland Study of Depression in Older Persons (NESDO). We assumed that this association would not be explained by the residual symptom of a depressed mood, which we explicitly corrected for.
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