Vascular risk factors for depression and apathy | Part 1 72 and cardiovascular disease and moderate concordance for cerebrovascular disease 52 53 54. However, we only accounted for already diagnosed diseases, probably missing underdiagnosed diseases (for example underdiagnosed diabetes) 55. There are also benefits of using self-report measurements in a cross-sectional design: relationships can be studied in a large non-clinical population at relatively low costs. A third limitation might be a bias due to selective dropout of the physically frail elderly women. However, because of stratification for age at enrolment in the NBS, this study still included a large sample of the very old, which is often missed in other studies. Strengths of this study include the use of different levels of vascular disease according to association with cerebrovascular damage, which gave more insight than a composite score would have done. In addition, we corrected for disability and comorbid (nonvascular) chronic diseases, which mediated the relationship between vascular disease and depression in some previous reports 56. Though our data clearly support the important role of vascular disease, they also highlight the necessity to broaden the risk model of late-life depression. Gender-differences in the associations between vascular disease and depression and gender-differences in the role of an interaction between vascular disease and neuroticism could explain some negative or inconsistent findings in mixedpopulations 57 58 59. Final conclusion We conclude that in elderly women with CRDS the predictive value of (self-reported) vascular disease is not as large as in men of similar age. In men with both vascular disease and a high level of neuroticism, the effect of neuroticism was tempered, maybe by the presence of apathy. A future aim should be to replicate and extend the results of this study in a longitudinal design. Acknowledgements Principal investigators of the Nijmegen Biomedical Study are L.A.L.M. Kiemeney, M. den Heijer, A.L.M. Verbeek, D.W. Swinkels en B. Franke.
RkJQdWJsaXNoZXIy MjY0ODMw