20 Vascular risk factors for depression and apathy Chapter 6 comprises a systematic review of studies investigating whether subclinical CSVD is associated with apathy in the general population? Apathy studies will be included in which CSVD is defined as white matter hyperintensities (WMH) or white matter diffusivity changes, lacunar infarcts, cerebral microbleeds, decreasing cortical thickness and/or perivascular spaces. We also considered studies with peripheral proxies for CSVD, i.e. the ankle brachial index, intima media thickness, cardio-femoral pulse wave velocity, hypertension or cardiovascular disease. Our final study presented in Chapter 7 explores whether CSVD can be a (sole) cause of apathy? The vascular apathy hypothesis is evaluated in depth in a narrative review in which the Bradford-Hill criteria are applied to distinguish between association and causation. We will use the results to determine whether vascular apathy can indeed be considered a distinct clinical syndrome, while reflecting on the pros and cons of the use of the term ‘vascular apathy’.
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