Vascular risk factors for depression and apathy | Part 1 64 Methods Sample The present sample was drawn from the Nijmegen Biomedical Study (NBS), a populationbased survey conducted in 2002 and 2003 by the Department of Epidemiology and Biostatistics and the Department of Clinical Chemistry of the Radboud University Nijmegen Medical Centre. 21756 Age- and sex- stratified randomly selected inhabitants of the municipality of Nijmegen received an invitation to fill out a postal questionnaire on, among others, lifestyle, and medical history, and to donate blood. The response to the initial questionnaire was 43 % in all age groups 26 and 40% in subjects aged 70 years and older. The response to additional questionnaires sent in 2004 and 2005 to all responders aged 70 years and older (N=2253) was 71% (N=1596). These additional questionnaires were used for the present study. Only information on the level of education and the smoking history were taken from the initial questionnaire. Exclusion criteria for the present study were a diagnosis of dementia or a history of bipolar disorder. Measurements Depression- Clinically relevant depressive symptoms (CRDS) were measured by the 20item Epidemiological Studies Depression scale (CES-D), and defined as a score of ≥16. The CES-D is a valid and widely used instrument for the detection of depressive symptoms 27. The traditional cut-off of the CES-D (≥16), shows a sensitivity of 100% and a specificity of 88% for major depressive disorder in older inhabitants of the Netherlands 28. Neuroticism - Neuroticism (range: 0-12) was measured using the Dutch version of the revised Eysenck Personality Questionnaire (EPQ-RSS) 29. Results of the Dutch version of this questionnaire strongly resemble those of the English version 30. The EPQ-RSS is based on a 3-factor model of personality: neuroticism, extraversion and psychoticism. Neuroticism is a stable personality trait that also in later life can be measured reliably as it is not significantly affected by physical health variables 15. Nonetheless, an acute depression amplifies the personality profile of people prone to depression 31. After recovery neuroticism decreases, but the overall shape of the profile doesn’t change 32 33. The relationship between change in personality and change in depressive symptoms is at most moderate and does not differ between men and women. Cerebrovascular risk factors (CVRF) and cerebrovascular disease- Hypertension, diabetes mellitus, hypercholesterolemia, smoking, severe obesity, low physical activity and cardiac diseases were assessed, since they are well-documented as stroke risk factors 34 35. Most of these CVRF were linked to depression in earlier studies 8 9 10 11. Misclassification due to over reporting of hypertension, diabetes mellitus, hypercholesterolemia and cardiac diseases was reduced by requiring both a confirmative self-report and the use of appropriate medication for the specific disease. Participants were inquired about current smoking. Length and weight were asked for and body mass indexes were computed as follows: length/weight2 (m/kg2); severe obesity was defined as a BMI of ≥ 30 (m/kg2)36.
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