Part II | Vascular risk factors for depression and apathy 91 5 A second limitation is the duration of follow-up at 6 years. This timepoint of our evaluation was purely pragmatic as this follow-up assessment has included the SAS in both cohort studies. The lack of data on the participants lost to follow-up, might have obscured some small correlations as dropout might have been related to a more severe vascular disease status. Furthermore, since the SAS was administered only once in NESDA, our evaluation was merely cross-sectional in nature and we were unable to track the course of apathy in relation to vascular factors and mood. Another limitation is the use of a self-report scale for apathy, since respondents with minimal cognitive impairment (MCI) or dementia tend to report lower apathy levels than peers without these cognitive impairments, probably due to less cognitive insight 56. Although dementia was an exclusion criterion for participation in this study, some participants could have been suffering from MCI, which could have influenced the association between the apathy sum score and vascular risk factors or vascular diseases. Conclusion The results from this study do not support the hypothesis that apathy in remitted depression is linked with cerebrovascular damage of the fronto-striatal circuitries. Since apathy is highly frequent in remitted depression, its etiological basis warrants more attention in future research. This is especially relevant as apathy is related to a lower quality of life 57, functional decline 58 and a poorer prognosis for a variety of health outcomes 59, irrespective of its underlying pathophysiology. Fundings: NESDA: The infrastructure for the NESDA study (www.nesda.nl) is funded through the Geestkracht program of the Netherlands Organization for Health Research and Development (ZonMw, grant number 10-000-1002) and financial contributions by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Leiden University Medical Center, Leiden University, GGZ Rivierduinen, University Medical Center Groningen, University of Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Rob Giel Onderzoekscentrum) NESDO: The infrastructure for NESDO is funded through the Fonds NutsOhra, Stichting tot Steun VCVGZ, NARSAD The Brain and Behaviour Research Fund, and the participating universities and mental health care organizations (VU University Medical Center, Leiden University Medical Center, University Medical Center Groningen, Radboud University Nijmegen Medical Center, and GGZ inGeest, GGNet, GGZ Nijmegen, GGZ Rivierduinen, Lentis, and Parnassia)
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